Oral rehydration solution (ORS), a form of oral rehydration therapy (ORT), is a well-known treatment for diarrhea in children. ORS has shown its potential in drastically reducing child mortality; however, UNICEF reported that <50% of children younger than 5 years of age, suffering from diarrhea, in low-income and middle-income countries (LMICs) received ORS in 2016. 

A number of recommended home fluids (RHF) are used as an alternative to ORT; however, the role of RHF in preventing child mortality remains unclear. Some studies have previously reported a considerable variation between countries in ORS and RHF use, but subnational variation is still unclear. So a study produced high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs.

The researchers utilized a Bayesian geostatistical model including 15 spatial covariates. The data were collected from 385 household surveys across 94 LMICs. Utilizing these data, estimation of an annual proportion of children younger than 5 years of age with diarrhea who received ORS or RHF (or both) was done on continuous continent-wide surfaces in 2000–17. 

Analysis of geographical inequality in coverage across administrative units and estimation of the number of diarrheal deaths averted by increased coverage over the study period were also done. 

The study rendered the following results-

• Some countries demonstrated increase use of ORS among children with diarrhoea from 2000 to 2017
• <50% coverage was noted in the majority of second administrative-level units
• Nearly 6,519,000 children with diarrhoea did not receive any form of ORT as a treatment regimen in 2017.
• With the increase in ORS use, a decline in RHF use was observed in many locations, causing relatively constant overall ORT coverage from 2000 to 2017.
• Some countries showed uniformity in the distribution of ORS subnationally, while others demonstrated within-country geographical inequalities.
• 11 countries showed at least 50% difference in one of their units compared with the country mean.
• Increases in ORS use over time resulted in a decline in RHF use as well as diarrheal mortality in many locations
• 52 230 diarrheal deaths (36 910–68 860) were estimated to be averted by scaling up of ORS coverage between 2000 and 2017.
• Subnational areas in Colombia, Nigeria, and Sudan demonstrated diarrheal mortality higher than average, while ORS coverage to be lower than average.

This study produced and mapped subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrheal deaths across LMICs from 2000 to 2017, rendering ease in tracking progress over time. These results, combined with detailed subnational estimates of diarrheal morbidity and mortality, are good to support subnational needs assessments aiding to the better understanding among the policy makers′ of within-country disparities. 

This therapy is yet to achieve a larger gain in reducing mortality by reducing geographical inequalities in ORS coverage.

Source: Local Burden of Disease Diarrhoea Collaborators. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17. Lancet Glob Health. 2020;8(8):e1038-e1060. doi:10.1016/S2214-109X(20)30230-8