Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review

Abstract

Background Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. Methods A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. Conclusion A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. Registration A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).

Knowledge and Practices on the Prevention and Management of Diarrhea in Children Under-2 Years Among Women Dwelling in Urban Slums of Karachi, Pakistan

“…However, several studies reported that mothers and other caregivers in Pakistan still treat diarrhea in children with home remedies or self-prescribed medication, including antibiotics, and only one third of caregivers manage pediatric diarrhea using ORS (Aftab et al, 2018 ; Khan et al, 2019 ). One of the main reasons for these findings is the inaccessibility and non-affordability of ORS which constitutes a major barrier for ORS therapy in Pakistan, especially in socioeconomically deprived areas (Ezezika et al, 2021 ). Thus, efforts should be made to increase the accessibility and affordability of ORS for example by providing subsidiary in ORS pricing.…”

Projecting Temperature-Attributable Mortality and Hospital Admissions due to Enteric Infections in the Philippines

“…2020 ). In addition, there is a need to strengthen measures for mortality deterrence by proper management of dehydration through effective delivery of oral rehydration solution and zinc supplementation services by primary health care facilities ( APHA 2018 ; Ezezika et al. 2021 ).…”

“…Therefore, introducing vaccines and sustaining the gains from water, sanitation, and hygiene as well as child nutrition programs can help prevent infections in the future (Riddle et al 2018;Troeger et al 2020). In addition, there is a need to strengthen measures for mortality deterrence by proper management of dehydration through effective delivery of oral rehydration solution and zinc supplementation services by primary health care facilities (APHA 2018;Ezezika et al 2021).…”

What are the barriers and facilitators to polio vaccination and eradication programs? A systematic review

“…In addition, the selection of a determinant framework (CFIR) is a potential limitation as such frameworks have been criticized for their inadequacy in addressing causal mechanisms or how change takes place [49]. However, the use of the CFIR allowed the findings to be placed in the context of the wider implementation research literature and has been successfully applied in similar systematic reviews [50,51]. Finally, we extracted only qualitative-oriented data from each eligible article; thus, other significant results might have been overlooked.…”