Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030

Abstract

BackgroundChildhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low- and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur.MethodsWe used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction.ResultsDiarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level.ConclusionsEmploying the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.

Strong community-based health systems and national governance predict improvement in coverage of oral rehydration solution (ORS): a multilevel longitudinal model

“…There is some additional supportive evidence for these findings. From the time IMCI was introduced in the late to mid-1990s, at least until the mid-late 2000s when integrated community case management became a new focus, the program to control diarrheal diseases became more narrow, focusing on training first-level health facility workers, and losing much of the emphasis on diarrhea management in the home or availability of affordable ORS in the community (Fontaine O., personal communication) [42].…”

Access to oral rehydration solution and zinc supplementation for treatment of childhood diarrhoeal diseases in Sudan

“…The decline in the total diarrhoeal diseases-related mortality globally has been attributed to the increased use of oral rehydration solution (ORS), zinc supplementation, improved nutrition, hygiene, and sanitation [10][11][12][13]. The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommended ORS and zinc supplementation as a primary treatment for diarrhoeal diseases in children because ORS can reduce diarrhoeal deaths significantly and zinc supplementation can reduce the duration, severity, and recurrence of diarrhoeal diseases in children in the 2 to 3 months following its use [9][10][11][12][13].…”

Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan: evidence from two longitudinal cohort studies 15 years apart

“…Addressing persistent health challenges, such as childhood morbidity and mortality in lower-and middle-income countries, requires sustained intervention, a key component of which is building local engagement and capacity in the community [1,2]. Despite considerable success in reducing the global burden of childhood pneumonia and diarrhea through, for example, improvements in nutritional status, exclusive breast-feeding, and immunization for pneumonia and the use of oral rehydration and more recently, rotavirus vaccine for diarrhea [3,4], these two diseases continue to be leading causes of under-5 mortality and morbidity even though they are readily preventable [5][6][7][8]. Many existing child health interventions require sustained behavior change [9] (e.g.…”