Abstract
BackgroundIn 2010, diarrhea caused 0.75 million child deaths, accounting for nearly 12% of all under-five mortality worldwide. Many evidence-based interventions can reduce diarrhea mortality, including oral rehydration solution (ORS), zinc, and improved sanitation. Yet global coverage levels of such interventions remain low. A new scorecard of diarrhea control, showing how different countries are performing in their control efforts, could draw greater attention to the low coverage levels of proven interventions.MethodsWe conducted in-depth qualitative interviews with 21 experts, purposively sampled for their relevant academic or implementation expertise, to explore their views on (a) the value of a scorecard of global diarrhea control and (b) which indicators should be included in such a scorecard. We then conducted a ranking exercise in which we compiled a list of all 49 indicators suggested by the experts, sent the list to the 21 experts, and asked them to choose 10 indicators that they would include and 10 that they would exclude from such a scorecard. Finally, we created a “prototype” scorecard based on the 9 highest-ranked indicators.ResultsKey themes that emerged from coding the interview transcripts were: a scorecard could facilitate country comparisons; it could help to identify best practices, set priorities, and spur donor action; and it could help with goal-setting and accountability in diarrhea control. The nine highest ranking indicators, in descending order, were ORS coverage, rotavirus vaccine coverage, zinc coverage, diarrhea-specific mortality rate, diarrhea prevalence, proportion of population with access to improved sanitation, proportion with access to improved drinking water, exclusive breastfeeding coverage, and measles vaccine coverage.ConclusionA new scorecard of global diarrhea control could help track progress, focus prevention and treatment efforts on the most effective interventions, establish transparency and accountability, and alert donors and ministries of health to inadequacies in diarrhea control efforts.
Highlights
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) estimate that in 2010 diarrhea killed 751,000 children under five years, making it the second leading cause of childhood deaths worldwide after pneumonia [1]
We investigated experts’ views on which indicators should be included in such a scorecard and used a ranking exercise to prioritize the suggested indicators in order to create a ‘‘prototype’’ scorecard
Sixteen out of the 21 key informants (KIs) responded to our request to choose 10 indicators that they would include and 10 that they would exclude from a diarrhea control scorecard (a 76% response rate)
Summary
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) estimate that in 2010 diarrhea killed 751,000 children under five years, making it the second leading cause of childhood deaths worldwide after pneumonia [1]. A recent analysis using the Lives Saved Tool, a computer-based decision-making tool, found that scaling up these seven preventive interventions and three therapeutic interventions to near-universal coverage in 68 high child mortality countries would reduce diarrhea mortality by 92% at a cost of only $0.80 per capita [4]. Median coverage of improved sanitation in the 68 countries where over 95% of all child deaths occur worldwide is currently only about 40% [6]. Across these 68 high child mortality countries, the prevalence of hand-washing with soap ranges from only 3% to 42% [4]. Many evidence-based interventions can reduce diarrhea mortality, including oral rehydration solution (ORS), zinc, and improved sanitation. A new scorecard of diarrhea control, showing how different countries are performing in their control efforts, could draw greater attention to the low coverage levels of proven interventions
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