Abstract
BackgroundMore than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals.MethodsThe sample is drawn using a stratified two-stage cluster sampling design with census enumeration areas, typically, selected first as primary sampling units (PSUs) and then a fixed number of households from each PSU. We examined national and sub-regional prevalence of ORS use during a recent episode of diarrhea (within 2 weeks of survey) using DHSs for 2007–2010 (1st Period), and 2013–2016 (2nd Period). Weighted proportions of ORS were obtained and multivariable- design-adjusted logistic regression analysis was used to obtain Odds Ratios (aORs) and 95% confidence intervals (CIs) and weighted proportions of ORS coverage.ResultsCrude ORS coverage increased from 21.0% (95% CI: 17.4–24.9) in 1st Period to 40.5% (36.5–44.6) in 2nd Period in Zimbabwe; increased from 60.8% (56.1–65.3) to 64.7% (61.8–67.5) in Zambia; and decreased from 72.3% (68.4–75.9) to 64.6% (60.9–68.1) in Malawi. The rates of change in coverage among provinces in Zimbabwe ranged from 10.3% over the three cycles (approximately 10 years) in Midlands to 44.2% in Matabeleland South; in Zambia from − 9.5% in Eastern Province to 24.4% in Luapula; and in Malawi from − 16.5% in the Northern Province to − 3.2% in Southern Province. The aORs for ORS use was 3.95(2.66–5.86) for Zimbabwe, 2.83 (2.35–3.40) for Zambia, and, 0.71(0.59–0.87) for Malawi.ConclusionORS coverage increased in Zimbabwe, stagnated in Zambia, but declined in Malawi. Monitoring national and province-level trends of ORS use illuminates geographic inequalities and helps identify priority areas for targeting resource allocation.. Provision of safe drinking-water, adequate sanitation and hygiene will help reduce the causes and the incidence of diarrhea. Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of ORS to reduce the burden of diarrhea should be developed and implemented.
Highlights
More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease
Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of Oral rehydration solution (ORS) to reduce the burden of diarrhea should be developed and implemented
Oral rehydration solution (ORS), known as oral rehydration therapy (ORT) has significant potential to drastically reduce child deaths caused by dehydration and under-nutrition in children with diarrhea
Summary
More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals. Diarrhea is the second leading cause of death and malnutrition in children under 5 years (U5) of age annually responsible for more than 500,000 deaths globally [1]. Oral rehydration solution (ORS), known as oral rehydration therapy (ORT) has significant potential to drastically reduce child deaths caused by dehydration and under-nutrition in children with diarrhea. UNICEF estimates from 2000 suggest that only 34% of children under 5 years in low- and middle-income countries (LMICs) received ORS to treat diarrhea; coverage increased to 44% in 2016, implying that majority of children under 5 with diarrhea were not treated [5, 6]. .ORS is especially suitable in locations where intravenous fluids are readily available [8]
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