Abstract
BackgroundDiarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries.MethodsWe analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver’s care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys.ResultsOverall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or ‘increased fluids’ and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of ‘increased fluids’ decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%.ConclusionsVery limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver’s care seeking behavior and health care provider’s case management practices is needed to improve diarrhea case management in low- and-middle-income countries.
Highlights
Diarrhea remains to be a main cause of childhood mortality
Experts argue that that Millennium development goal (MDG)-4 could not be accomplished since childhood diarrhea which accounts for about 10% of all under-5 child deaths [2] was not effectively tackled owing to inadequate implementation of existing evidence-based interventions for diarrhea [3, 4]
Though a 60% reduction of child mortality rate from diarrhea has been achieved between 2000 and 2013, a further reduction targeted during the sustainable development goals (SDG) era requires a further improvement in coverage and quality of diarrhea case management [5]
Summary
Diarrhea case management indicators reflect the effectiveness of child survival interventions. Experts argue that that MDG-4 could not be accomplished since childhood diarrhea which accounts for about 10% of all under-5 child deaths [2] was not effectively tackled owing to inadequate implementation of existing evidence-based interventions for diarrhea [3, 4]. Though a 60% reduction of child mortality rate from diarrhea has been achieved between 2000 and 2013, a further reduction targeted during the sustainable development goals (SDG) era requires a further improvement in coverage and quality of diarrhea case management [5]. Case management of diarrhea under Integrated Management of Childhood Illness strategy (IMCI) [10] by training the healthcare providers (HCP) has been shown to improve their case management skills [11]
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