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dc.contributor.authorWiens, Kirsten E
dc.contributor.authorLindstedt, Paulina A
dc.contributor.authorBlacker, Brigette F
dc.contributor.authorJohnson, Kimberly B
dc.contributor.authorBaumann, Mathew M
dc.contributor.authorSchaeffer, Lauren E
dc.contributor.authorAbbastabar Sr, Hedayat
dc.contributor.authorAbd-Allah, Foad
dc.contributor.authorAbdelalim, Ahmed
dc.contributor.authorAbdollahpour, Ibrahim
dc.contributor.authorHussein Abegaz, Kedir
dc.contributor.authorNegesse Abejie, Ayenew
dc.contributor.authorGuimarães Abreu, Lucas
dc.contributor.authorAbrigo, Michael RM
dc.contributor.authorAbualhasan, Ahmed
dc.contributor.authorKokou Accrombessi, Manfred Mario
dc.contributor.authorAcharya, Dilaram
dc.contributor.authorAdabi, Maryam
dc.contributor.authorAdamu, Abdu A
dc.contributor.authorAdebayo, Oladimeji M
dc.contributor.authorAdedoyin Sr, Rufus Adesoji
dc.contributor.authorAdekanmbi, Victor
dc.contributor.authorAdetokunboh Sr, Olatunji O
dc.contributor.authorMeressa Adhena, Beyene
dc.contributor.authorAfarideh, Mohsen
dc.contributor.authorAhmad, Sohail
dc.contributor.authorAhmadi, Keivan
dc.contributor.authorAhmed, Anwar E
dc.contributor.authorBeshir Ahmed, Muktar
dc.contributor.authorAhmed, Rushdia
dc.contributor.authorYihunie Akalu, Temesgen
dc.contributor.authorAlahdab, Fares
dc.contributor.authorAl-Aly, Ziyad
dc.contributor.authorAlam Sr, Noore
dc.contributor.authorAlam, Samiah
dc.contributor.authorMelak Alamene, Genet
dc.contributor.authorAlanzi, Turki M
dc.contributor.authorAlcalde-Rabanal, Jacqueline Elizabeth
dc.contributor.authorAbdulqadir Ali, Beriwan
dc.contributor.authorAlijanzadeh, Mehran
dc.contributor.authorAlipour, Vahid
dc.contributor.authorAljunid, Syed Mohamed
dc.contributor.authorAlmasi Sr, Ali
dc.contributor.authorAlmasi-Hashiani, Amir
dc.contributor.authorAl-Mekhlafi, Hesham M
dc.contributor.authorAltirkawi, Khalid A
dc.contributor.authorAlvis-Guzman, Nelson
dc.contributor.authorAlvis-Zakzuk, Nelson J
dc.contributor.authorAmini Sr, Saeed
dc.contributor.authorMaever Amit Sr, Arianna L
dc.contributor.authorAndrei Sr, Catalina Liliana
dc.contributor.authorAnjomshoa, Mina
dc.contributor.authorAnoushiravani Sr, Amir
dc.contributor.authorAnsari, Fereshteh
dc.contributor.authorAbelardo Antonio, Carl T
dc.contributor.authorAntony, Benny
dc.contributor.authorAntriyandarti, Ernoiz
dc.contributor.authorArabloo, Jalal
dc.contributor.authorAmin Aref Sr, Hany Mohamed
dc.contributor.authorAremu, Olatunde
dc.contributor.authorArmoon, Bahram
dc.contributor.authorArora Sr, Amit
dc.contributor.authorAryal, Krishna K
dc.contributor.authorArzani, Afsaneh
dc.contributor.authorAsadi-Aliabadi, Mehran
dc.contributor.authorTasew Atalay, Hagos
dc.contributor.authorAthari Sr, Seyyed Shamsadin
dc.contributor.authorMasoume Athari, Seyyede
dc.contributor.authorAtre, Sachin R
dc.contributor.authorAusloos, Marcel
dc.contributor.authorAwoke, Nefsu
dc.contributor.authorAyala Quintanilla, Beatriz Paulina
dc.contributor.authorAyano, Getinet
dc.contributor.authorAyanore Sr, Martin Amogre
dc.contributor.authorAynalem IV, Yared Asmare
dc.contributor.authorAzari, Samad
dc.contributor.authorAzzopardi, Peter S
dc.contributor.authorBabaee, Ebrahim
dc.contributor.authorKayode Babalola, Tesleem
dc.contributor.authorBadawi Sr, Alaa
dc.contributor.authorBairwa, Mohan
dc.contributor.authorBakkannavar, Shankar M
dc.contributor.authorBalakrishnan, Senthilkumar
dc.contributor.authorGeleto Bali, Ayele
dc.contributor.authorBanach Sr, Maciej
dc.contributor.authorMattar Banoub Sr, Joseph Adel
dc.contributor.authorBarac, Aleksandra
dc.contributor.authorBärnighausen, Till Winfried
dc.contributor.authorBasaleem, Huda
dc.contributor.authorBasu, Sanjay
dc.contributor.authorBay, Vo Dinh
dc.contributor.authorBayati, Mohsen
dc.contributor.authorBaye, Estifanos
dc.contributor.authorBedi, Neeraj
dc.contributor.authorBeheshti, Mahya
dc.contributor.authorBehzadifar, Masoud
dc.contributor.authorBehzadifar, Meysam
dc.contributor.authorBegashaw Bekele, Bayu
dc.contributor.authorMuche Belayneh, Yaschilal
dc.contributor.authorBell Sr, Michellr L
dc.contributor.authorBennett Sr, Derrick A
dc.contributor.authorAjema Berbada, Dessalegn
dc.contributor.authorBernstein, Robert S
dc.contributor.authorBhat Sr, Anusha Ganapati
dc.contributor.authorBhattacharyya Sr, Krittika
dc.contributor.authorBhattarai, Suraj
dc.contributor.authorBhaumik, Soumyadeep
dc.contributor.authorBhutta, Zulfiqar A
dc.contributor.authorBijani, Ali
dc.contributor.authorBikbov, Boris
dc.contributor.authorBirihane IV, Binyam Minuye
dc.contributor.authorKishore Biswas, Raaj
dc.contributor.authorBohlouli, Somayeh
dc.contributor.authorAmensisa Bojia, Hunduma
dc.contributor.authorBoufous, Soufiane
dc.contributor.authorBrady, Oliver J
dc.contributor.authorBragazzi, Nicola Luigi
dc.contributor.authorBriko, Andrey Nikolaevich
dc.contributor.authorBriko, Nikolay Ivanovich
dc.contributor.authorBritton, Gabrielle B
dc.contributor.authorNagaraja Sr, Sharath Burugina
dc.contributor.authorBusse Sr, Reinhard
dc.contributor.authorButt, Zahid A
dc.contributor.authorCámera Sr, Luis LA Alberto
dc.contributor.authorCampos-Nonato Sr, Ismael R
dc.contributor.authorCano, Jorge
dc.contributor.authorCar, Josip
dc.contributor.authorCárdenas, Rosario
dc.contributor.authorCarvalho Sr, Felix
dc.contributor.authorCastañeda-Orjuela Sr, Carlos A
dc.contributor.authorCastro, Franz
dc.contributor.authorChanie Sr, Wagaye Fentahun
dc.contributor.authorChatterjee, Pranab
dc.contributor.authorChattu, Vijay Kumar
dc.contributor.authorChichiabellu Jr, Tesfaye Yitna
dc.contributor.authorChin Sr, Ken Lee
dc.contributor.authorChristopher, Devasahayam J
dc.contributor.authorChu, Dinh-Toi
dc.contributor.authorCormier, Natalie Maria
dc.contributor.authorCosta, Vera Marisa
dc.contributor.authorCulquichicon, Carlos
dc.contributor.authorSoboka Daba, Matiwos
dc.contributor.authorDamiani Sr, Giovanni
dc.contributor.authorDandona, Lalit
dc.contributor.authorDandona, Rakhi
dc.contributor.authorDang, Anh Kim
dc.contributor.authorDarwesh, Aso Mohammad
dc.contributor.authorDarwish, Amira Hamed
dc.contributor.authorDaryani Sr, Ahmad
dc.contributor.authorDas, Jai K
dc.date.accessioned2020-09-02T03:04:23Z
dc.date.available2020-09-02T03:04:23Z
dc.date.issued2020-08-01
dc.identifier.otherhttps://doi.org/10.1016/S2214-109X(20)30230-8
dc.identifier.urihttp://repositorio-indicasat.org.pa/handle/123456789/247
dc.descriptionBackground Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage.en_US
dc.description.abstractBackground Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage.en_US
dc.language.isoengen_US
dc.rightshttps://creativecommons.org/licenses/by-nc-sa/4.0/
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectMapping geographicalen_US
dc.subjectinequalities in oral rehydrationen_US
dc.subjecttherapy coverage in low-incomeen_US
dc.subjectmiddle-incomeen_US
dc.subjectcountriesen_US
dc.titleMapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17en_US
dc.typeinfo:eu-repo/semantics/articleen_US
dc.typeinfo:eu-repo/semantics/publishedVersion


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