Bangladesh: a success case in combating childhood diarrhoea

Abstract

BackgroundBangladesh had a large reduction in childhood deaths due to diarrhoeal disease in recent decades. This paper explores the preventive, promotive, curative and contextual drivers that helped Bangladesh achieve this exemplary success.MethodsPrimary and secondary data collection approaches were used to document trends in reduction of Diarrhoea Specific Mortality Rate (DSMR) between 1980 and 2015, understand what policies and programmes played key roles, and estimate the contribution of specific interventions that were implemented during the period. Data acquisition involved relevant document reviews and in-depth interviews with key stake-holders. A systematic search of literature was undertaken to explore socio-economic, aetiological, behavioural, and nutritional drivers of diarrhoeal disease reduction in Bangladesh. Finally, we used LiST (Lives Saved Tool) to model the contributions of the relevant interventions during three time periods (1980-2015, 1980-2000 and 2000-2015), and to project the number of lives saved in 2030 (compared to 2015) if these interventions were implemented at near universal coverage (90%).ResultsThe factors which likely had the most impact on DSMR were the coordinated efforts of the Government of Bangladesh (GoB) with non-government organizations (NGOs) and the private sector that enabled swift implementation, at scale, of interventions like oral rehydration solution (ORS) and zinc, promotion of breastfeeding, handwashing and sanitary latrines (WASH), as well as improvements in female education and nutrition. Compared to 1980, we found ORS and reduction in stunting prevalence had the greatest impact on DSMR, saving roughly 70 000 lives combined in 2015. Until 2000, ORS had a higher contribution to DSMR reduction than reduction in stunting prevalence. This proportionate contribution was reversed during 2000-2015. At near universal coverage (90%) of combined direct diarrhoeal disease, nutrition and WASH interventions, we project that an additional 5356 deaths due to diarrhoea could be averted in 2030.ConclusionBangladesh’s achievement in reduction of DSMR highlights the important role of an enabling policy environment that fostered coordinated efforts of the public and private sectors and NGOs for maximal impact. To maintain this momentum, evidence-based interventions should be scaled up at universal coverage.

Perception and Practices of Home Management of Acute Watery Diarrhoea and Its Impact on Dehydration

“…However, mothers may use variety of terms to describe diarrhoea, depending for example, upon whether the stool is loose, watery bloody or mucoid or there is vomiting. Infants who are exclusively breast-fed, normally pass several soft or semi-liquid stools each day; for them, it is practical to define diarrheoa as an increase in stool frequency or liquidity that is considered abnormal by the mother [1]. In this study most of the caregivers' (85%) perception about diarrhoea is increase in the frequency and fluidity of stool (Table 3).…”

“…Factors of particular importance include prevention of dehydration during diarrhoeal episodes through the use of ORS, support of nutritional status through the continuation of an adequate diet, and the avoidance of harmful practices [3]. Most cases of diarrhea can be treated at home by the health care givers without getting admission into hospital [1]. Most diarrhoea deaths occur due to ignorance of health care givers about home management of diarrhea.…”

“…Diarrhoea is one of the commonest causes of death in children in developing countries [1]. Despite the fact that the Control of Diarrhoeal Disease program (CDD) of the World Health Organization (WHO) was launched in 1980 with the aim of promoting oral rehydration treatment (ORT), 3-4 million children are still dying of diarrhea every year [2].…”

“…The majority of deaths occur in Africa, South-East Asia and Latin America. 80% of these deaths occur in the first 2 years of life [1].…”

“…Most cases of diarrhea can be treated at home by the care givers without getting admission into hospital. In at least 95% of episodes of watery diarrhea dehydration can be prevented using only ORS solution [1]. Most diarrheal deaths are due to ignorance of health care givers about home management of diarrhea [6].…”