Diarrhea management in children under five in sub-Saharan Africa: does the source of care matter? A Countdown analysis

Abstract

BackgroundDiarrhea remains a high burden disease, responsible for nine percent of deaths in children under five globally. We analyzed diarrhea management practices in young children and their association with the source of care.MethodsWe used Demographic and Health Survey data from 12 countries in sub-Saharan Africa with high burdens of childhood diarrhea. We classified the quality of diarrhea management practices as good, fair, or poor based on mothers’ reports for children with diarrhea, using WHO/UNICEF recommendations for appropriate treatment. We described the prevalence of diarrhea management by type and assessed the association between good management and source of care, adjusting for potential confounders.ResultsPrevalence of good diarrhea management is low in 11 of the 12 analyzed surveys, varying from 17 % in Cote d’Ivoire to 38 % in Niger. The exception is Sierra Leone, where prevalence of good practice is 67 %. Prevalence of good management was low even among children taken to health facilities [median 52 %, range: 34–64 %]. Diarrhea careseeking from health facilities or community providers was associated with higher odds of good management than care from traditional/informal sources or no care. Careseeking from facilities did not result systematically in a higher likelihood of good diarrhea management than care from community providers. The odds of good diarrhea management were similar for community versus facility providers in six countries, higher in community than facility providers in two countries, and higher in facility than in community providers in four countries.ConclusionMany children’s lives can be saved with correct management of childhood diarrhea. Too many children are not receiving adequate care for diarrhea in high-burden sub-Saharan African countries, even among those seen in health facilities. Redoubling efforts to increase careseeking and improve quality of care for childhood diarrhea in both health facilities and at community level is an urgent priority.

Determinants of antimicrobial use in diarrhoea management among under-five children in Zomba, Malawi

“…Other researchers established that these drugs are mostly bought from drug-retail outlets under the prescription of a pharmasist or a friend (Shafie et al, 2018;Ayalew, 2017;Bachrach and Gardner, 2002). These findings are in agreement with available published literature which indicated that intentions for selfmedication with antibiotics result from the need to save money and the desire to act promptly to treat suspected or confirmed bacterial infections (Carvajal-Vélez et al, 2016;Chalovich and Eisenberg, 2013;Le et al, 2011). This knowledge of the condition is obtained from the health facility after the initial visit and knowledge of the exact medication that was provided (Viberg et al, 2010;Alghadeer et al, 2018).…”

“…Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual (Le Doare et al, 2015). Diarrhoeal disease is the second important cause of under-five mortality, and is liable for death of around 760,000 children every year (Carvajal-Vélez et al, 2016). Despite the fact that diarrhoea related mortality has reduced over the years in developing countries (including Malawi), morbidity as a result of diarrhoeal disease continues to remain the main cause of misery among young children (Alam et al, 2011;Munos et al, 2010).…”

“…This key role of antibiotics has contributed to high usage of antibiotics in management of diarrhoea which is contributing to increased cases of antimicrobial resistance (Padhy et al, 2017;Alghadeer et al, 2018). Oral Rehydration Salts (ORS) and Zinc supplementation during diarrhoea illness has been shown to reduce the duration and severity of diarrhoea episodes in many countries which in the long run reduces morbidity and mortality among under-five children (Carvajal-Vélez et al, 2016). Communities need to be encouraged to use ORS in management of diarrhoea related illnesses which has been proved to be very effective in counteracting rotavirus which in the long run will reduce overuse and misuse of antibiotics.…”

“…In a study conducted in Thailand where there was low antibiotic usage in treating diarrhoea, the decision not to use antibiotics was driven by medical professionals (Carvajal-Vélez et al, 2016). In other similar studies conducted across the globe, the decision to use antimicrobials was triggered by mother's/caregiver's knowledge of the previous medical condition without visiting a healthcare facility (Gera et al, 2016;Ocan et al, 2014a;Chalovich and Eisenberg, 2013).…”

Factors associated with childhood diarrhea in Rwanda: a secondary data analysis of the Rwanda demographic and health survey 2014-15

“…[1,2] Diarrhea is a high burden disease and accounts for nine percent of all deaths among children under five years old worldwide. [3] Diarrhea causes nearly 1.7 billion cases every year. [4] The global burden of diarrheal disease and deaths varies in developed and developing countries with half of all diarrheal deaths occurring in the African region.…”