Prevalence and predictors of oral rehydration therapy, zinc, and other treatments for diarrhoea among children under-five in sub-Saharan Africa

Aboagye, Richard Gyan; Seidu, Abdul‐Aziz; Frimpong, James Boadu; Cadri, Abdul; Afaya, Agani; Hagan, John Elvis; Yaya, Sanni

doi:10.1371/journal.pone.0275495

Cited by 7 publications

(4 citation statements)

References 41 publications

(48 reference statements)

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“…Thus, to ameliorate the attractiveness of primary health facilities, the reliability of the supply chain for relevant medicines, especially antimalarials, should be one priority. Strengthening primary health facilities is equally important for the management of diarrhoea Concordantly with other studies in sub-Saharan Africa [24], we found oral rehydration solution use to be very low despite its generally positive image. The reasons remain unclear, however, the dropping coverage of oral rehydration solution and zinc could be a promising target for community empowerment according to Integrated Community Case Management, as it does not require advanced medical skills or a prescription.…”

Section: Discussionsupporting

confidence: 89%

Understanding pre‐hospital disease management of fever and diarrhoea in children—Care pathways in rural Tanzania

Lamshöft,

Liheluka,

Ginski

et al. 2024

Tropical Med Int Health

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ObjectiveMany children in sub‐Saharan Africa die from infectious diseases like malaria, pneumonia, and diarrhoea that can be prevented by early diagnosis, effective and targeted treatment. This study aimed to gain insights into case management practices by parents before they present their children to hospital.MethodsWe conducted a cross‐sectional study among 332 parents attending a district hospital with their under‐fives symptomatic with fever and/or diarrhoea between November 2019 and July 2020 in rural Tanzania. Timely and targeted treatment was defined as seeking health care within 24 h of fever onset, and continued fluid intake in case of diarrhoea.ResultsThe main admission diagnoses were acute respiratory infections (61.8%), malaria (25.3%), diarrhoea (18.4%) and suspected sepsis (8.1%). The majority of children (91%) received treatment prior to admission, mostly antipyretics (75.6%), local herbal medicines (26.8%), and antibiotics (17.8%)—half of them without prescription from a clinician. For diarrhoea, the use of oral rehydration solution was rare (9.0%), although perceived as easily accessible and affordable. 49.4% of the parents presented their children directly to the hospital, 23.2% went to a pharmacy/drug shop and 19.3% to a primary health facility first. Malaria symptoms began mostly 3 days before the hospital visit; only 25.4% of febrile children visited any health facility within 24 h of disease onset. Prior use of local herbal medicine (AOR = 3.2; 95% CI 1.4–7.3), visiting the pharmacy (adjusted Odds Ratio [AOR] = 3.1; 95% confidence interval [CI]: 1.0–9.8), the dispensary being the nearest health facility (AOR = 3.0; 95% CI: 1.5–6.2), and financial difficulties (AOR = 2.2; 95% CI 1.1–4.5) were associated with delayed treatment.ConclusionThis study suggests that antipyretics and antibiotics dispensed at pharmacies/drug shops, as well as use of local herbal medicines, delay early diagnosis and treatment, which can be life‐threatening. Pharmacies/drug shops could be integrated as key focal points for sensitising community members on how to respond to paediatric illnesses and encourage the use of oral rehydration solutions.

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Section: Discussionsupporting

confidence: 89%

Understanding pre‐hospital disease management of fever and diarrhoea in children—Care pathways in rural Tanzania

Lamshöft,

Liheluka,

Ginski

et al. 2024

Tropical Med Int Health

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“…It is also indicated that there are gaps in access to ORS between the richest and poorest households in most regions, including sub-Saharan Africa [5]. Factors that influence use of ORS for children with diarrhea include household wealth, exposure to media, health-seeking behaviour, recognition of severity of signs of dehydration, availability of ORS, awareness of ORS, residence, mother's age, age, health insurance, among others [6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of oral rehydration solution use and its determinants in the treatment of diarrhea among under-five children in sub-Saharan Africa

Adedokun,

Yaya

2024

PLoS ONE

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Background Diarrhea is the second leading cause of under-five deaths claiming half a million children every year. Most of these deaths occurred in sub-Saharan Africa and South Asia. Oral rehydration solution (ORS) has been described as the most effective treatment of diarrhea. However, only 36% of children with diarrhea received ORS in sub-Saharan Africa. This study examined the factors associated with ORS use for children with diarrhea in the sub-region. Methods Demographic and Health Surveys (DHS) data sets of 31 countries in sub-Saharan Africa were used in this study. The data involved 30,102 under-five children with diarrhea. The multivariable analysis involved binary logistic regression. Results Prevalence of ORS use was 38% in sub-Saharan Africa with countries such as Namibia (71.8%), Zambia (66.4%) and Malawi (63.8%) having the highest rates. Use of ORS was most common among children whose mothers had secondary or higher education (45%), were exposed to media (41%) and attended antenatal care (41%). ORS use was significantly associated with secondary or higher education (OR = 1.63; 95%CI: [1.47–1.81]; p<0.001), exposure to media (OR = 1.17; 95%CI: [1.07–1.27]; p<0.001), antenatal care attendance (OR = 2.33; 95%CI: [1.08–1.27]; p<0.001), child’s age (OR = 1.46; 95%CI: [1.35–1.59]; p<0.001), child’s size at birth (OR = 1.08; 95%CI: [1.00–1.17]; p<0.05), household size (OR = 1.28; 95%CI:[1.06–1.54]; p<0.05) and source of drinking water (OR = 1.18; 95%CI: [1.09–1.29]; p<0.001). Conclusion This study revealed a 38% prevalence of ORS use during diarrhea episodes in sub-Saharan Africa. This is low as it is less than the 44% recorded for developing countries as a whole. While this study emphasises the need for a further study on effects of severity of diarrhea on ORS use and factors determining differences in ORS use among countries, it also calls for interventions that will increase use of ORS is sub-Saharan Africa. Such interventions should include increase in literacy rate among girls and women, increase in the proportion of women with access to media, involvement of health workers in programmes that would promote antenatal care utilization among women at community level and provision of social amenities like pipe-borne water.

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“…Oral rehydration solution (ORS), a mixture of clean water, salt and sugar, and preferably administered with zinc supplementation, has been shown to reduce the mean duration of diarrhea (by about 20%), mortality due to diarrhea (by 23%), stool output and the risk of a subsequent episode in the 2 to 3 months after supplementation [2][3][4]. However, usage of ORS is reported to be low in most low-and middle-income countries [5,6]. The use of recommended home fluid (RHF) was promoted by the World Health Organization (WHO) in addition to ORS and the combination is referred to as oral rehydration therapy (ORT).…”

Section: Introductionmentioning

confidence: 99%

A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria

Gayawan,

Cameron,

Okitika

et al. 2024

PLoS ONE

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We assess progress towards improved case management of childhood diarrhea in Nigeria over a period of targeted health systems reform from 2013 to 2018. Individual and community data from three Demographic and Health Survey rounds are leveraged in a geospatial model designed for stratified estimation by venue of treatment seeking and State. Our analysis reveals a highly regionalised health system undergoing rapid change. Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44–0.69; 95% CI] in 2008; 0.70 [0.54–0.83] in 2018) or chemist/pharmacy (0.28 [0.17–0.42] in 2008; 0.48 [0.31–0.64] in 2018). Yet State-level variations in venue attendance and performance by venue have conspired to hold the overall proportion receiving this potentially life-saving therapy (0.45 [0.35–0.55] in 2018) to well-below ideal coverage levels. High performing states that have demonstrated significant improvements include Kano, Jigawa and Borno, while under-performing states that have suffered declines in coverage include Kaduna and Taraba. The use of antibiotics is not recommended for mild cases of childhood diarrhea yet remains concerningly high nationally (0.27 [0.19–0.36] in 2018) with negligible variation between venues. Antibiotic use rates are particularly high in Enugu, Kaduna, Taraba, Kano, Niger and Kebbi, yet welcome reductions were identified in Jigawa, Adamawa and Osun. These results support the conclusions of previous studies and build the strength of evidence that urgent action is needed throughout the multi-tiered health system to improve the quality and equity of care for common childhood illnesses in Nigeria.

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Prevalence and predictors of oral rehydration therapy, zinc, and other treatments for diarrhoea among children under-five in sub-Saharan Africa

Cited by 7 publications

References 41 publications

Understanding pre‐hospital disease management of fever and diarrhoea in children—Care pathways in rural Tanzania

Understanding pre‐hospital disease management of fever and diarrhoea in children—Care pathways in rural Tanzania

Prevalence of oral rehydration solution use and its determinants in the treatment of diarrhea among under-five children in sub-Saharan Africa

A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria

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