Private Sector Provision of Oral Rehydration Therapy for Child Diarrhea in Sub-Saharan Africa

Sood, Neeraj; Wagner, Zachary

doi:10.4269/ajtmh.13-0279

Cited by 21 publications

(20 citation statements)

References 26 publications

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“…We also found that mean daily temperature was associated with incident diarrhea though not with cholera. Previous analyses of non-cholera diarrhea from Bangladesh have shown a similar trend of increasing diarrhea with increasing temperature [ 30 , 31 ], though a more nuanced relationship with cholera and temperature has been noted in other analyses [ 32 ]. Our estimates of the relationship between lagged ORS sales and diarrhea and cholera suggest that future predictive models should consider the influence of temperature on the relationship between sales and incidence.…”

Section: Discussionmentioning

confidence: 87%

Tracking Cholera through Surveillance of Oral Rehydration Solution Sales at Pharmacies: Insights from Urban Bangladesh

et al. 2015

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BackgroundIn Bangladesh, pharmacy-purchased oral rehydration solution (ORS) is often used to treat diarrhea, including cholera. Over-the-counter sales have been used for epidemiologic surveillance in the past, but rarely, if ever, in low-income countries. With few early indicators for cholera outbreaks in endemic areas, diarrhea-related product sales may serve as a useful surveillance tool.Methodology/Principal FindingsWe tracked daily ORS sales at 50 pharmacies and drug-sellers in an urban Bangladesh community of 129,000 for 6-months while simultaneously conducting surveillance for diarrhea hospitalizations among residents. We developed a mobile phone based system to track the sales of ORS and deployed it in parallel with a paper-based system. Our objectives were to determine if the mobile phone system was practical and acceptable to pharmacists and drug sellers, whether data were reported accurately compared to a paper-based system, and whether ORS sales were associated with future incidence of cholera hospitalizations within the community. We recorded 47,215 customers purchasing ORS, and 315 hospitalized diarrhea cases, 22% of which had culture-confirmed cholera. ORS sales and diarrhea incidence were independently associated with the mean daily temperature; therefore both unadjusted and adjusted models were explored. Through unadjusted cross-correlation statistics and generalized linear models, we found increases in ORS sales were significantly associated with increases in hospitalized diarrhea cases up to 9-days later and hospitalized cholera cases up to one day later. After adjusting for mean daily temperature, ORS was significantly associated with hospitalized diarrhea two days later and hospitalized cholera one day later.Conclusions/SignificancePharmacy sales data may serve as a feasible and useful surveillance tool. Given the relatively short lagged correlation between ORS sales and diarrhea, rapid and accurate sales data are key. More work is needed in creating actionable algorithms that make use of this data and in understanding the generalizability of our findings to other settings.

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Section: Discussionmentioning

confidence: 87%

Tracking Cholera through Surveillance of Oral Rehydration Solution Sales at Pharmacies: Insights from Urban Bangladesh

et al. 2015

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“…We could not test socio-economic or geographic differentials in 2-week prevalence of diarrhea and case management indicators since the data analysed were aggregated. However, association of diarrhea with lower socio-economic status has been illustrated in previous reports [35, 38] and geographic variations within countries are well documented in DHS reports [32]. The validity of the indicators that were carefully selected by the WHO and UNICEF after field studies and technical consultations, has been questioned.…”

Section: Discussionmentioning

confidence: 99%

Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985–2012

2017

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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.

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“…Recent studies performed in South India and Sub-Saharan Africa have shown that, regardless of receiving formal diarrhea management training, healthcare professionals treating children with diarrhea tended to prescribe more antibiotics, injections and anti-diarrheal medications than oral rehydration solutions and zinc Sood & Wagner, 2014). Efforts are therefore needed to evaluate healthcare professionals' clinical management of childhood diarrhea in the most affected area of the globe.…”

Section: -Introductionmentioning

confidence: 95%

Management of childhood diarrhea by healthcare professionals in low income countries: An integrative review

Diallo

Cong

Henderson

et al. 2017

International Journal of Nursing Studies

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Private Sector Provision of Oral Rehydration Therapy for Child Diarrhea in Sub-Saharan Africa

Cited by 21 publications

References 26 publications

Tracking Cholera through Surveillance of Oral Rehydration Solution Sales at Pharmacies: Insights from Urban Bangladesh

Tracking Cholera through Surveillance of Oral Rehydration Solution Sales at Pharmacies: Insights from Urban Bangladesh

Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985–2012

Management of childhood diarrhea by healthcare professionals in low income countries: An integrative review

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