TY - JOUR
T1 - Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030
AU - Black, Robert
AU - Fontaine, Olivier
AU - Lamberti, Laura
AU - Bhan, Maharaj
AU - Huicho, Luis
AU - El Arifeen, Shams
AU - Masanja, Honorati
AU - Walker, Christa Fischer
AU - Mengestu, Tigest Ketsela
AU - Pearson, Luwei
AU - Young, Mark
AU - Orobaton, Nosa
AU - Chu, Yue
AU - Jackson, Bianca
AU - Bateman, Massee
AU - Walker, Neff
AU - Merson, Michael
N1 - Funding Information:
Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the funding agencies. Funding: The Bill & Melinda Gates Foundation provided financial support to the Johns Hopkins Bloomberg School of Public Health for the Control of Childhood Diarrhea Mortality (grant # 1154742) and the Maternal and Child Epidemiology Estimation (grant # 1096225). Authorship contribution: REB and MM conceptualized the analyses and coordinated the work. YC provided the mortality analyses. OF, MM, TKM, LP and MY wrote on changes in clinical management and diarrhea program efforts. NW, BJ and REB conducted the LiST analyses. REB wrote the first draft of the manuscript; all authors contributing to editing the final manuscript. Competing interests: NO and LL work for the Bill & Melinda Gates Foundation that provided funding for the analyses. The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no further conflicts of interest.
Funding Information:
The Bill & Melinda Gates Foundation provided financial support to the Johns Hopkins Bloomberg School of Public Health for the Control of Childhood Diarrhea Mortality (grant # 1154742) and the Maternal and Child Epidemiology Estimation (grant # 1096225).
Publisher Copyright:
© 2019 ISGH.
PY - 2019
Y1 - 2019
N2 - Background Childhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low-and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur. Methods We used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction. Results Diarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level. Conclusions Employing the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.
AB - Background Childhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low-and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur. Methods We used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction. Results Diarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level. Conclusions Employing the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.
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U2 - 10.7189/jogh.09.020801
DO - 10.7189/jogh.09.020801
M3 - Article
C2 - 31673345
AN - SCOPUS:85074350371
VL - 9
JO - Journal of Global Health
JF - Journal of Global Health
SN - 2047-2978
IS - 2
M1 - 020801
ER -