ABSTRACT
Background: Oral rehydration salts (ORS) therapy for diarrheal diseases is considered an effective therapy that can be applied in many resource-poor settings. Nevertheless, it has been consistently underutilized, and as a result, its potential to reduce child mortality has not been fully exploited. In Ethiopia, the use of ORS therapy for children under five has been inadequate. Like any other health behavior, the provision of ORS therapy to children during diarrheal episodes by caregivers is complex and context dependent. Identifying the factors may help promote wider application.
Design and methods: We used data from the 2016 Ethiopia Demographic and Health Survey (EDHS-2016). Samples were selected by a two-stage stratified cluster sampling method. We used data on children under five years of age whose mothers (aged 15-49 years) reported that the child had had diarrhea within two weeks before the survey was conducted (n=1221). The dependent variable was whether these children received ORS therapy. The contextual independent factors were socio-demographic variables (mothers’ age, child’s age, child’s sex, child’s place of residence, household wealth, and mother/ husband/partner’s education levels and work status), as well as media exposure and healthcare utilization.
Results: The prevalence of ORS therapy use among the children was 30%. Mothers who had made at least four prenatal visits during their last pregnancy were 87% more likely to use ORS therapy for their children than those who had fewer prenatal visits (OR=1.874; CI: 1.140-3.082; p=0.013).
Conclusions: Integrating efforts for scaling-up ORS use with prenatal health care services may have an extra benefit of promoting children’s wellbeing and survival.
REFERENCES
UNICEF. Oral rehydration salts & zinc: Market and supply update. 2018. Available from: https://www.unicef.org/supply/index_90295.html
WHO. Diarrheal diseases. 2017. Available from https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1151-210. DOI: https://doi.org/10.1016/S0140-6736(17)32152-9
Mills A. Health care systems in low-and middle-income countries. N Engl J Med 2014;370:552-7. DOI: https://doi.org/10.1056/NEJMra1110897
Awasthi S. Improving management of dehydration in children younger than 5 years in low-and-middle-income countries. Lancet Global Health 2016;4:e674-5. DOI: https://doi.org/10.1016/S2214-109X(16)30179-6
Black RE. Progress in the use of ORS and zinc for the treatment of childhood diarrhea. J Glob Health 2019;9:010101. DOI: https://doi.org/10.7189/jogh.09.010101
Troeger C, Blacker BF, Khalil IA, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018;18:1211-28. DOI: https://doi.org/10.1016/S1473-3099(18)30362-1
WHO. Handbook: IMCI Integrated Management of Childhood Illness. Geneva; 2005.
Munos MK, Walker CL, Black RE. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. Int J Epidemiol 2010;39:i75-87. DOI: https://doi.org/10.1093/ije/dyq025
Wagner Z, Asiimwe JB, Dow WH, Levine DI. The role of price and convenience in use of oral rehydration salts to treat child diarrhea: A cluster randomized trial in Uganda. PLoS Med2019;16:e1002734.
Central Statistical Agency Ethiopia, ICF International. Ethiopia Demographic and Health Survey, 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF International. 2017. Available from: https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf
Santosham M, Chandran A, Fitzwater S, et al. Progress and barriers for the control of diarrheal disease. Lancet 2010;376:63-7. DOI: https://doi.org/10.1016/S0140-6736(10)60356-X
WHO. New guidelines on antenatal care for a positive pregnancy experience. 2016. Available from: https://www.who.int/reproductivehealth/news/antenatal-care/en/
Wagner Z, Shah M, Sood N. Barriers to use of oral rehydration salts for child diarrhea in the private sector: evidence from India. J Trop Pediatr 2014;61:37-43. DOI: https://doi.org/10.1093/tropej/fmu063
Wagner Z, Asiimwe JB, Dow WH, Levine DI. The role of price and convenience in use of oral rehydration salts to treat child diarrhea: A cluster randomized trial in Uganda. PLoS Med 2019;16:e1002734. DOI: https://doi.org/10.1371/journal.pmed.1002734
Mengistie B, Berhane Y, Worku A. Predictors of oral rehydration therapy use among under-five children with diarrhea in Eastern Ethiopia: a community based case control study. BMC Public Health 2012;12:1029. DOI: https://doi.org/10.1186/1471-2458-12-1029
UNICEF. Child survival and the SDGs: Looking ahead: Child survival and the Sustainable Development Goals. 2019. Available from: https://data.unicef.org/topic/child-survivalchild-survival-sdgs/
Schroder K, Battu A, Wentworth L, et al. Increasing coverage of pediatric diarrhea treatment in high-burden countries. J Glob Health 2019;9:0010503. DOI: https://doi.org/10.7189/jogh.09.010503
Tegegne TK, Chojenta C, Getachew T, et al. Antenatal care use in Ethiopia: a spatial and multilevel analysis. BMC Pregnancy Childbirth 2019;19:399. DOI: https://doi.org/10.1186/s12884-019-2550-x