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Li S, Wang C, Zeng H, Han Z. Effects of different combinations of antibacterial compound supplements in calf pellets on growth performance, health, blood parameters, and rumen microbiome of dairy calves. Front Vet Sci 2024; 11:1376758. [PMID: 38803795 PMCID: PMC11128685 DOI: 10.3389/fvets.2024.1376758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
This study investigated the effects of different combinations of antibacterial compounds (attapulgite, plant essential oils, and chitosan oligosaccharides) on growth performance, blood biochemical parameters, and rumen microbiome of calves. A total of 48 preweaning calves were randomly divided into four groups (n = 12 per group), and fed the following full mixed-ration granule diets for the 67-d-feeding trial: (1) basal diet (control group); (2) basal diet +1,000 g/t attapulgite, plant essential oils, and chitosan oligosaccharide (AEOCO group); (3) basal diet +1,000 g/t attapulgite and chitosan oligosaccharide (ACO group); and (4) basal diet +1,000 g/t attapulgite and plant essential oil (AEO group). The results showed that the daily weight gain of the AEOCO and AEO groups significantly increased (p < 0.05), whereas the feed conversion ratio decreased compared with that of the control group. Among the three treatment groups, AEO group showed the most positive effect, with the diarrhea rate reduced by 68.2% compared with that of the control group. Total protein and globulin levels were lower in the AEO group than in the control group. Albumin levels were higher in the AEOCO and AEO groups than in the control group. Immunoglobulin A, immunoglobulin G, and immunoglobulin M concentrations were higher in the AEOCO group (p < 0.05) than in the control group. The interleukin-6 concentration was lower in the AEOCO and AEO groups than in the control group (p < 0.05). The Chao 1 richness and ACE indices were higher in the AEOCO group than in the control group (p < 0.05). The ACO group had a significantly lower (p < 0.05) relative abundance of Firmicutes than the control group. The relative abundance of Bacteroidetes was the lowest in the control group, whereas that of Spirochaetota and Fibrobacteriota was the highest (p < 0.05). The relative abundance of Succiniclasticum was higher in the ACO and AEO groups (p < 0.05). These findings indicate that the combination of attapulgite, plant essential oils, and chitosan oligosaccharides has ameliorative effects on the growth performance, blood parameters, and rumen microbiome of calves.
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Affiliation(s)
| | | | | | - Zhaoyu Han
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, China
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Shen X, Wang F, Li Y, Su B, Song Z, Cong B. Changing Patterns in Digestive Diseases Mortality in Urban and Rural Areas - China, 1987-2021. China CDC Wkly 2023; 5:1115-1119. [PMID: 38124886 PMCID: PMC10728559 DOI: 10.46234/ccdcw2023.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
What is already known about this topic? Digestive diseases (DDs) are a global health concern with a substantial epidemiological and economic impact, given their high prevalence. What is added by this report? This study investigated the trends in mortality related to DDs in China from 1987 to 2021, focusing on the urban-rural divide. Additionally, it aimed to determine the specific impacts of age, period, and cohort on DDs mortality. What are the implications for public health practice? There is a need to prioritize and allocate more resources toward the future management of DDs in order to effectively address the challenges posed by urbanization and aging populations.
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Affiliation(s)
- Xinran Shen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Feng Wang
- Department of Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Yuling Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Binbin Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Zhiqiang Song
- Department of Gastroenterology, Peking University Third Hospital, Beijing, China
| | - Bin Cong
- Department of Forensic Medicine, Hebei Medical University, Hebei Key Laboratory of Forensic Medicine, Collaborative Innovation Center of Forensic Medical Molecular Identification, Shijiazhuang City, Hebei Province, China
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Water sanitation and hygiene in Sub-Saharan Africa: Coverage, risks of diarrheal diseases, and urbanization. JOURNAL OF BIOSAFETY AND BIOSECURITY 2021. [DOI: 10.1016/j.jobb.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Webb P, Danaei G, Masters WA, Rosettie KL, Leech AA, Cohen J, Blakstad M, Kranz S, Mozaffarian D. Modelling the potential cost-effectiveness of food-based programs to reduce malnutrition. GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2021; 29:100550. [PMID: 34164258 PMCID: PMC8202230 DOI: 10.1016/j.gfs.2021.100550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 01/24/2023]
Abstract
Poor quality diets contribute to malnutrition globally, but evidence is weak on the cost-effectiveness of food-based interventions that shift diets. This study assessed 11 candidate interventions developed through Delphi techniques to improve diets in India, Nigeria, and Ethiopia. A Markov simulation model incorporated time, individual-level, nutrition, and policy parameters to estimate health impacts and cost-effectiveness for reducing stunting, anaemia, diarrhea, and mortality in preschool children. At an assumed 80% coverage, interventions considered would potentially save between 0·16 and 3·20 years of life per child. The average cost-effectiveness ratio ranged from US$9 to US$2000 per life year saved. This approach, linking expert knowledge, known costs, and modelling, offers potential for estimating cost-effective investments for better informed policy choice where empirical evidence is limited. Few studies estimate the potential cost-effectiveness of programs for improving health through diets. Expert knowledge linked to modelling offers a basis for assessing potential alternatives where data are lacking. Our analysis assessed 11 candidate interventions for Ethiopia, India, and Nigeria derived from local expert opinion. Modelling demonstrates these programs' potential health impacts and cost-effectiveness. The modelling of estimated benefits can support best-buy policy and program choices.
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Affiliation(s)
- Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Goodarz Danaei
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Katherine L Rosettie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Ashley A Leech
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.,Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joshua Cohen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mia Blakstad
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Kranz
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Masanja H, Mongi P, Baraka J, Jackson B, Kisisiwe Y, Manji K, Iriya N, John T, Kimatta S, Walker N, Black RE. Factors associated with the decline in under five diarrhea mortality in Tanzania from 1980-2015. J Glob Health 2020; 9:020806. [PMID: 31673350 PMCID: PMC6816318 DOI: 10.7189/jogh.09.020806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Tanzania has made great progress in reducing diarrhea mortality in under- five children. We examined factors associated with the decline and projected the impact of scaling up interventions or reducing risk factors on diarrhea deaths. Methods We reviewed economic, health, and diarrhea-related policies, reports and programs implemented during 1980 to 2015. We used the Lives Saved Tool to determine the percentage reduction in diarrhea-specific mortality attributable to changes in coverage of the interventions and risk factors, including direct diarrhea-related interventions, nutrition, and water, sanitation and hygiene (WASH). We projected the number of diarrhea deaths that could be prevented in 2030, assuming near universal coverage of different intervention packages. Results Diarrhea-specific mortality among under-five children in Tanzania declined by 89% from 35.3 deaths per 1000 live births in 1980 to 3.9 deaths per 1000 live births in 2015. Factors associated with diarrhea-specific under-five mortality reduction included oral rehydration solution (ORS) use, changes in stunting prevalence, vitamin A supplementation, rotavirus vaccine, change in wasting prevalence and change in age-appropriate breastfeeding practices. Universal coverage of direct diarrhea, nutrition and WASH interventions has the potential reduce the diarrhea-specific mortality rate by 90%. Conclusions Scaling up of a few key childhood interventions such as ORS and nutrition, and reducing the prevalence of stunting would address the remaining diarrhea-specific under-five mortality by 2030.
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Affiliation(s)
| | - Pyande Mongi
- World Health Organization, Dar-es-Salaam, Tanzania
| | | | | | - Yasinta Kisisiwe
- Ministry of Health Community Development Gender Elderly and Children, Dodoma, Tanzania
| | - Karim Manji
- Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Nemes Iriya
- World Health Organization, Dar-es-Salaam, Tanzania
| | | | - Said Kimatta
- Management Sciences for Health, Dar-es-Salaam, Tanzania
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
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Black R, Fontaine O, Lamberti L, Bhan M, Huicho L, El Arifeen S, Masanja H, Walker CF, Mengestu TK, Pearson L, Young M, Orobaton N, Chu Y, Jackson B, Bateman M, Walker N, Merson M. Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health 2019; 9:020801. [PMID: 31673345 PMCID: PMC6815873 DOI: 10.7189/jogh.09.020801] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
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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Affiliation(s)
- Robert Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Olivier Fontaine
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health Child and Adolescent Health and Development, Geneva, Switzerland
| | - Laura Lamberti
- Bill & Melinda Gates Foundation, Enteric Diarrheal Diseases, Seattle, Washington, USA
| | - Maharaj Bhan
- Indian Institute of Technology, New Delhi, India
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Lima, Peru
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Christa Fischer Walker
- US Centers for Disease Control and Prevention, Maternal and Child Health, Windhoek, Namibia
| | | | - Luwei Pearson
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Mark Young
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Maternal, Newborn and Child Health, Seattle, Washington, USA
| | - Yue Chu
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Bianca Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Massee Bateman
- US Agency for International Development (USAID), Jakarta, Indonesia
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA (deceased)
| | - Michael Merson
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
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Huicho L, Tavera M, Huayanay-Espinoza CA, Béjar-Díaz M, Rivera-Ch M, Tam Y, Walker N, Black RE. Drivers of the progress achieved by Peru in reducing childhood diarrhoea mortality: a country case study. J Glob Health 2019; 9:020805. [PMID: 31673349 PMCID: PMC6816317 DOI: 10.7189/jogh.09.020805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood diarrhoea mortality has declined substantially in Peru in recent decades. We documented trends in childhood diarrhoea mortality from 1980 to 2015, along with trends in coverage of diarrhoea-related interventions and risk factors, to identify the main drivers of mortality reduction. METHODS We conducted desk reviews on social determinants, policies and programmes, and diarrhoea-related interventions implemented during the study period. We reviewed different datasets on child mortality, and on coverage of diarrhoea-related interventions. We received input from individuals familiar with implementation of diarrhoea-related policies and programmes. We used the Lives Saved Tool (LiST) to help explain the reasons for the decline in diarrhoea mortality from 1980 to 2015 and to predict additional reduction with further scale up of diarrhoea-related interventions by 2030. RESULTS In Peru under-five diarrhoea mortality declined from 23.3 in 1980 to 0.8 per 1000 livebirths in 2015. The percentage of under-five diarrhoea deaths as related to total under-five deaths was reduced from 17.8% in 1980 to 4.9% in 2015. Gross domestic product increased and poverty declined from 1990 to 2015. Access to improved water increased from 56% in 1986 to 79.3% in 2015. Oral rehydrating salts (ORS) use during an episode of diarrhoea increased from 3.6% in 1986 to 32% in 2015. Vertical programmes focused on diarrhoea management with ORS were implemented successfully in the 1980s and 1990s, and were replaced by integrated crosscutting interventions since the early 2000s. LiST analyses showed that about half (53.9%) of the reduction in diarrhoea mortality could be attributed to improved water, sanitation and hygiene, 25.0% to direct diarrhoea interventions and 21.1% to nutrition. The remaining mortality could be reduced by three-quarters by 2030 with improved diarrhoea treatment and further with enhanced breastfeeding practices and reduction in stunting. LiST does not take into account the role of social determinants. CONCLUSIONS The reduction of diarrhoeal under-five mortality in Peru can be explained by a combination of factors, including improvement of social determinants, child nutrition, diarrhoea treatment with ORS and prevention with rotavirus vaccine and increased access to water and sanitation. The already low rate of diarrhoea mortality could be further reduced by a number of interventions, especially additional use of ORS and zinc for diarrhoea treatment. Peru is a remarkable example of a country that was able to reduce childhood diarrhoea mortality by implementing interventions through vertical programmes initially, and afterwards through implementation of integrated multisectoral packages targeting prevalent illnesses and multi-causal problems like stunting.
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Affiliation(s)
- Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Pediatría, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Carlos A Huayanay-Espinoza
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - María Rivera-Ch
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Yvonne Tam
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
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Choudhary TS, Sinha B, Khera A, Bhandari N, Chu Y, Jackson B, Walker N, Black RE, Merson M, Bhan MK. Factors associated with the decline in under-five diarrhea mortality in India: a LiST analysis. J Glob Health 2019; 9:020804. [PMID: 31673348 PMCID: PMC6816285 DOI: 10.7189/jogh.09.020804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND India has achieved 86% reduction in the number of under-five diarrheal deaths from 1980 to 2015. Nonetheless diarrhea is still among the leading causes of under-five deaths. The aim of this analysis was to study the contribution of factors that led to decline in diarrheal deaths in the country and the effect of scaling up of intervention packages to address the remaining diarrheal deaths. METHODS We assessed the attribution of different factors and intervention packages such as direct diarrhea case management interventions, nutritional factors and WASH interventions which contributed to diarrhea specific under-five mortality reduction (DSMR) during 1980 to 2015 using the Lives Saved Tool (LiST). The potential impact of scaling up different packages of interventions to achieve universal coverage levels by year 2030 on reducing the number of remaining diarrheal deaths were estimated. RESULTS The major factors associated with DSMR reduction in under-fives during 1980 to 2015, were increase in ORS use, reduction in stunting prevalence, improved sanitation, changes in age appropriate breastfeeding practices, increase in the vitamin-A supplementation and persistent diarrhea treatment. ORS use and reduction in stunting were the two key interventions, each accounting for around 32% of the lives saved during this period. Scaling up the direct diarrhea case management interventions from the current coverage levels in 2015 to achieve universal coverage levels by 2030 can save around 82 000 additional lives. If the universal targets for nutritional factors and WASH interventions can be achieved, an additional 23 675 lives can potentially be saved. CONCLUSIONS While it is crucial to improve the coverage and equity in ORS use, an integrated approach to promote nutrition, WASH and direct diarrhea interventions is likely to yield the highest impact on reducing the remaining diarrheal deaths in under-five children.
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Affiliation(s)
- Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Bireshwar Sinha
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ajay Khera
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Yue Chu
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Bianca Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Michael Merson
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
| | - Maharaj Kishan Bhan
- Indian Institute of Technology, New Delhi, India
- Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC) New Delhi, India
- Society for Essential Health Action and Training (SEHAT), New Delhi, India
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Billah SM, Raihana S, Ali NB, Iqbal A, Rahman MM, Khan ANS, Karim F, Karim MA, Hassan A, Jackson B, Walker N, Hossain MA, Sarker S, Black RE, El Arifeen S. Bangladesh: a success case in combating childhood diarrhoea. J Glob Health 2019; 9:020803. [PMID: 31673347 PMCID: PMC6816141 DOI: 10.7189/jogh.09.020803] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Bangladesh had a large reduction in childhood deaths due to diarrhoeal disease in recent decades. This paper explores the preventive, promotive, curative and contextual drivers that helped Bangladesh achieve this exemplary success. METHODS Primary and secondary data collection approaches were used to document trends in reduction of Diarrhoea Specific Mortality Rate (DSMR) between 1980 and 2015, understand what policies and programmes played key roles, and estimate the contribution of specific interventions that were implemented during the period. Data acquisition involved relevant document reviews and in-depth interviews with key stake-holders. A systematic search of literature was undertaken to explore socio-economic, aetiological, behavioural, and nutritional drivers of diarrhoeal disease reduction in Bangladesh. Finally, we used LiST (Lives Saved Tool) to model the contributions of the relevant interventions during three time periods (1980-2015, 1980-2000 and 2000-2015), and to project the number of lives saved in 2030 (compared to 2015) if these interventions were implemented at near universal coverage (90%). RESULTS The factors which likely had the most impact on DSMR were the coordinated efforts of the Government of Bangladesh (GoB) with non-government organizations (NGOs) and the private sector that enabled swift implementation, at scale, of interventions like oral rehydration solution (ORS) and zinc, promotion of breastfeeding, handwashing and sanitary latrines (WASH), as well as improvements in female education and nutrition. Compared to 1980, we found ORS and reduction in stunting prevalence had the greatest impact on DSMR, saving roughly 70 000 lives combined in 2015. Until 2000, ORS had a higher contribution to DSMR reduction than reduction in stunting prevalence. This proportionate contribution was reversed during 2000-2015. At near universal coverage (90%) of combined direct diarrhoeal disease, nutrition and WASH interventions, we project that an additional 5356 deaths due to diarrhoea could be averted in 2030. CONCLUSION Bangladesh's achievement in reduction of DSMR highlights the important role of an enabling policy environment that fostered coordinated efforts of the public and private sectors and NGOs for maximal impact. To maintain this momentum, evidence-based interventions should be scaled up at universal coverage.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahreen Raihana
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nazia Binte Ali
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afrin Iqbal
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Masudur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdullah Nurus Salam Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohd Anisul Karim
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aniqa Hassan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Bianca Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - M Altaf Hossain
- Directorate General for Health Services, Government of Bangladesh, Dhaka, Bangladesh
| | | | - Robert E Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Hategeka C, Tuyisenge G, Bayingana C, Tuyisenge L. Effects of scaling up various community-level interventions on child mortality in Burundi, Kenya, Rwanda, Uganda and Tanzania: a modeling study. Glob Health Res Policy 2019; 4:1. [PMID: 31168481 PMCID: PMC6545006 DOI: 10.1186/s41256-019-0106-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/13/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Improving child health remains one of the most significant health challenges in sub-Saharan Africa, a region that accounts for half of the global burden of under-five mortality despite having approximately 13% of the world population and 25% of births globally. Improving access to evidence-based community-level interventions has increasingly been advocated to contribute to reducing child mortality and, thus, help low-and middle-income countries (LMICs) achieve the child health related Sustainable Development Goal (SDG) target. Nevertheless, the coverage of community-level interventions remains suboptimal. In this study, we estimated the potential impact of scaling up various community-level interventions on child mortality in five East African Community (EAC) countries (i.e., Burundi, Kenya, Rwanda, Uganda and the United Republic of Tanzania). METHODS We identified ten preventive and curative community-level interventions that have been reported to reduce child mortality: Breastfeeding promotion, complementary feeding, vitamin A supplementation, Zinc for treatment of diarrhea, hand washing with soap, hygienic disposal of children's stools, oral rehydration solution (ORS), oral antibiotics for treatment of pneumonia, treatment for moderate acute malnutrition (MAM), and prevention of malaria using insecticide-treated nets and indoor residual spraying (ITN/IRS). Using the Lives Saved Tool, we modeled the impact on child mortality of scaling up these 10 interventions from baseline coverage (2016) to ideal coverage (99%) by 2030 (ideal scale-up scenario) relative to business as usual (BAU) scenario (forecasted coverage based on prior coverage trends). Our outcome measures include number of child deaths prevented. RESULTS Compared to BAU scenario, ideal scale-up of the 10 interventions could prevent approximately 74,200 (sensitivity bounds 59,068-88,611) child deaths by 2030 including 10,100 (8210-11,870) deaths in Burundi, 10,300 (7831-12,619) deaths in Kenya, 4350 (3678-4958) deaths in Rwanda, 20,600 (16049-25,162) deaths in Uganda, and 28,900 (23300-34,002) deaths in the United Republic of Tanzania. The top four interventions (oral antibiotics for pneumonia, ORS, hand washing with soap, and treatment for MAM) account for over 75.0% of all deaths prevented in each EAC country: 78.4% in Burundi, 76.0% in Kenya, 81.8% in Rwanda, 91.0% in Uganda and 88.5% in the United Republic of Tanzania. CONCLUSIONS Scaling up interventions that can be delivered at community level by community health workers could contribute to substantial reduction of child mortality in EAC and could help the EAC region achieve child health-related SDG target. Our findings suggest that the top four community-level interventions could account for more than three-quarters of all deaths prevented across EAC countries. Going forward, costs of scaling up each intervention will be estimated to guide policy decisions including health resource allocations in EAC countries.
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Affiliation(s)
- Celestin Hategeka
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC Canada
| | | | - Christian Bayingana
- Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, MD USA
| | - Lisine Tuyisenge
- Department of Paediatrics and Child Health, University Teaching Hospital of Kigali, Kigali, Rwanda
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Mishra NR, Mohanty SK, Mittra D, Shah M, Meitei WB. Projecting stunting and wasting under alternative scenarios in Odisha, India, 2015-2030: a Lives Saved Tool (LiST)-based approach. BMJ Open 2019; 9:e028681. [PMID: 31142537 PMCID: PMC6549738 DOI: 10.1136/bmjopen-2018-028681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Although nutrition-specific interventions are designed based on maternal, household and community-level correlates, no attempt has been made to project stunting and wasting and identify intervention priorities in India. The objective of this paper is to model the stunting and wasting in the state of Odisha, India by scaling up maternal and child health interventions under alternative scenarios. DESIGN This study primarily used data from National Family Health Survey 4, 2015-2016. MEASURES The LiST (Lives Saved Tool) software is used to model the nutritional outcomes and prioritise interventions. The projections were carried out under four alternative scenarios: scenario 1-if the coverage indicators continued based on past trends; scenario 2-scaled up to the level of the richest quintile; scenario 3-scaled up to that of Tamil Nadu; and scenario 4-scaled up to an aspirational coverage level. RESULTS In 2015, out of 3.52 million under-5 children in Odisha, around 1.20 million were stunted. By 2030, the numbers of stunted children will be 1.11 million under scenario 1, 1.07 million under scenario 2, 1.09 million under scenario 3 and 0.89 million under scenario 4. The projected stunting level will be 25% under scenario 4 and around 31% under all other scenarios. By 2030, the level of wasting will remain unchanged at 20% under the first three scenarios and 4.3% under scenario 4. Appropriate complementary feeding would avert about half of the total stunting cases under all four scenarios, followed by zinc supplementation. Water connection at home, washing hands with soap and improved sanitation are other effective interventions. CONCLUSION Sustaining the maternal and child health interventions, promoting evidence-based stunting and wasting reduction interventions, and a multisectoral approach can achieve the World Health Assembly targets and Sustainable Development Goals of undernutrition in Odisha.
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Affiliation(s)
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Devjit Mittra
- Azim Premji Philanthrophic Initiatives, Bhubaneswar, Odisha, India
| | - Mansi Shah
- Azim Premji Philanthropic Initiatives, Bengaluru, Karnataka, India
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LiST modelling with monitoring data to estimate impact on child mortality of an ORS and zinc programme with public sector providers in Bihar, India. BMC Public Health 2018; 18:103. [PMID: 29304779 PMCID: PMC5755448 DOI: 10.1186/s12889-017-5008-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/20/2017] [Indexed: 12/02/2022] Open
Abstract
Background Many interventions have attempted to increase vulnerable and remote populations’ access to ORS and zinc to reduce child mortality from diarrhoea. However, the impact of these interventions is difficult to measure. From 2010 to 15, Micronutrient Initiative (MI), worked with the public sector in Bihar, India to enable community health workers to treat and report uncomplicated child diarrhoea with ORS and zinc. We describe how we estimated programme’s impact on child mortality with Lives Saved Tool (LiST) modelling and data from MI’s management information system (MIS). This study demonstrates that using LiST modelling and MIS data are viable options for evaluating programmes to reduce child mortality. Methods We used MI’s programme monitoring data to estimate coverage rates and LiST modelling software to estimate programme impact on child mortality. Four scenarios estimated the effects of different rates of programme scale-up and programme coverage on estimated child mortality by measuring children’s lives saved. Results The programme saved an estimated 806–975 children under-5 who had diarrhoea during five-year project phase. Increasing ORS and zinc coverage rates to 19.8% & 18.3% respectively under public sector coverage with effective treatment would have increased the programme’s impact on child mortality and could have achieved the project goal of saving 4200 children’s lives during the five-year programme. Conclusions Programme monitoring data can be used with LiST modelling software to estimate coverage rates and programme impact on child mortality. This modelling approach may cost less and yield estimates sooner than directly measuring programme impact with population-based surveys. However, users must be cautious about relying on modelled estimates of impact and ensure that the programme monitoring data used is complete and precise about the programme aspects that are modelled. Otherwise, LiST may mis-estimate impact on child mortality. Further, LiST software may require modifications to its built-in assumptions to capture programmatic inputs. LiST assumes that mortality rates and cause of death structure change only in response to changes in programme coverage. In Bihar, overall child mortality has decreased and diarrhoea seems to be less lethal than previously, but at present LiST does not adjust its estimates for these sorts of changes.
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Abstract
BACKGROUND The worldwide burden of stillbirths is large, with an estimated 2.6 million babies stillborn in 2015 including 1.3 million dying during labour. The Every Newborn Action Plan set a stillbirth target of ≤12 per 1000 in all countries by 2030. Planning tools will be essential as countries set policy and plan investment to scale up interventions to meet this target. This paper summarises the approach taken for modelling the impact of scaling-up health interventions on stillbirths in the Lives Saved tool (LiST), and potential future refinements. METHODS The specific application to stillbirths of the general method for modelling the impact of interventions in LiST is described. The evidence for the effectiveness of potential interventions to reduce stillbirths are reviewed and the assumptions of the affected fraction of stillbirths who could potentially benefit from these interventions are presented. The current assumptions and their effects on stillbirth reduction are described and potential future improvements discussed. RESULTS High quality evidence are not available for all parameters in the LiST stillbirth model. Cause-specific mortality data is not available for stillbirths, therefore stillbirths are modelled in LiST using an attributable fraction approach by timing of stillbirths (antepartum/ intrapartum). Of 35 potential interventions to reduce stillbirths identified, eight interventions are currently modelled in LiST. These include childbirth care, induction for prolonged pregnancy, multiple micronutrient and balanced energy supplementation, malaria prevention and detection and management of hypertensive disorders of pregnancy, diabetes and syphilis. For three of the interventions, childbirth care, detection and management of hypertensive disorders of pregnancy, and diabetes the estimate of effectiveness is based on expert opinion through a Delphi process. Only for malaria is coverage information available, with coverage estimated using expert opinion for all other interventions. Going forward, potential improvements identified include improving of effectiveness and coverage estimates for included interventions and addition of further interventions. CONCLUSIONS Known effective interventions have the potential to reduce stillbirths and can be modelled using the LiST tool. Data for stillbirths are improving. Going forward the LiST tool should seek, where possible, to incorporate these improving data, and to continually be refined to provide an increasingly reliable tool for policy and programming purposes.
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Jackson BD, Black RE. A Literature Review of the Effect of Malaria on Stunting. J Nutr 2017; 147:2163S-2168S. [PMID: 28904111 DOI: 10.3945/jn.116.242289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/30/2016] [Accepted: 05/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The current version of the Lives Saved Tool (LiST) maternal and child health impact modeling software does not include an effect of malaria on stunting.Objective: This literature review was undertaken to determine whether such a causal link should be included in the LiST model.Methods: The PubMed, Embase, and Scopus databases were searched by using broad search terms. The searches returned a total of 4281 documents. Twelve studies from among the retrieved documents were included in the review according to the inclusion and exclusion criteria.Results: There was mixed evidence for an effect of malaria on stunting among longitudinal observational studies, and none of the randomized controlled trials of malaria interventions found an effect of the interventions on stunting.Conclusions: There is insufficient evidence to include malaria as a determinant of stunting or an effect of malaria interventions on stunting in the LiST model. The paucity and heterogeneity of the available literature were a major limitation. In addition, the studies included in the review consistently fulfilled their ethical responsibility to treat children under observation for malaria, which may have interfered with the natural history of the disease and prevented any observable effect on stunting or linear growth.
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Affiliation(s)
- Bianca D Jackson
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, MD
| | - Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, MD
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Muro F, Meta J, Renju J, Mushi A, Mbakilwa H, Olomi R, Reyburn H, Hildenwall H. "It is good to take her early to the doctor" - mothers' understanding of childhood pneumonia symptoms and health care seeking in Kilimanjaro region, Tanzania. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2017; 17:27. [PMID: 28938895 PMCID: PMC5610440 DOI: 10.1186/s12914-017-0135-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/17/2017] [Indexed: 11/24/2022]
Abstract
Background Pneumonia is among the leading causes of avoidable deaths for young children globally. The main burden of mortality falls on children from poor and rural families who are less likely to obtain the treatment they need, highlighting inequities in access to effective care and treatment. Caretakers’ illness perceptions and care-seeking practices are of major importance for children with pneumonia to receive adequate care. This study qualitatively explores the caretaker concepts of childhood pneumonia in relation to treatment seeking behaviour and health worker management in Moshi urban district, Tanzania. Methods In May - July 2013 data was gathered through different qualitative data collection techniques including five focus group discussions (FGDs) with mothers of children under-five years of age. The FGDs involved free listing of pneumonia symptoms and video presentations of children with respiratory symptoms done, these were triangulated with ten case narratives with mothers of children admitted with pneumonia and eleven in-depth interviews with hospital health workers. Transcripts were coded and analysed using qualitative content analysis. Results Mothers demonstrated good awareness of common childhood illnesses including pneumonia, which was often associated with symptoms such as cough, flu, chest tightness, fever, and difficulty in breathing. Mothers had mixed views on causative factors and treatments options but generally preferred modern medicine for persisting and severe symptoms. However, all respondent reported access to health facilities as a barrier to care, associated with transport, personal safety and economic constraints. Conclusion Local illness concepts and traditional treatment options did not constitute barriers to care for pneumonia symptoms. Poor access to health facilities was the main barrier. Decentralisation of care through community health workers may improve access to care but needs to be combined with strengthened referral systems and accessible hospital care for those in need.
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Affiliation(s)
- Florida Muro
- Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania. .,Kilimanjaro Christian Medical Centre, P.O.Box 3010, Moshi, Tanzania.
| | - Judith Meta
- Joint Malaria Programme - Kilimanjaro Christian Medical Centre, P.O.Box 2228, Moshi, Tanzania
| | - Jenny Renju
- Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania.,London School of Hygiene and Tropical Medicine (LSHTM), Keppel St, London, WICE7HT, UK
| | - Adiel Mushi
- The National Institute for Medical Research (NIMR), 3 Barack Obama Drive, P. O. Box 9653, 11101, Dar es Salaam, Tanzania
| | - Hilda Mbakilwa
- Joint Malaria Programme - Kilimanjaro Christian Medical Centre, P.O.Box 2228, Moshi, Tanzania
| | - Raimos Olomi
- Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, P.O.Box 3010, Moshi, Tanzania
| | - Hugh Reyburn
- Joint Malaria Programme - Kilimanjaro Christian Medical Centre, P.O.Box 2228, Moshi, Tanzania.,London School of Hygiene and Tropical Medicine (LSHTM), Keppel St, London, WICE7HT, UK
| | - Helena Hildenwall
- Department of Public Health Sciences, Global Health - Health System and Policy Research Group, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Nkonki LL, Chola LL, Tugendhaft AA, Hofman KK. Modelling the cost of community interventions to reduce child mortality in South Africa using the Lives Saved Tool (LiST). BMJ Open 2017; 7:e011425. [PMID: 28851766 PMCID: PMC5577872 DOI: 10.1136/bmjopen-2016-011425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/18/2017] [Accepted: 03/17/2017] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To estimate the costs and impact on reducing child mortality of scaling up interventions that can be delivered by community health workers at community level from a provider's perspective. SETTING In this study, we used the Lives Saved Tool (LiST), a module in the spectrum software. Within the spectrum software, LiST interacts with other modules, the AIDS Impact Module, Family Planning Module and Demography Projections Module (Dem Proj), to model the impact of more than 60 interventions that affect cause-specific mortality. PARTICIPANTS DemProj Based on National South African Data. INTERVENTIONS A total of nine interventions namely, breastfeeding promotion, complementary feeding, vitamin supplementation, hand washing with soap, hygienic disposal of children's stools, oral rehydration solution, oral antibiotics for the treatment of pneumonia, therapeutic feeding for wasting and treatment for moderate malnutrition. PRIMARY AND SECONDARY OUTCOME MEASURES Reducing child mortality. RESULTS A total of 9 interventions can prevent 8891 deaths by 2030. Hand washing with soap (21%) accounts for the highest number of deaths prevented, followed by therapeutic feeding (19%) and oral rehydration therapy (16%). The top 5 interventions account for 77% of all deaths prevented. At scale, an estimated cost of US$169.5 million (US$3 per capita) per year will be required in community health worker costs. CONCLUSION The use of community health workers offers enormous opportunities for saving lives. These programmes require appropriate financial investments. Findings from this study show what can be achieved if concerted effort is channelled towards the identified set of life-saving interventions.
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Affiliation(s)
- Lungiswa Ll Nkonki
- Division of Community Health, Centre for Health Systems and Services Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Lumbwe L Chola
- Population Health, Health Systems and Innovation, Human Science Research Council, Pretoria, South africa
| | - Aviva A Tugendhaft
- PRICELESS SA-MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South africa
| | - Karen K Hofman
- PRICELESS SA-MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South africa
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A long way to go - Estimates of combined water, sanitation and hygiene coverage for 25 sub-Saharan African countries. PLoS One 2017; 12:e0171783. [PMID: 28182796 PMCID: PMC5300760 DOI: 10.1371/journal.pone.0171783] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/25/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Water, sanitation and hygiene (WASH) are essential for a healthy and dignified life. International targets to reduce inadequate WASH coverage were set under the Millennium Development Goals (MDGs, 1990-2015) and now the Sustainable Development Goals (SDGs, 2016-2030). The MDGs called for halving the proportion of the population without access to adequate water and sanitation, whereas the SDGs call for universal access, require the progressive reduction of inequalities, and include hygiene in addition to water and sanitation. Estimating access to complete WASH coverage provides a baseline for monitoring during the SDG period. Sub-Saharan Africa (SSA) has among the lowest rates of WASH coverage globally. METHODS The most recent available Demographic Household Survey (DHS) or Multiple Indicator Cluster Survey (MICS) data for 25 countries in SSA were analysed to estimate national and regional coverage for combined water and sanitation (a combined MDG indicator for 'improved' access) and combined water with collection time within 30 minutes plus sanitation and hygiene (a combined SDG indicator for 'basic' access). Coverage rates were estimated separately for urban and rural populations and for wealth quintiles. Frequency ratios and percentage point differences for urban and rural coverage were calculated to give both relative and absolute measures of urban-rural inequality. Wealth inequalities were assessed by visual examination of coverage across wealth quintiles in urban and rural populations and by calculating concentration indices as standard measures of relative wealth related inequality that give an indication of how unevenly a health indicator is distributed across the wealth distribution. RESULTS Combined MDG coverage in SSA was 20%, and combined basic SDG coverage was 4%; an estimated 921 million people lacked basic SDG coverage. Relative measures of inequality were higher for combined basic SDG coverage than combined MDG coverage, but absolute inequality was lower. Rural combined basic SDG coverage was close to zero in many countries. CONCLUSIONS Our estimates help to quantify the scale of progress required to achieve universal WASH access in low-income countries, as envisaged under the water and sanitation SDG. Monitoring and reporting changes in the proportion of the national population with access to water, sanitation and hygiene may be useful in focusing WASH policy and investments towards the areas of greatest need.
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Bosomprah S, Beach LB, Beres LK, Newman J, Kapasa K, Rudd C, Njobvu L, Guffey B, Hubbard S, Foo K, Bolton-Moore C, Stringer J, Chilengi R. Findings from a comprehensive diarrhoea prevention and treatment programme in Lusaka, Zambia. BMC Public Health 2016; 16:475. [PMID: 27268226 PMCID: PMC4895989 DOI: 10.1186/s12889-016-3089-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/04/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The Programme for the Awareness and Elimination of Diarrhoea (PAED) was a pilot comprehensive diarrhoea prevention and control programme aimed to reduce post-neonatal, all-cause under-five mortality by 15 % in Lusaka Province. Interventions included introduction of the rotavirus vaccine, improved clinical case management of diarrhoea, and a comprehensive community prevention and advocacy campaign on hand washing with soap, exclusive breastfeeding up to 6 months of age, and the use of ORS and Zinc. This study aimed to assess the impact of PAED on under-5 mortality. METHODS The study was a pre-post evaluation design. The Demographic and Health Survey style population-based two-stage approach was used to collect data at the beginning of the intervention and 3 years following the start of intervention implementation in Lusaka province. The primary outcome of interest was an all-cause, post-neonatal under-five mortality rate defined as the probability of dying after the 28th day and before the fifth birthday among children aged 1-59 months. The Kaplan-Meier time to event analysis was used to estimate the probability of death; multiplying this probability by 1000 to yield the post-neonatal mortality rate. Survival-time inverse probability weighting model was used to estimate Average Treatment Effect (ATE). RESULTS The percentage of children under age 5 who had diarrhoea in the last 2 weeks preceding the survey declined from 15.8 % (95 % CI: 15.2 %, 16.4 %) in 2012 to 12.7 % (95 % CI: 12.3 %, 13.2 %) in 2015. Over the same period, mortality in post-neonatal children under 5 years of age declined by 34 %, from an estimated rate of 29 deaths per 1000 live births (95 % CI: (26, 32) death per 1000 live births) to 19 deaths per 1000 live births (95 % CI: (16, 21) death per 1000 live births). When every child in the population of children aged 1-59 months is exposed to the intervention, the average time-to-death was estimated to be about 8 months more than when no child is exposed (ATE = 7.9; 95 % CI: 4.4,11.5; P < 0.001). CONCLUSION Well-packaged diarrhoea preventive and treatment interventions delivered at the clinic and community-level could potentially reduce probability of death among children aged 1-59 months.
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Affiliation(s)
- Samuel Bosomprah
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
| | - Lauren B Beach
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Laura K Beres
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan Newman
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Kabwe Kapasa
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Cheryl Rudd
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Lungowe Njobvu
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Brad Guffey
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Sydney Hubbard
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Karen Foo
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
| | - Jeffrey Stringer
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Roma Chilengi
- Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Status of vaccine research and development for enterotoxigenic Escherichia coli. Vaccine 2016; 34:2880-2886. [PMID: 26988259 DOI: 10.1016/j.vaccine.2016.02.076] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/10/2016] [Indexed: 12/21/2022]
Abstract
Enterotoxigenic Escherichia coli (ETEC) is one of the most common bacterial causes of diarrhea-associated morbidity and mortality, particularly among infants and young children in developing countries. Still, the true impact on child and traveler health is likely underestimated. There are currently no licensed vaccines for ETEC, but studies indicate high public health impact, cost-effectiveness, and feasibility of immune protection through vaccination. ETEC vaccine development remains a World Health Organization priority. Traditionally, ETEC vaccine development efforts have focused on inducing antitoxin and anticolonization antigen immunity, as studies indicate that antibodies against both antigen types can contribute to protection and thus have potential for vaccines. Leading cellular vaccine candidates are ETVAX (a mixture of four inactivated strains) and ACE527 (a mixture of three live attenuated strains), both of which have been found to be safe and immunogenic in Phase 1/2 trials. ETVAX is the furthest along in development with descending-age studies already underway in Bangladesh. Other ETEC vaccine candidates based on protein subunits, toxoids (both LT and ST), or novel, more broadly conserved ETEC antigens are also under development. Of these, a protein adhesin-based subunit approach is the most advanced. Impact and economic models suggest favorable vaccine cost-effectiveness, which may help expand market interest in ETEC vaccines. Combination vaccine formulations may help improve the economic case for development and use, and better point-of-care diagnostics will help to raise awareness of the true health burden of ETEC and highlight the potential public health benefit of ETEC vaccine introduction. Better diagnostics and vaccine demand forecasting will also improve vaccine development financing and support accelerated uptake once a licensed vaccine becomes available.
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McGee SA, Chola L, Tugendhaft A, Mubaiwa V, Moran N, McKerrow N, Kamugisha L, Hofman K. Strategic planning for saving the lives of mothers, newborns and children and preventing stillbirths in KwaZulu-Natal province South Africa: modelling using the Lives Saved Tool (LiST). BMC Public Health 2016; 16:49. [PMID: 26786979 PMCID: PMC4719569 DOI: 10.1186/s12889-015-2661-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/22/2015] [Indexed: 11/27/2022] Open
Abstract
Background KwaZulu-Natal province in South Africa has the largest population of children under the age of five and experiences the highest number of child births per annum in the country. Its population has also been ravaged by the dual epidemics of HIV and TB and it has struggled to meet targets for maternal and child mortality. In South Africa’s federal system, provinces have decision-making power on the prioritization and allocation of resources within their jurisdiction. As part of strategic planning for 2015–2019, KwaZulu-Natal provincial authorities requested an assessment of current mortality levels in the province and identification and costing of priority interventions for saving additional maternal, newborn and child lives, as well as preventing stillbirths in the province. Methods The Lives Saved Tool (LiST) was used to determine the set of interventions, which could save the most additional maternal and child lives and prevent stillbirths from 2015–2019, and the costs of these. The impact of family planning was assessed using two scenarios by increasing baseline coverage of modern contraception by 0.5 percentage points or 1 percentage point per annum. Results A total of 7,043 additional child and 297 additional maternal lives could be saved, and 2,000 stillbirths could be prevented over five years. Seventeen interventions account for 75 % of additional lives saved. Increasing family planning contributes to a further reduction of up to 137 maternal and 3,168 child deaths. The set of priority interventions scaled up to achievable levels, with no increase in contraception would require an additional US$91 million over five years or US$1.72 per capita population per year. By increasing contraceptive prevalence by one percentage point per year, overall costs to scale up to achievable coverage package, decrease by US$24 million over five years. Conclusion Focused attention on a set of key interventions could have a significant impact on averting stillbirths and maternal and neonatal mortality in KwaZulu-Natal. Concerted effort to prioritize family planning will save more lives overall and has the potential to decrease costs in other areas of maternal and child care. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2661-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shelley-Ann McGee
- Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Lumbwe Chola
- Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Aviva Tugendhaft
- Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - Victoria Mubaiwa
- Department of Health, Province of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Neil Moran
- Department of Health, Province of KwaZulu-Natal, Pietermaritzburg, South Africa.,Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Neil McKerrow
- Department of Health, Province of KwaZulu-Natal, Pietermaritzburg, South Africa.,Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Karen Hofman
- Priority Cost-Effective Lessons for System Strengthening South Africa (PRICELESS SA), Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa.
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Brandt KG, Antunes MMDC, da Silva GAP. Acute diarrhea: evidence‐based management. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Brandt KG, Castro Antunes MMD, Silva GAPD. Acute diarrhea: evidence-based management. J Pediatr (Rio J) 2015; 91:S36-43. [PMID: 26351768 DOI: 10.1016/j.jped.2015.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. DATA SOURCE PubMed, Scopus, Google Scholar. DATA SUMMARY There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. CONCLUSIONS Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.
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Affiliation(s)
- Kátia Galeão Brandt
- Centro de Ciências da Saúde (CCS), Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
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Carter E, Bryce J, Perin J, Newby H. Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review. BMC Public Health 2015; 15:788. [PMID: 26282400 PMCID: PMC4538749 DOI: 10.1186/s12889-015-2127-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Harmful practices in the management of childhood diarrhea are associated with negative health outcomes, and conflict with WHO treatment guidelines. These practices include restriction of fluids, breast milk and/or food intake during diarrhea episodes, and incorrect use of modern medicines. We conducted a systematic review of English-language literature published since 1990 to assess the documented prevalence of these four harmful practices, and beliefs, motivations, and contextual factors associated with harmful practices in low- and middle-income countries. METHODS We electronically searched PubMed, Embase, Ovid Global Health, and the WHO Global Health Library. Publications reporting the prevalence or substantive findings on beliefs, motivations, or context related to at least one of the four harmful practices were included, regardless of study design or representativeness of the sample population. RESULTS Of the 114 articles included in the review, 79 reported the prevalence of at least one harmful practice and 35 studies reported on beliefs, motivations, or context for harmful practices. Most studies relied on sub-national population samples and many were limited to small sample sizes. Study design, study population, and definition of harmful practices varied across studies. Reported prevalence of harmful practices varied greatly across study populations, and we were unable to identify clearly defined patterns across regions, countries, or time periods. Caregivers reported that diarrhea management practices were based on the advice of others (health workers, relatives, community members), as well as their own observations or understanding of the efficacy of certain treatments for diarrhea. Others reported following traditionally held beliefs on the causes and cures for specific diarrheal diseases. CONCLUSIONS Available evidence suggests that harmful practices in diarrhea treatment are common in some countries with a high burden of diarrhea-related mortality. These practices can reduce correct management of diarrheal disease in children and result in treatment failure, sustained nutritional deficits, and increased diarrhea mortality. The lack of consistency in sampling, measurement, and reporting identified in this literature review highlights the need to document harmful practices using standard methods of measurement and reporting for the continued reduction of diarrhea mortality.
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Affiliation(s)
- Emily Carter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Holly Newby
- Division of Policy and Strategy, Data and Analytics Section UNICEF, UNICEF, 3 UN Plaza, New York, NY, 10017, USA.
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Chola L, Michalow J, Tugendhaft A, Hofman K. Reducing diarrhoea deaths in South Africa: costs and effects of scaling up essential interventions to prevent and treat diarrhoea in under-five children. BMC Public Health 2015; 15:394. [PMID: 25925130 PMCID: PMC4411658 DOI: 10.1186/s12889-015-1689-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/26/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diarrhoea is one of the leading causes of morbidity and mortality in South African children, accounting for approximately 20% of under-five deaths. Though progress has been made in scaling up multiple interventions to reduce diarrhoea in the last decade, challenges still remain. In this paper, we model the cost and impact of scaling up 13 interventions to prevent and treat childhood diarrhoea in South Africa. METHODS Modelling was done using the Lives Saved Tool (LiST). Using 2014 as the baseline, intervention coverage was increased from 2015 until 2030. Three scale up scenarios were compared: by 2030, 1) coverage of all interventions increased by ten percentage points; 2) intervention coverage increased by 20 percentage points; 3) and intervention coverage increased to 99%. RESULTS The model estimates 13 million diarrhoea cases at baseline. Scaling up intervention coverage averted between 3 million and 5.3 million diarrhoea cases. In 2030, diarrhoeal deaths are expected to reduce from an estimated 5,500 in 2014 to 2,800 in scenario one, 1,400 in scenario two and 100 in scenario three. The additional cost of implementing all 13 interventions will range from US$510 million (US$9 per capita) to US$960 million (US$18 per capita), of which the health system costs range between US$40 million (less than US$1 per capita) and US$170 million (US$3 per capita). CONCLUSION Scaling up 13 essential interventions could have a substantial impact on reducing diarrhoeal deaths in South African children, which would contribute toward reducing child mortality in the post-MDG era. Preventive measures are key and the government should focus on improving water, sanitation and hygiene. The investments required to achieve these results seem feasible considering current health expenditure.
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Affiliation(s)
- Lumbwe Chola
- Priority Cost-Effective Lessons for Systems Strengthening South Africa (PRICELESS SA) - Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Julia Michalow
- Priority Cost-Effective Lessons for Systems Strengthening South Africa (PRICELESS SA) - Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Aviva Tugendhaft
- Priority Cost-Effective Lessons for Systems Strengthening South Africa (PRICELESS SA) - Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Karen Hofman
- Priority Cost-Effective Lessons for Systems Strengthening South Africa (PRICELESS SA) - Medical Research Council/Wits Rural Public Health and Health Transition Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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