Diarrhea management in children under five in sub-Saharan Africa: does the source of care matter? A Countdown
Liliana Carvajal-Vélez1, Agbessi Amouzou2, Jamie Perin3
1United Nations Children's Fund UNICEF, 3 UN Plaza, New York City, NY, 10017, USA. liliana.carvajal.a@gmail.com.
Insights
Childhood diarrhea management is often poor in sub-Saharan Africa, even in health facilities. Improving care quality at both community and facility levels is crucial for saving young lives.
Area of Science:
- Pediatrics
- Global Health
- Public Health Policy
Background:
- Diarrhea is a leading cause of death in children under five globally, accounting for 9% of mortality.
- Effective diarrhea management practices are critical for reducing child mortality in high-burden regions.
Purpose of the Study:
- To analyze diarrhea management practices in young children in sub-Saharan Africa.
- To assess the association between the quality of diarrhea management and the source of care utilized.
Main Methods:
- Utilized Demographic and Health Survey data from 12 sub-Saharan African countries.
- Classified diarrhea management quality as good, fair, or poor based on WHO/UNICEF guidelines.
- Assessed associations between management quality and care source, adjusting for confounders.
Main Results:
- Good diarrhea management prevalence was low (17-38%) in 11 of 12 countries, with Sierra Leone being an exception (67%).
- Even children seeking care at health facilities showed limited good management practices (median 52%).
- Care from health facilities or community providers was linked to better management than informal/traditional sources or no care; facility vs. community provider effectiveness varied by country.
Conclusions:
- Inadequate diarrhea care for children persists in high-burden sub-Saharan African countries, including within healthcare facilities.
- Significant improvements in careseeking and quality of care are urgently needed at both community and facility levels.
- Saving children's lives requires immediate, focused efforts on optimizing diarrhea management strategies.
Background:
Diarrhea remains a high burden disease, responsible for nine percent of deaths in children under five globally. We analyzed diarrhea management practices in young children and their association with the source of care.
Methods:
We used Demographic and Health Survey data from 12 countries in sub-Saharan Africa with high burdens of childhood diarrhea. We classified the quality of diarrhea management practices as good, fair, or poor based on mothers' reports for children with diarrhea, using WHO/UNICEF recommendations for appropriate treatment. We described the prevalence of diarrhea management by type and assessed the association between good management and source of care, adjusting for potential confounders.
Results:
Prevalence of good diarrhea management is low in 11 of the 12 analyzed surveys, varying from 17 % in Cote d'Ivoire to 38 % in Niger. The exception is Sierra Leone, where prevalence of good practice is 67 %. Prevalence of good management was low even among children taken to health facilities [median 52 %, range: 34-64 %]. Diarrhea careseeking from health facilities or community providers was associated with higher odds of good management than care from traditional/informal sources or no care. Careseeking from facilities did not result systematically in a higher likelihood of good diarrhea management than care from community providers. The odds of good diarrhea management were similar for community versus facility providers in six countries, higher in community than facility providers in two countries, and higher in facility than in community providers in four countries.
Conclusion:
Many children's lives can be saved with correct management of childhood diarrhea. Too many children are not receiving adequate care for diarrhea in high-burden sub-Saharan African countries, even among those seen in health facilities. Redoubling efforts to increase careseeking and improve quality of care for childhood diarrhea in both health facilities and at community level is an urgent priority.
More Related Videos
Related Concept Videos
01:18Drugs Affecting GI Tract Motility: Antimicrobials as Antidiarrheal Agents
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:17Drugs for Treatment of Diarrhea-Predominant IBS
Two specific drugs used in the treatment are alosetron (Lotronex) and eluxadoline (Viberzi). Alosetron, a 5-HT3 antagonist, works by slowing the movement of stools in the gut, reducing bowel...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:29Drug Dosing: Infants and Children
01:17Urinary Tract Infection IV: Nursing Management