Research Article: Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis

Date Published: March 22, 2011

Publisher: Public Library of Science

Author(s): Christa L. Fischer Walker, Ingrid K. Friberg, Nancy Binkin, Mark Young, Neff Walker, Olivier Fontaine, Eva Weissman, Akanksha Gupta, Robert E. Black, David Osrin

Abstract: Using the Lives Saved Tool (LiST) Christa Fischer-Walker and colleagues estimate that
scale-up of diarrhea prevention and treatment interventions over 5 years in 68 high
child mortality countries could avert nearly 5 million deaths.

Partial Text: Diarrhea remains a leading cause of morbidity and mortality among children under 5 y of
age in low- and middle-income countries [1]. Diarrhea mortality has declined from an estimated 4.5 million
deaths in the early 1980s to 1.3 million in 2008 with the advent of oral rehydration
salts (ORS), the implementation of routine vitamin A supplementation and measles
vaccine, improved sanitation, access to clean water, and hand washing, which are major
risk factors for diarrhea incidence in many parts of the world [1],[2]. Given the availability of
cost-effective prevention and treatment interventions, however, the number of deaths
owing to diarrhea remains unacceptably high. Further reduction of diarrhea mortality is
critical if the fourth United Nations’ Millennium Development Goal (MDG4)
—reduction of child mortality by two-thirds of the 1990 level (12.4 million deaths
per year) — is to be achieved by 2015.

LiST is a child survival modeling tool that uses country level under-5
mortality rates and cause of death profiles, and models the effects of changes in
coverage of interventions on overall and cause-specific mortality rates for children
under 5 y of age ( [4],[6]. It is built into the Spectrum policy
modeling system, which includes a demographic platform based on UN population data, HIV,
and family planning inputs. As a public access tool, analyses such as these can be
performed, repeated, or altered by researchers or program and policy leaders alike. The
effectiveness of each of the diarrhea interventions incorporated into the
LiST tool has been recently reviewed by the Child Health
Epidemiology Reference Group (CHERG) [7]–[11] and as part of a universal and
published review [12],[13]. The CHERG reviews go beyond previously published systematic
reviews and meta-analyses, utilizing all available data to provide the best estimate for
the effect of each intervention on diarrhea-specific mortality [6]. In previous exercises, the
LiST tool has estimated mortality reductions due to coverage changes
that have matched well to the measured changes in mortality [14],[15].

Figure 1 presents trends in the
number of diarrheal deaths between 2010 and 2015 for each of the two scenarios; it
also shows the proportion of diarrheal deaths that would occur each year relative to the
2010 baseline values. Under the ambitious scenario, the number of diarrheal deaths would
decline from more than 1.39 million a year in the baseline year of 2010 to 334,000 in
2015, which represents a 78% decline and nearly 1 million deaths averted in 2015.
Over the 5-y scale-up period, more than 3.8 million deaths would be averted. Assuming
linear scale-up, the estimated additional cost to achieve this reduction is
US$0.49 per capita in 2015 for the non-WASH interventions and an additional
US$1.78 per capita if 100% of the cost of the WASH interventions was to be
borne by the public health system (Table
3). The total additional cost for scaling up all non-WASH interventions as per
the ambitious scenario in these 68 countries over a 5-y period is US$7.7 billion.
If WASH interventions were to be included the costs would rise to US$49.2

In this exercise we used LiST to simulate the potential lives that
could be saved by scaling-up ten simple and effective interventions for the prevention
and treatment of diarrhea in 68 priority countries. The results of this modeling
exercise demonstrate that with currently available technology, diarrheal deaths could be
reduced by at least 78% by the end of 2015. To reach MDG4 by 2015, the number of
child deaths needs to be reduced by an additional 4.6 million annually from the 2008
estimate of 8.8 million. Reducing diarrheal deaths by more than 1.4 million per year
would be a major contribution toward this goal.



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