Drivers of Decline in Diarrhea Mortality Between GEMS and VIDA Studies.
Clin Infect Dis
; 76(76 Suppl1): S58-S65, 2023 04 19.
Article
em En
| MEDLINE
| ID: mdl-37074431
ABSTRACT
BACKGROUND:
Statistical modeling suggests that decreasing diarrhea-associated mortality rates in recent decades are largely attributed to improved case management, rotavirus vaccine, and economic development.METHODS:
We examined data collected in 2 multisite population-based diarrhea case-control studies, both conducted in The Gambia, Kenya, and Mali the Global Enteric Multicenter Study (GEMS; 2008-2011) and Vaccine Impact on Diarrhea in Africa (VIDA; 2015-2018). Population-level diarrhea mortality and risk factor prevalence, estimated using these study data, were used to calculate the attribution of risk factors and interventions for diarrhea mortality using a counterfactual framework. We performed a decomposition of the effects of the changes in exposure to each risk factor between GEMS and VIDA on diarrhea mortality for each site.RESULTS:
Diarrhea mortality among children under 5 in our African sites decreased by 65.3% (95% confidence interval [CI] -80.0%, -45.0%) from GEMS to VIDA. Kenya and Mali had large relative declines in diarrhea mortality between the 2 periods with 85.9% (95% CI -95.1%, -71.5%) and 78.0% (95% CI -96.0%, 36.3%) reductions, respectively. Among the risk factors considered, the largest declines in diarrhea mortality between the 2 study periods were attributed to reduction in childhood wasting (27.2%; 95% CI -39.3%, -16.8%) and an increased rotavirus vaccine coverage (23.1%; 95% CI -28.4%, -19.4%), zinc for diarrhea treatment (12.1%; 95% CI -16.0%, -8.9%), and oral rehydration salts (ORS) for diarrhea treatment (10.2%).CONCLUSIONS:
The VIDA study sites demonstrated exceptional reduction in diarrhea mortality over the last decade. Site-specific differences highlight an opportunity for implementation science in collaboration with policymakers to improve the equitable coverage of these interventions globally.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
/
2_ODS3
/
3_ND
/
4_TD
/
7_ODS3_muertes_prevenibles_nacidos_ninos
Base de dados:
MEDLINE
Assunto principal:
Infecções por Rotavirus
/
Vacinas contra Rotavirus
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
/
Humans
/
Infant
País/Região como assunto:
Africa
Idioma:
En
Revista:
Clin Infect Dis
Ano de publicação:
2023
Tipo de documento:
Article