Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, United States.
J Glob Health. 2019 Dec;9(2):020803. doi: 10.7189/jogh.09.020803.
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.
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%).
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.
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.
近年来，孟加拉国在降低儿童腹泻死亡率方面取得了巨大成就。本文探讨了预防、促进、治疗和背景因素，这些因素帮助孟加拉国取得了这一杰出的成功。
采用初级和二级数据收集方法，记录 1980 年至 2015 年腹泻特定死亡率（DSMR）降低的趋势，了解哪些政策和方案发挥了关键作用，并估计在此期间实施的具体干预措施的贡献。数据收集包括相关文件审查和与主要利益攸关方进行深入访谈。系统地搜索文献，探讨了孟加拉国腹泻病减少的社会经济、病因、行为和营养驱动因素。最后，我们使用 LiST（生命挽救工具）在三个时间段（1980-2015 年、1980-2000 年和 2000-2015 年）内对相关干预措施的贡献进行建模，并预测如果这些干预措施在接近普遍覆盖（90%）的情况下实施，2030 年（与 2015 年相比）将挽救多少生命。
对 DSMR 影响最大的因素可能是孟加拉国政府（GoB）与非政府组织（NGO）和私营部门的协调努力，这些努力使干预措施（如口服补液盐（ORS）和锌）能够迅速大规模实施，促进母乳喂养、洗手和卫生厕所（WASH），以及提高女性教育和营养水平。与 1980 年相比，我们发现 ORS 和减少发育迟缓的患病率对 DSMR 的影响最大，在 2015 年总共挽救了大约 7 万人的生命。直到 2000 年，ORS 对 DSMR 降低的贡献高于减少发育迟缓的患病率。这种比例贡献在 2000-2015 年期间发生了逆转。在联合直接腹泻病、营养和 WASH 干预措施接近普遍覆盖（90%）的情况下，我们预计 2030 年因腹泻而额外死亡的人数将减少 5356 人。
孟加拉国在降低 DSMR 方面取得的成就突出表明，有利的政策环境对于促进公共和私营部门以及非政府组织的协调努力以实现最大影响具有重要作用。为了保持这一势头，应在普遍覆盖的基础上扩大基于证据的干预措施。
