Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
Ministry of Health and Family Welfare, Government of India, New Delhi, India.
J Glob Health. 2019 Dec;9(2):020804. doi: 10.7189/jogh.09.020804.
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.
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.
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.
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.
印度在 1980 年至 2015 年期间，将五岁以下儿童腹泻死亡人数减少了 86%。尽管如此，腹泻仍然是导致五岁以下儿童死亡的主要原因之一。本分析旨在研究导致该国腹泻死亡人数下降的因素以及扩大干预措施包以解决剩余腹泻死亡人数的影响。
我们使用 Lives Saved Tool（LiST）评估了在 1980 年至 2015 年期间，直接腹泻病例管理干预、营养因素和 WASH 干预等不同因素和干预措施包对腹泻特定五岁以下儿童死亡率降低（DSMR）的归因以及扩大不同干预措施包的潜力，以实现到 2030 年普及水平对减少剩余腹泻死亡人数的影响。
在 1980 年至 2015 年期间，与减少五岁以下儿童 DSMR 相关的主要因素是口服补液盐使用增加、发育迟缓患病率降低、改善卫生条件、改变适当年龄的母乳喂养做法、维生素 A 补充增加和持续腹泻治疗。口服补液盐使用和发育迟缓减少是两个关键干预措施，各占这期间拯救生命的 32%左右。如果将直接腹泻病例管理干预从 2015 年的现有覆盖率提高到普及水平，到 2030 年可额外挽救约 82000 条生命。如果能够实现营养因素和 WASH 干预的普遍目标，可能会额外挽救 23675 条生命。
虽然提高口服补液盐使用的覆盖率和公平性至关重要，但促进营养、WASH 和直接腹泻干预的综合方法可能会对减少五岁以下儿童剩余腹泻死亡人数产生最大影响。
