Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia.
Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institutes of Health Science, Wollega University, Nekemte, Ethiopia.
BMC Public Health. 2024 May 16;24(1):1329. doi: 10.1186/s12889-024-18827-w.
INTRODUCTION: Even though childhood diarrhea is treated with a simple treatment solution, it continues to be one of the leading causes of under-five child mortality and malnutrition globally. In resource-limited settings such as Sub-Saharan Africa (SSA), the combination of oral rehydration salts (ORS) and zinc is regarded as an effective treatment for diarrhea; however, its utilization is very low. The purpose of this study was to determine the proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA. METHODS: The proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA were determined using secondary data analysis of recent Demographic and Health Surveys (DHS) of 35 SSA countries. The study included a total of 44,341 under-five children with diarrhea in weighted samples. A generalized linear mixed-effects model with robust error variance was used. For the variables included in the final model, adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were estimated. A model with the lowest deviance value were considered as the best-fitted model. RESULT: The pooled proportion of co-utilization of ORS and zinc for the treatment of diarrhea among under five children in SSA countries was 43.58% with a 95% CI (43.15%, 44.01%). Sex of the child, maternal age, residence, maternal educational and employment status, wealth index, media exposure, perceived distance to health facility and insurance coverage were statistically significant determinants of ORS and Zinc co-utilization for treating diarrhea among under five children in SSA. CONCLUSION: Only less than half of under-five children with diarrhea in SSA were treated with a combination of ORS and zinc. Thus, strengthening information dissemination through mass media, and community-level health education programs are important to scale up the utilization of the recommended combination treatment. Furthermore, increasing health insurance coverage, and establishing strategies to address the community with difficulty in accessing health facilities is also crucial in improving the use of the treatment.
简介：尽管儿童腹泻的治疗方法很简单，但它仍然是全球导致五岁以下儿童死亡和营养不良的主要原因之一。在资源有限的撒哈拉以南非洲（SSA）地区，口服补液盐（ORS）和锌的联合使用被认为是治疗腹泻的有效方法；然而，其利用率非常低。本研究旨在确定 SSA 地区五岁以下腹泻儿童联合使用 ORS 和锌的比例及其相关因素。
方法：利用最近的 35 个 SSA 国家的人口与健康调查（DHS）的二级数据分析，确定 SSA 地区五岁以下腹泻儿童联合使用 ORS 和锌的比例及其相关因素。研究共纳入了 44341 名在加权样本中患有腹泻的五岁以下儿童。使用稳健误差方差的广义线性混合效应模型。对于最终模型中包含的变量，使用 95%置信区间（CI）估计调整后的流行率比（aPR）。考虑到具有最低偏差值的模型，将其作为最佳拟合模型。
结果：SSA 国家五岁以下腹泻儿童联合使用 ORS 和锌治疗腹泻的比例为 43.58%，95%CI（43.15%，44.01%）。儿童的性别、母亲年龄、居住地、母亲的教育和就业状况、财富指数、媒体接触、对医疗机构的感知距离和保险覆盖范围是影响 SSA 地区五岁以下腹泻儿童联合使用 ORS 和锌治疗腹泻的重要决定因素。
结论：只有不到一半的 SSA 地区五岁以下腹泻儿童接受了 ORS 和锌的联合治疗。因此，通过大众媒体加强信息传播，以及在社区层面开展健康教育计划，对于扩大推荐联合治疗的使用非常重要。此外，增加健康保险覆盖范围，并制定策略解决难以获得卫生设施的社区的问题，对于提高治疗的使用也至关重要。
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