Department of Community Health Sciences, Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada.
Shri Murughendr Shivayogi Vishvast Vidyapeeth M G C G Memorial College, Athani, Belgaum, India.
PLoS One. 2024 Oct 3;19(10):e0307657. doi: 10.1371/journal.pone.0307657. eCollection 2024.
Diarrhoea is one of the deadliest diseases and causing death among children in India, but no systematic attempt is made to understand it especially its control using oral rehydration salts (ORS). It is well known that use of ORS and Zinc have been effective in containing diarrhoea among children. An attempt is made using large scale national data set in India to understand use of ORS and Zinc to control diarrhoea and their associated factors among diarrhoeal children under five in India.
Publicly available most recent cross-sectional National Family Health Survey data in India was used for the study. The multi-stage cluster sampling design was used with 2011 Census of India as a sampling frame. Households were selected using a Systematic Random Sampling design from selected primary sampling units in rural and urban clusters. From the selected households, the eligible children were those who suffered from diarrhoea in the two weeks preceding the survey and were less than 5 years old. Using this criterion, out of 232,920 children in the survey of less than five years, 16,213 sample diarrheal children found to be available for the study. Both descriptive and inferential statistical techniques were used to analyse the data.
Across India, 61% and 31% of the children were given ORS and Zinc respectively. However, combined ORS + Zinc treatment was only around 24%. The treatment of ORS, Zinc, and combined ORS + Zinc supplementations were significantly higher among younger children, children of 24-35 age group mothers, children from rich wealth index groups, belong to Hindu religion and general caste compared to their counterparts. The logistic regression results showed that consumption of ORS among diarrhoeal children under five years of age depends upon size of a child at birth. For instance, diarrheal children who were very small size at birth compared to very large at birth, had 39% lower odds of consuming ORS (AOR = 0.61; CI 0.48, 0.78; p<0.001). Another important variable is place of first treatment sought for diarrheal children. That is children who first sought treatment in private hospital compared to government hospital had 52% lower odds of ORS consumption. The logistic regression adjusted AORs are similar with Zinc and ORS + Zinc supplementations.
To improve the coverage and management of childhood diarrhoea in India, planning activities should focus not only on distribution, and increasing knowledge of ORS preparation especially for urban slum residents and rural disadvantaged groups through demonstration. There should be also proper focus on providing ongoing pathways to ensure proper supply chains.
腹泻是印度最致命的疾病之一，也是导致印度儿童死亡的主要原因，但目前尚未系统地尝试使用口服补液盐 (ORS) 来了解和控制腹泻。众所周知，使用 ORS 和锌在控制儿童腹泻方面是有效的。本研究试图利用印度的大规模国家数据集，了解在印度五岁以下腹泻儿童中使用 ORS 和锌来控制腹泻及其相关因素。
本研究使用了印度最新的全国家庭健康调查的公开可获取的横断面数据。采用多阶段聚类抽样设计，以 2011 年印度人口普查作为抽样框架。采用系统随机抽样设计，从农村和城市集群的选定初级抽样单位中选择家庭。从选定的家庭中，选择在调查前两周内患有腹泻且年龄小于 5 岁的合格儿童。根据这一标准，在调查的 232920 名五岁以下儿童中，有 16213 名腹泻儿童可供研究。本研究采用描述性和推断性统计技术来分析数据。
在印度，分别有 61%和 31%的儿童使用了 ORS 和锌。然而，ORS+锌联合治疗的比例仅为 24%左右。在年龄较小、母亲年龄在 24-35 岁、来自富裕财富指数组、属于印度教和普通种姓的儿童中，ORS、锌和 ORS+锌补充剂的治疗率显著更高。逻辑回归结果表明，五岁以下腹泻儿童使用 ORS 的情况取决于出生时儿童的大小。例如，与出生时非常大的儿童相比，出生时非常小的腹泻儿童使用 ORS 的可能性低 39%（调整比值比[AOR] = 0.61；95%置信区间[CI]为 0.48-0.78；p<0.001）。另一个重要的变量是儿童首次寻求治疗的地点。与在政府医院相比，在私立医院首次接受治疗的儿童使用 ORS 的可能性低 52%（调整后的比值比[AOR] = 0.48；95%CI为 0.36-0.63；p<0.001）。逻辑回归调整后的 AORs 与锌和 ORS+锌补充剂相似。
为了提高印度儿童腹泻的覆盖率和管理水平，规划活动不仅应集中于分发和提高 ORS 制备知识，特别是针对城市贫民窟居民和农村弱势群体，通过示范进行推广。还应适当关注提供持续的途径，以确保适当的供应链。
