Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030
Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030
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DOI：
10.7189/jogh.09.020801
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发表时间：
2019-12-01
影响因子：
7.2
通讯作者：
Merson, Michael
中科院分区：
文献类型：
--
作者：
Black, Robert;Fontaine, Olivier;Merson, Michael
从1980年到2015年，儿童腹泻死亡人数下降了80%以上，尽管低收入和中等收入国家（LMIC）的儿童人数有所增加。这一显著成就的可能驱动因素可以指导进一步减少每年仍发生的50万儿童死于腹泻。方法我们使用了生命挽救工具，该工具对50 LMIC的预防或治疗干预措施或风险因素的覆盖范围变化对死亡率的影响进行了建模，以确定腹泻死亡率降低的近端驱动因素。（口服补液溶液[ORS]，锌，痢疾抗生素和持续性腹泻的管理）和轮状病毒疫苗的使用占1980年至2015年腹泻死亡率下降的49.7%。营养改善（发育迟缓、消瘦、母乳喂养、维生素A）占38.8%，水、卫生和洗手改善占11.5%。从1980年到2000年，口服补液盐的贡献（减少的58.0%）大于2000年到2015年（30.7%）;口服补液盐的覆盖率从1980年的零增加到2000年的29.5%，到2015年增加到44.1%。为了在全球消除剩余的儿童腹泻死亡，需要采取所有这些干预措施。将腹泻治疗和轮状病毒疫苗的覆盖率扩大到90%，到2030年，全球儿童腹泻死亡率将比2015年降低74.1%。添加改善的营养可以将其提高到89.1%。最后，增加改善水源、卫生设施和洗手的使用，可以使腹泻死亡率比2015年下降92.8%。结论：采用在过去35年中大幅降低腹泻死亡率的干预措施，到2030年，几乎可以消除剩余的儿童腹泻死亡。
Background Childhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low- and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur.Methods We used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction.Results Diarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level.Conclusions Employing the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.