Factors associated with the decline in under-five diarrhea mortality in India: a LiST analysis.

dc.contributor.author

Choudhary, Tarun Shankar

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Sinha, Bireshwar

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Khera, Ajay

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Bhandari, Nita

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Chu, Yue

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Jackson, Bianca

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Walker, Neff

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Black, Robert E

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Merson, Michael

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Bhan, Maharaj Kishan

dc.date.accessioned

2023-08-04T21:41:27Z

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2023-08-04T21:41:27Z

dc.date.issued

2019-12

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2023-08-04T21:41:26Z

dc.description.abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
dc.identifier

jogh-09-020804

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2047-2978

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2047-2986

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https://hdl.handle.net/10161/28674

dc.language

eng

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International Global Health Society

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Journal of global health

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10.7189/jogh.09.020804

dc.subject

Humans

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Diarrhea

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Child Mortality

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Infant Mortality

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Risk Factors

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Child, Preschool

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Infant

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Infant, Newborn

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India

dc.title

Factors associated with the decline in under-five diarrhea mortality in India: a LiST analysis.

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Journal article

pubs.begin-page

020804

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2

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Medicine

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Medicine, General Internal Medicine

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Institutes and Provost's Academic Units

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University Institutes and Centers

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Duke Global Health Institute

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Initiatives

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Duke - Margolis Center For Health Policy

pubs.publication-status

Published

pubs.volume

9

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