advanced search

<< Back To Home

MEASURING COVERAGE IN MNCH: CURRENT INDICATORS FOR MEASURING COVERAGE OF DIARRHEA TREATMENT INTERVENTIONS AND OPPORTUNITIES FOR IMPROVEMENT

Wednesday, 12th of June 2013

• MEASURING COVERAGE IN MNCH: CURRENT INDICATORS FOR MEASURING COVERAGE OF DIARRHEA TREATMENT INTERVENTIONS AND OPPORTUNITIES FOR IMPROVEMENT

Full text, with graphics, is at

http://www.ploscollections.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001385

 

Abstract

Diarrhea morbidity and mortality remain important child health problems in low- and middle-income countries. The treatment of diarrhea and accurate measurement of treatment coverage are critical if child mortality is going to continue to decline. In this review, we examine diarrhea treatment coverage indicators collected in two large-scale community-based household surveys—the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). Current surveys do not distinguish between children with mild diarrhea episodes and those at risk for dehydration. Additional disease severity questions may improve the identification of cases of severe diarrhea but research is needed to identify indicators with the highest sensitivity and specificity. We also review the current treatment indicators in these surveys and highlight three areas for improvement and research. First, specific questions on fluids other than oral rehydration salts (ORS) should be eliminated to refocus the treatment of dehydration on ORS and to prevent confusion between prevention and treatment of dehydration. Second, consistency across surveys and throughout translations is needed for questions about the caregiver behavior of “offering" the sick child fluid and food. Third, breastfeeding should be separated from other fluid and food questions to capture the frequency and duration of nursing sessions offered during the illness. Research is also needed to assess the accuracy of the current zinc indicator to determine if caregivers are correctly recalling zinc treatment for current and recent diarrhea episodes.

Citation: Fischer Walker CL, Fontaine O, Black RE (2013) Measuring Coverage in MNCH: Current Indicators for Measuring Coverage of Diarrhea Treatment Interventions and Opportunities for Improvement. PLoS Med 10(5): e1001385. doi:10.1371/journal.pmed.1001385

Academic Editor: David Osrin, Wellcome Trust Senior Research Fellow in Clinical Science, UCL Reader in International Child Health, Honorary Consultant, Great Ormond Street Hospital for Children, United Kingdom

Published: May 7, 2013

Copyright: © 2013 Fischer Walker et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was conducted under the auspices of the Child Health Epidemiology Reference Group (CHERG) for WHO and UNICEF, with financial support from the Bill & Melinda Gates Foundation through their grant to the US Fund for UNICEF. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: DHS, Demographic and Health Survey/s; MICS, Multiple Indicator Cluster Survey/s; MNCH, maternal, newborn, and child health; NPV, negative predictive value; ORS, oral rehydration salts; PPV, positive predictive value

Provenance: Submitted as part of a sponsored Collection; externally reviewed.

This paper is part of the PLOS Medicine “Measuring Coverage in MNCH" Collection