1921
Volume 90, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Although diarrheal mortality is cheaply preventable with oral rehydration therapy (ORT), over 700,000 children die of diarrhea annually and many health providers fail to treat diarrheal cases with ORT. Provision of ORT may differ between for-profit and public providers. This study used Demographic and Health Survey data from 19,059 children across 29 countries in sub-Saharan Africa from 2003 to 2011 to measure differences in child diarrhea treatment between private for-profit and public health providers. Differences in treatment provision were estimated using probit regression models controlling for key confounders. For-profit providers were 15% points less likely to provide ORT (95% confidence interval [CI] 13–17) than public providers and 12% points more likely to provide other treatments (95% CI 10–15). These disparities in ORT provision were more pronounced for poorer children in rural areas. As private healthcare in sub-Saharan Africa continues to expand, interventions to increase private sector provision of ORT should be explored.

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2014-05-07
2017-11-18
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References

  1. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O'Brien KL, Campbell H, Black RE, , 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.[Crossref]
  2. Cash RA, Nalin DR, Rochat R, Reller LB, Haque ZA, Mizanur Rahman AS, , 1970. A clinical trial of oral therapy in a rural cholera-treatment center. Am J Trop Med Hyg 19: 653656.
  3. Pierce NF, Sack RB, Mitra RC, Banwell JG, Brigham KL, Fedson DS, Mondal A, , 1969. Replacement of water and electrolyte losses in cholera by an oral glucose-electrolyte solution. Ann Intern Med 70: 11731181.[Crossref]
  4. Santosham M, , 1982. Oral rehydration therapy of infantile diarrhea: a controlled study of well-nourished children hospitalized in the United States and Panama. N Engl J Med 306: 10701076.[Crossref]
  5. Spandorfer PR, Alessandrini EA, Joffe MD, Localio R, Shaw KN, , 2005. Oral versus intravenous rehydration of moderately dehydrated children: a randomized, controlled trial. Pediatrics 115: 295301.[Crossref]
  6. Munos MK, Walker CLF, Black RE, , 2010. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. Int J Epidemiol 39 (Suppl 1): i75i87.[Crossref]
  7. Victora CG, Bryce J, Fontaine O, Monasch R, , 2000. Reducing deaths from diarrhoea through oral rehydration therapy. Geneva: World Health Organization.
  8. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, , 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 21512161.[Crossref]
  9. USAID, 2005. Diarrhea Treatment Guidelines: Including New Recommendations for the Use of ORS and Zinc Supplementation for Clinic-Based Healthcare Workers. Arlington, VA: USAID Micronutrient Program.
  10. Forsberg BC, Petzold MG, Tomson G, Allebeck P, , 2007. Diarrhea case management in low- and middle-income countries: an unfinished agenda. Bull World Health Organ 85: 4248.[Crossref]
  11. Pantenburg B, Ochoa TJ, Ecker L, Ruiz J, , 2012. Use of commercially available oral rehydration solutions in Lima, Peru. Am J Trop Med Hyg 86: 922924.[Crossref]
  12. Ram PK, Choi M, Blum LS, Wamae AW, Mintz ED, Bartlett AV, , 2008. Declines in case management of diarrhea among children less than five years old. Bull World Health Organ 86: EF.[Crossref]
  13. Santosham M, Chandran A, Fitzwater S, Fischer-Walker C, Baqui AH, Black R, , 2010. Progress and barriers for the control of diarrhoeal disease. Lancet 376: 6367.[Crossref]
  14. Igun UA, , 1994. Reported and actual prescription of oral rehydration therapy for childhood diarrhoeas by retail pharmacists in Nigeria. Soc Sci Med 39: 797806.[Crossref]
  15. Tomson G, Sterky G, , 1986. Self-prescribing by way of pharmacies in three Asian developing countries. Lancet 2: 620622.[Crossref]
  16. Ickx P, , 1996. Central Asia Infectious Diseases Program, Simulated Purchase Survey, Rational Pharmaceutical Management, Kazakhstan. Arlington, VA: BASICS.
  17. Howteerakul N, Higginbotham N, Freeman S, Dibley MJ, , 2003. ORS is never enough: physician rationales for altering standard treatment guidelines when managing childhood diarrhoea in Thailand. Soc Sci Medicine 57: 10311044.[Crossref]
  18. Baqui AH, Black RE, El Arifeen S, Yunus M, Zaman K, Begum N, Roess AA, Santosham M, , 2004. Zinc therapy for diarrhoea increased the use of oral rehydration therapy and reduced the use of antibiotics in Bangladeshi children. J Health Popul Nutr 22: 440442.
  19. Aung T, McFarland W, Khin HS, Montagu D, , 2012. Incidence of pediatric diarrhea and public–private preferences for treatment in rural Myanmar: a randomized cluster survey. J Trop Pediatr 59: 1016.[Crossref]
  20. Muhuri PK, Anker M, Bryce J, , 1996. Treatment patterns for childhood diarrhoea: evidence from demographic and health surveys. Bull World Health Organ 74: 135.
  21. Langsten R, Hill K, , 1995. Treatment of childhood diarrhea in rural Egypt. Soc Sci Med 40: 9891001.[Crossref]
  22. Waters HR, Hatt LE, Black RE, , 2008. The role of private providers in treating child diarrhoea in Latin America. Health Econ 17: 2129.[Crossref]
  23. Database of Medicine Prices, Availability, Affordability and Price Components, 2008. Available at: http://www.haiweb.org/MedPriceDatabase/. Accessed September 20, 2013.
  24. IFC, 2011. Healthy Partnerships: How Governments Can Engage the Private Sector to Improve Health in Africa. Washington, DC: World Bank Publications.
  25. Berendes S, Heywood P, Oliver S, Garner P, , 2011. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med 8: e1000433.[Crossref]
  26. WHO, UNICEF, 2009. Diarrhoea: Why children are still dying and what can be done. Geneva: UNICEF/WHO.
  27. Rutstein SO, Johnson K, , 2004. The DHS Wealth Index. Calverton, MD: Demographic and Health Surveys.
  28. Rutstein SO, Rojas G, , 2006. Guide to DHS Statistics. Calverton, MD: Demographic and Health Surveys.
  29. Waters H, Hatt L, Peters D, , 2003. Working with the private sector for child health. Health Policy Plan 18: 127137.[Crossref]
  30. Larson CP, Saha UR, Islam R, Roy N, , 2006. Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care. Int J Epidemiol 35: 14301439.[Crossref]
  31. Paphassarang C, Philavong K, Boupha B, Blas E, , 2002. Equity, privatization and cost recovery in urban health care: the case of Lao PDR. Health Policy Plan 17 (Suppl 1): 7284.[Crossref]
  32. Sood N, Burger N, Yoong J, Kopf D, Spreng C, , 2011. Firm-level perspectives on public sector engagement with private healthcare providers: survey evidence from Ghana and Kenya. PLoS ONE 6: e27194.[Crossref]
  33. Staff World Bank, 2011. Healthy Partnerships: how governments can engage the private sector to improve health in Africa. Washington, DC: World Bank Publications.
  34. Sood N, Wagner Z, , 2012. For-profit sector immunization service provision: does low provision create a barrier to take-up? Health Policy Plan 28: 730738.[Crossref]
  35. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D, , 2012. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med 9: e1001244.[Crossref]
  36. Kangwana BP, Kedenge SV, Noor AM, Alegana VA, Nyandigisi AJ, Pandit J, Fegan GW, Todd JE, Brooker S, Snow RW, , 2011. The impact of retail-sector delivery of artemether–lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial. PLoS Med 8: e1000437.[Crossref]
  37. Sabot OJ, Mwita A, Cohen JM, Ipuge Y, Gordon M, Bishop D, Odhiambo M, Ward L, Goodman C, , 2009. Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania. PLoS ONE 4: e6857.[Crossref]
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  • Received : 22 May 2013
  • Accepted : 13 Dec 2013

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