Findings from a comprehensive diarrhoea prevention and treatment programme in Lusaka, Zambia

• Published in: BMC public health 2016-06, Vol.16 (1), p.475-475, Article 475
• Main Authors: Bosomprah, Samuel, Beach, Lauren B, Beres, Laura K, Newman, Jonathan, Kapasa, Kabwe, Rudd, Cheryl, Njobvu, Lungowe, Guffey, Brad, Hubbard, Sydney, Foo, Karen, Bolton-Moore, Carolyn, Stringer, Jeffrey, Chilengi, Roma
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Births; Breast Feeding; Breastfeeding & lactation; Child, Preschool; Children; Community Health Services; Data collection; Death; Demographics; Diarrhea; Diarrhea, Infantile - mortality; Diarrhea, Infantile - prevention & control; Fatalities; Female; Forecasts and trends; Hand Disinfection; Households; Humans; Hygiene; Immunization; Infant; Infant Mortality; Infant, Newborn; Infection control; Intervention; Male; Maternal-Child Health Services; Medicine, Preventive; Methods; Middle Aged; Mortality; Neonates; Polls & surveys; Population; Prevention; Preventive health services; Public health; Public health administration; Questionnaires; Rotavirus; Rotavirus - immunology; Rotavirus Infections - mortality; Rotavirus Infections - prevention & control; Vaccination; Vaccines; Viral Vaccines - administration & dosage; Viruses; Womens health; Young Adult; Zambia - epidemiology
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-016-3089-7

The Programme for the Awareness and Elimination of Diarrhoea (PAED) was a pilot comprehensive diarrhoea prevention and control programme aimed to reduce post-neonatal, all-cause under-five mortality by 15 % in Lusaka Province. Interventions included introduction of the rotavirus vaccine, improved clinical case management of diarrhoea, and a comprehensive community prevention and advocacy campaign on hand washing with soap, exclusive breastfeeding up to 6 months of age, and the use of ORS and Zinc. This study aimed to assess the impact of PAED on under-5 mortality. The study was a pre-post evaluation design. The Demographic and Health Survey style population-based two-stage approach was used to collect data at the beginning of the intervention and 3 years following the start of intervention implementation in Lusaka province. The primary outcome of interest was an all-cause, post-neonatal under-five mortality rate defined as the probability of dying after the 28th day and before the fifth birthday among children aged 1-59 months. The Kaplan-Meier time to event analysis was used to estimate the probability of death; multiplying this probability by 1000 to yield the post-neonatal mortality rate. Survival-time inverse probability weighting model was used to estimate Average Treatment Effect (ATE). The percentage of children under age 5 who had diarrhoea in the last 2 weeks preceding the survey declined from 15.8 % (95 % CI: 15.2 %, 16.4 %) in 2012 to 12.7 % (95 % CI: 12.3 %, 13.2 %) in 2015. Over the same period, mortality in post-neonatal children under 5 years of age declined by 34 %, from an estimated rate of 29 deaths per 1000 live births (95 % CI: (26, 32) death per 1000 live births) to 19 deaths per 1000 live births (95 % CI: (16, 21) death per 1000 live births). When every child in the population of children aged 1-59 months is exposed to the intervention, the average time-to-death was estimated to be about 8 months more than when no child is exposed (ATE = 7.9; 95 % CI: 4.4,11.5; P