title: Scaling up diarrhea prevention and treatment interventions: a Lives Saved Tool analysis.
abstract: BACKGROUND
  Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated.
  
  
  RESULTS
  We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. We also conduct a simple costing exercise to estimate cost per capita and total costs for each scale-up scenario. Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively. With universal coverage nearly 5 million diarrheal deaths could be averted during the 5-year scale-up period for an additional cost of US$12.5 billion invested across 68 priority countries for individual-level prevention and treatment interventions, and an additional US$84.8 billion would be required for the addition of all water and sanitation interventions.
  
  
  CONCLUSIONS
  Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations' Millennium Development Goal 4 (MDG4) by 2015.
authors: Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA. cfischer@jhsph.edu
authors: Christa L
authors: CL
authors: Fischer Walker
authors: Ingrid K
authors: IK
authors: Friberg
authors: Nancy
authors: N
authors: Binkin
authors: Mark
authors: M
authors: Young
authors: Neff
authors: N
authors: Walker
authors: Olivier
authors: O
authors: Fontaine
authors: Eva
authors: E
authors: Weissman
authors: Akanksha
authors: A
authors: Gupta
authors: Robert E
authors: RE
authors: Black
mesh_terms: D001942:Breast Feeding; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003967:Diarrhea / Q000191:economics / Q000401:mortality* / Q000517:prevention & control* / Q000628:therapy; D004812:Epidemiologic Methods; D014943:Global Health; D006801:Humans