title: Private sector provision of oral rehydration therapy for child diarrhea in sub-Saharan Africa.
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.
authors.affiliation: University of Southern California, Department of Pharmaceutical Economics and Policy, Los Angeles, California; Leonard D. Schaeffer Center for Health Policy and Economics, Los Angeles, California; University of California, Berkeley, School of Public Health, Berkeley, California.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Sood
authors.forename: Zachary
authors.initials: Z
authors.lastname: Wagner
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D002675:Child, Preschool; D003681:Dehydration / Q000453:epidemiology / Q000628:therapy*; D003967:Diarrhea / Q000453:epidemiology / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D017149:Private Sector; D012959:Socioeconomic Factors
references.citation: Lancet. 2012 Jun 9;379(9832):2151-61
references.pmid: 22579125
references.citation: Lancet. 2013 Apr 20;381(9875):1405-1416
references.pmid: 23582727
references.citation: Am J Trop Med Hyg. 2012 Jun;86(6):922-4
references.pmid: 22665594
references.citation: Bull World Health Organ. 2008 Mar;86(3):E-F
references.pmid: 18368194
references.citation: Soc Sci Med. 2003 Sep;57(6):1031-44
references.pmid: 12878103
references.citation: Health Policy Plan. 2002 Dec;17 Suppl:72-84
references.pmid: 12477744
references.citation: Soc Sci Med. 1995 Apr;40(7):989-1001
references.pmid: 7792637
references.citation: Bull World Health Organ. 2000;78(10):1246-55
references.pmid: 11100619
references.citation: J Trop Pediatr. 2013 Feb;59(1):10-6
references.pmid: 22874876
references.citation: Int J Epidemiol. 2006 Dec;35(6):1430-9
references.pmid: 16997849
references.citation: Int J Epidemiol. 2010 Apr;39 Suppl 1:i75-87
references.pmid: 20348131
references.citation: N Engl J Med. 1982 May 6;306(18):1070-6
references.pmid: 7040950
references.citation: Bull World Health Organ. 1996;74(2):135-46
references.pmid: 8706228
references.citation: PLoS One. 2011;6(11):e27194
references.pmid: 22132092
references.citation: Health Econ. 2008 Jan;17(1):21-9
references.pmid: 17407175
references.citation: PLoS One. 2009 Sep 02;4(9):e6857
references.pmid: 19724644
references.citation: PLoS Med. 2011 Apr;8(4):e1000433
references.pmid: 21532746
references.citation: Soc Sci Med. 1994 Sep;39(6):797-806
references.pmid: 7973875
references.citation: Am J Trop Med Hyg. 1970 Jul;19(4):653-6
references.pmid: 5425504
references.citation: PLoS Med. 2012;9(6):e1001244
references.pmid: 22723748
references.citation: Health Policy Plan. 2003 Jun;18(2):127-37
references.pmid: 12740317
references.citation: J Health Popul Nutr. 2004 Dec;22(4):440-2
references.pmid: 15663177
references.citation: Bull World Health Organ. 2007 Jan;85(1):42-8
references.pmid: 17242757
references.citation: Ann Intern Med. 1969 Jun;70(6):1173-81
references.pmid: 5789507
references.citation: Health Policy Plan. 2013 Oct;28(7):730-8
references.pmid: 23144204
references.citation: Pediatrics. 2005 Feb;115(2):295-301
references.pmid: 15687435
references.citation: Lancet. 2010 Jul 3;376(9734):63-7
references.pmid: 20609988
references.citation: Lancet. 1986 Sep 13;2(8507):620-2
references.pmid: 2875329
references.citation: PLoS Med. 2011 May;8(5):e1000437
references.pmid: 21655317