Findings from a comprehensive diarrhoea prevention and treatment programme in Lusaka, Zambia.
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 < 0.001).



Well-packaged diarrhoea preventive and treatment interventions delivered at the clinic and community-level could potentially reduce probability of death among children aged 1-59 months.
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia. sbosomprah@ug.edu.gh.|Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana. sbosomprah@ug.edu.gh.
Samuel
S
Bosomprah
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Lauren B
LB
Beach
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.|Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Laura K
LK
Beres
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Jonathan
J
Newman
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Kabwe
K
Kapasa
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Cheryl
C
Rudd
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Lungowe
L
Njobvu
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Brad
B
Guffey
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Sydney
S
Hubbard
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Karen
K
Foo
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.
Carolyn
C
Bolton-Moore
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Jeffrey
J
Stringer
Center for Infectious Disease Research Zambia, 5032 Great North Road, P.O. Box 34681, 10101, Lusaka, Zambia.|Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Roma
R
Chilengi
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D002675:Child, Preschool; D003153:Community Health Services; D003968:Diarrhea, Infantile / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D000068101:Maternal-Child Health Services; D008875:Middle Aged; D012401:Rotavirus / Q000276:immunology; D012400:Rotavirus Infections / Q000401:mortality / Q000517:prevention & control*; D014611:Vaccination; D014765:Viral Vaccines / Q000008:administration & dosage; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
D014765:Viral Vaccines