Socioeconomic Inequalities in the Prevalence and Management of Childhood Diarrhoea: Potential Health Gains to be Achieved

Background: Diarrhoea represents a major burden of childhood disease in countries with low and middle incomes. The need for targeting poorer socioeconomic groups has been forwarded as a priority in diarrhoea control. The aim of this study was to determine the role of socioeconomic inequalities in the control of childhood diarrhoea. Methods: Household data on prevalence and case management of diarrhoea in children aged 0–4 years from 93 Demographic Health Surveys (DHS) in 55 countries in 1990–2005 were analysed by wealth quintiles. Socioeconomic disparities and trends in inequalities were assessed. Findings: Households in the poorest socioeconomic group consistently showed higher morbidity attributable to diarrhoea and less frequent use of oral rehydration therapy (ORT) when compared with households in the richest socioeconomic group. If the prevalence of diarrhoea in all households were the same as that in the best-performing wealth quintiles, the prevalence of diarrhoea would be reduced by 22.8%. If all socioeconomic groups had adopted the ORT-use rates achieved by the best-performing wealth quintiles, overall use of ORT would have increased by 21.5%. This corresponds to an increase in treated episodes of diarrhoea of 481 million annually in the study population. Trend analysis did not show significant changes in inequalities over time. Interpretations: To increase efficiency in the control of diarrhoeal diseases, preventive measures should be targeted to the poor, rehydration products should be made more affordable and information on the importance of using ORT should be disseminated more intensively to disadvantaged groups.