Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17. Issue 8 (August 2020)

• Record Type: Journal Article
• Authors: Wiens, Kirsten E; Lindstedt, Paulina A; Blacker, Brigette F; Johnson, Kimberly B; Baumann, Mathew M; Schaeffer, Lauren E; Abbastabar, Hedayat; Abd-Allah, Foad; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abegaz, Kedir Hussein; Abejie, Ayenew Negesse; Abreu, Lucas Guimarães; Abrigo, Michael R M; Abualhasan, Ahmed; Accrombessi, Manfred Mario Kokou; Acharya, Dilaram; Adabi, Maryam; Adamu, Abdu A; Adebayo, Oladimeji M; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Adetokunboh, Olatunji O; Adhena, Beyene Meressa; Afarideh, Mohsen; Ahmad, Sohail; Ahmadi, Keivan; Ahmed, Anwar E; Ahmed, Muktar Beshir; Ahmed, Rushdia; Akalu, Temesgen Yihunie; Alahdab, Fares; Al-Aly, Ziyad; Alam, Noore; Alam, Samiah; Alamene, Genet Melak; Alanzi, Turki M; Alcalde-Rabanal, Jacqueline Elizabeth; Ali, Beriwan Abdulqadir; Alijanzadeh, Mehran; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi, Ali; Almasi-Hashiani, Amir; Al-Mekhlafi, Hesham M; Altirkawi, Khalid A; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J; Amini, Saeed; Amit, Arianna Maever L; Andrei, Catalina Liliana; Anjomshoa, Mina; Anoushiravani, Amir; Ansari, Fereshteh; Antonio, Carl Abelardo T; Antony, Benny; Antriyandarti, Ernoiz; Arabloo, Jalal; Aref, Hany Mohamed Amin; Aremu, Olatunde; Armoon, Bahram; Arora, Amit; Aryal, Krishna K; Arzani, Afsaneh; Asadi-Aliabadi, Mehran; Atalay, Hagos Tasew; Athari, Seyyed Shamsadin; Athari, Seyyede Masoume; Atre, Sachin R; Ausloos, Marcel; Awoke, Nefsu; Ayala Quintanilla, Beatriz Paulina; Ayano, Getinet; Ayanore, Martin Amogre; Aynalem IV, Yared Asmare; Azari, Samad; Azzopardi, Peter S; Babaee, Ebrahim; Babalola, Tesleem Kayode; Badawi, Alaa; Bairwa, Mohan; Bakkannavar, Shankar M; Balakrishnan, Senthilkumar; Bali, Ayele Geleto; Banach, Maciej; Banoub, Joseph Adel Mattar; Barac, Aleksandra; Bärnighausen, Till Winfried; Basaleem, Huda; Basu, Sanjay; Bay, Vo Dinh; Bayati, Mohsen; Baye, Estifanos; Bedi, Neeraj; Beheshti, Mahya Mahya Beheshti; Behzadifar, Masoud; Behzadifar, Meysam; Bekele, Bayu Begashaw; Belayneh, Yaschilal Muche; Bell, Michellr L; Bennett, Derrick A; Berbada, Dessalegn Ajema; Bernstein, Robert S; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bhattarai, Suraj; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A; Bijani, Ali; Bikbov, Boris; Birihane IV, Binyam Minuye; Biswas, Raaj Kishore; Bohlouli, Somayeh; Bojia I, Hunduma Amensisa Amensisa; Boufous, Soufiane; Brady, Oliver J; Bragazzi, Nicola Luigi; Briko, Andrey Nikolaevich; Briko, Nikolay Ivanovich; Britton, Gabrielle B; Burugina Nagaraja, Sharath; Busse, Reinhard; Butt, Zahid A; Cámera, Luis LA Alberto; Campos-Nonato, Ismael R; Cano, Jorge; Car, Josip; Cárdenas, Rosario; Carvalho, Felix; Castañeda-Orjuela, Carlos A; Castro, Franz; Chanie, Wagaye Fentahun; Chatterjee, Pranab; Chattu, Vijay Kumar; Chichiabellu, Tesfaye Yitna Yitna; Chin, Ken Lee; Christopher, Devasahayam J; Chu, Dinh-Toi; Cormier, Natalie Maria; Costa, Vera Marisa; Culquichicon, Carlos; Daba, Matiwos Soboka; Damiani, Giovanni; Dandona, Lalit; Dandona, Rakhi; Dang, Anh Kim; Darwesh, Aso Mohammad; Darwish, Amira Hamed; Daryani, Ahmad; Das, Jai K; Das Gupta, Rajat; Dash, Aditya Prasad; Davey, Gail; Dávila-Cervantes, Claudio Alberto; Davis, Adrian C; Davitoiu, Dragos Virgil; De la Hoz, Fernando Pio; Demis, Asmamaw Bizuneh; Demissie, Dereje Bayissa; Demissie, Getu Debalkie; Demoz, Gebre Teklemariam; Denova-Gutiérrez, Edgar; Deribe, Kebede; Desalew, Assefa; Deshpande, Aniruddha; Dharmaratne, Samath Dhamminda; Dhillon, Preeti; Dhimal, Meghnath; Dhungana, Govinda Prasad; Diaz, Daniel; Dipeolu, Isaac Oluwafemi; Djalalinia, Shirin; Doyle, Kerrie E; Dubljanin, Eleonora; Duko, Bereket; Duraes, Andre Rodrigues; Ebrahimi Kalan, Mohammad; Edinur, Hisham Atan; Effiong, Andem; Eftekhari, Aziz; El Nahas, Nevine; El Sayed, Iman; El Sayed Zaki, Maysaa; El Tantawi, Maha; Elema I, Teshome Bekele; Elhabashy, Hala Rashad; El-Jaafary, Shaimaa I; Elkout, Hajer; Elsharkawy, Aisha; Elyazar, Iqbal RF; Endalamaw, Aklilu; Endalew, Daniel Adane; Eskandarieh, Sharareh; Esteghamati, Alireza; Esteghamati, Sadaf; Etemadi, Arash; Ezekannagha, Oluchi; Fareed, Mohammad; Faridnia, Roghiyeh; Farzadfar, Farshad; Fazlzadeh, Mehdi; Feigin, Valery L; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Foigt, Nataliya A; Folayan, Morenike Oluwatoyin; Foroutan, Masoud; Franklin, Richard Charles; Fukumoto, Takeshi; Gad, Mohamed M; Gayesa, Reta Tsegaye; Gebre, Teshome; Gebremedhin, Ketema Bizuwork; Gebremeskel, Gebreamlak Gebremedhn; Gesesew, Hailay Abrha; Gezae, Kebede Embaye; Ghadiri, Keyghobad; Ghashghaee, Ahmad; Ghimire, Pramesh Raj; Gill, Paramjit Singh; Gill, Tiffany K; Ginindza, Themba G G; Gomes, Nelson G M; Gopalani, Sameer Vali; Goulart, Alessandra C; Goulart, Bárbara Niegia Garcia; Grada, Ayman; Gubari, Mohammed Ibrahim Mohialdeen; Gugnani, Harish Chander; Guido, Davide; Guimarães, Rafael Alves; Guo, Yuming; Gupta, Rajeev; Hafezi-Nejad, Nima; Haile, Dessalegn H; Hailu, Gessessew Bugssa; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hamadeh, Randah R; Hamidi, Samer; Handiso, Demelash Woldeyohannes; Haririan, Hamidreza; Hariyani, Ninuk; Hasaballah, Ahmed I; Hasan, Md Mehedi; Hasanpoor, Edris; Hasanzadeh, Amir; Hassankhani, Hadi; Hassen, Hamid Yimam; Hegazy, Mohamed I; Heibati, Behzad; Heidari, Behnam; Hendrie, Delia; Henry, Nathaniel J; Herteliu, Claudiu; Heydarpour, Fatemeh; Hidru I, Hagos Degefa de; Hird, Thomas R; Hoang, Chi Linh; Homaie Rad, Enayatollah; Hoogar, Praveen; Hoseini, Mohammad; Hossain, Naznin; Hosseini, Mostafa; Hosseinzadeh, Mehdi; Househ, Mowafa; Hsairi, Mohamed; Hu, Guoqing; Hussen, Mohammedaman Mama; Ibitoye, Segun Emmanuel; Igumbor, Ehimario U; Ilesanmi, Olayinka Stephen; Ilic, Milena D; Imani-Nasab, Mohammad Hasan; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Iwu, Chinwe Juliana; Izadi, Neda; Jaca, Anelisa; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jalali, Amir; Jayatilleke, Achala Upendra; Jha, Ravi Prakash; Jha, Vivekanand; Ji, John S; Jonas, Jost B; Jozwiak, Jacek Jerzy; Kabir, Ali; Kabir, Zubair; Kahsay, Amaha; Kalani, Hamed; Kanchan, Tanuj; Karami Matin, Behzad; Karch, André; Karim, Mohd Anisul; Karimi-Sari, Hamidreza; Karki, Surendra; Kasaeian, Amir; Kasahun, Gebremicheal Gebreslassie; Kasahun, Yawukal chane; Kasaye, Habtamu Kebebe; Kassa, Gebrehiwot G; Kassa, Getachew Mullu; Kayode, Gbenga A; Kazemi Karyani, Ali; Kebede, Mihiretu M; Keiyoro, Peter Njenga; Kelbore, Abraham Getachew; Kengne, Andre Pascal; Ketema, Daniel Bekele; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalilov, Rovshan; Khan, Ejaz Ahmad; Khan, Junaid; Khan I, Md Nuruzzaman; Khan, Muhammad Shahzeb; Khatab, Khaled; Khater, Amir M; Khater, Mona M; Khayamzadeh, Maryam; Khazaei, Mohammad; Khazaei, Salman; Khosravi, Mohammad Hossein; Khubchandani, Jagdish; Kiadaliri, Ali; Kim, Yun Jin; Kimokoti, Ruth W; Kisa, Adnan; Kisa, Sezer; Kissoon, Niranjan; KMShivakumar, Shivakumar KM Marulasiddaiah M; Kochhar, Sonali; Kolola, Tufa; Komaki, Hamidreza; Kosen, Soewarta; Koul, Parvaiz A; Koyanagi, Ai; Kraemer, Moritz U G; Krishan, Kewal; Kugbey, Nuworza; Kumar, G Anil; Kumar, Manasi; Kumar, Pushpendra; Kumar, Vivek; Kusuma, Dian; La Vecchia, Carlo; Lacey, Ben; Lad, Sheetal D; Lal, Dharmesh Kumar; Lam, Felix; Lami, Faris Hasan; Lamichhane, Prabhat; Lansingh, Van Charles; Lasrado, Savita; Laxmaiah, Avula; Lee, Paul H; LeGrand, Kate E; Leili, Mostafa; Lenjebo, Tsegaye Lolaso; Leshargie, Cheru Tesema; Levine, Aubrey J; Li, Shanshan; Linn, Shai; Liu, Shiwei; Liu, Simin; Lodha, Rakesh; Longbottom, Joshua; Lopez, Jaifred Christian F; Magdy Abd El Razek, Hassan; Magdy Abd El Razek, Muhammed; Mahadeshwara Prasad, D R; Mahasha, Phetole Walter; Mahotra, Narayan B; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A; Manafi, Navid; Manda, Ana Laura; Manohar, Narendar Dawani Dawanu; Mansournia, Mohammad Ali; Mapoma, Chabila Christopher; Maravilla, Joemer C; Martinez, Gabriel; Martini, Santi; Martins-Melo, Francisco Rogerlândio; Masaka, Anthony; Massenburg, Benjamin Ballard; Mathur, Manu Raj; Mayala, Benjamin K; Mazidi, Mohsen; McAlinden, Colm; Meharie, Birhanu Geta; Mehndiratta, Man Mohan; Mehta, Kala M; Mekonnen, Tefera C Chane; Meles, Gebrekiros Gebremichael; Memiah, Peter T N; Memish, Ziad A; Mendoza, Walter; Menezes, Ritesh G; Mereta, Seid Tiku; Meretoja, Tuomo J; Mestrovic, Tomislav; Miazgowski, Bartosz; Mihretie, Kebadnew Mulatu; Miller, Ted R; Mini, GK; Mirrakhimov, Erkin M; Moazen, Babak; Mohajer, Bahram; Mohamadi-Bolbanabad, Amjad; Mohammad, Dara K; Mohammad, Karzan Abdulmuhsin; Mohammad, Yousef; Mohammad Gholi Mezerji, Naser; Mohammadibakhsh, Roghayeh; Mohammadifard, Noushin; Mohammed, Jemal Abdu; Mohammed, Shafiu; Mohebi, Farnam; Mokdad, Ali H; Molokhia, Mariam; Monasta, Lorenzo; Moodley, Yoshan; Moore, Catrin E; Moradi, Ghobad; Moradi, Masoud; Moradi-Joo, Mohammad; Moradi-Lakeh, Maziar; Moraga, Paula; Morales, Linda; Moreno Velásquez, Ilais; Mosapour, Abbas; Mouodi, Simin; Mousavi, Seyyed Meysam; Mozaffor I, Miliva; Muchie, Kindie Fentahun; Mulaw, Getahun Fentaw; Munro, Sandra B; Muriithi, Moses K; Murray, Christopher J L; Murthy, GVS; Musa, Kamarul Imran; Mustafa, Ghulam; Muthupandian, Saravanan; Nabhan, Ashraf F; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naidoo, Kovin S; Naik, Gurudatta; Najafi, Farid; Nangia, Vinay; Nansseu, Jobert Richie; Nascimento, Bruno Ramos; Nazari, Javad; Ndwandwe, Duduzile Edith; Negoi, Ionut; Netsere, Henok Biresaw Netsere; Ngunjiri, Josephine W; Nguyen, Cuong Tat; Nguyen, Huong Lan Thi; Nguyen, Trang Huyen; Nigatu, Dabere; Nigatu, Solomon Gedlu; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A; Nojomi, Marzieh; Nong, Vuong Minh; Norheim, Ole F; Noubiap, Jean Jacques; Nouraei Motlagh, Soraya; Oancea, Bogdan; Ogah, Okechukwu Samuel; Ogbo, Felix Akpojene; Oh, In-Hwan; Olagunju, Andrew T; Olagunju, Tinuke O; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Onwujekwe, Obinna E; Oren, Eyal; Ortega-Altamirano, Doris V V; Osarenotor, Osayomwanbo; Osei, Frank B; Owolabi, Mayowa O; P A, Mahesh; Padubidri, Jagadish Rao; Pakhale, Smita; Patel, Sangram Kishor; Paternina-Caicedo, Angel J; Pathak, Ashish; Patton, George C; Paudel, Deepak; Paulos, Kebreab; Pepito, Veincent Christian Filipino; Pereira, Alexandre; Perico, Norberto; Pervaiz, Aslam; Pescarini, Julia Moreira; Piroozi, Bakhtiar; Pirsaheb, Meghdad; Postma, Maarten J; Pourjafar, Hadi; Pourmalek, Farshad; Pourshams, Akram; Poustchi, Hossein; Prada, Sergio I; Prasad, Narayan; Preotescu, Liliana; Quintana, Hedley; Rabiee, Navid; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi-Movaghar, Afarin; Rahimi-Movaghar, Vafa; Rahman, Mohammad Hifz Ur; Rahman, Muhammad Aziz; Rahman, SHAFIUR; Rajati, Fatemeh; Rana, Saleem Muhammad; Ranabhat, Chhabi Lal; Rasella, Davide; Rawaf, David Laith; Rawaf, Salman; Rawal, Lal; Rawasia, Wasiq Faraz; Renjith, Vishnu; Renzaho, Andre M N; Resnikoff, Serge; Reta, Melese Abate; Rezaei, Negar; Rezai, Mohammad sadegh; Riahi, Seyed Mohammad; Ribeiro, Ana Isabel; Rickard, Jennifer; Rios-Blancas, Maria; Roever, Leonardo; Ronfani, Luca; Roro, Elias Merdassa; Ross, Jennifer M; Rubagotti, Enrico; Rubino, Salvatore; Saad, Anas M; Sabde, Yogesh Damodar; Sabour, Siamak; Sadeghi, Ehsan; Safari, Yahya; Safari-Faramani, Roya; Sagar, Rajesh; Sahebkar, Amirhossein; Sahraian, Mohammad Ali; Sajadi, S Mohammad; Salahshoor, Mohammad Reza; Salam, Nasir; Salamati, Payman; Salem, Hosni; Salem I, Marwa R Rashad; Salimi, Yahya; Salimzadeh, Hamideh; Samy, Abdallah M; Sanabria, Juan; Santric-Milicevic, Milena M; Sao Jose, Bruno Piassi; Saraswathy, Sivan Yegnanarayana Iyer; Sarkar, Kaushik; Sarker, Abdur Razzaque; Sarrafzadegan I, Nizal; Sartorius, Benn; Sathian, Brijesh; Sathish, Thirunavukkarasu; Sawhney, Monika; Saxena, Sonia; Schwebel, David C; Senbeta IV, Anbissa Muleta; Senthilkumaran, Subramanian; Sepanlou, Sadaf G; Serván-Mori, Edson; Shabaninejad, Hosein; Shafieesabet, Azadeh; Shaikh, Masood Ali; Shalash, Ali S; Shallo, Seifadin Ahmed; Shams-Beyranvand, Mehran; Shamsi, MohammadBagher; Shamsizadeh, Morteza; Shannawaz, Mohammed; Sharafi, Kiomars; Sharifi, Hamid; Shehata, Hatem Samir; Sheikh, Aziz; Shetty, B Suresh Kumar; Shibuya, Kenji; Shiferaw, Wondimeneh Shibabaw; Shifti, Desalegn Markos; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Shirkoohi, Reza; Siabani, Soraya; Siddiqi, Tariq Jamal; Silva, Diego Augusto Santos; Singh, Ambrish; Singh, Jasvinder A; Singh, Narinder Pal; Singh, Virendra; Sisay, Malede Mequanent; Skiadaresi, Eirini; Sobhiyeh, Mohammad Reza; Sokhan, Anton; Soltani, Shahin; Somayaji, Ranjani; Soofi, Moslem; Sorrie, Muluken Bekele; Soyiri, Ireneous N; Sreeramareddy, Chandrashekhar T; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Suleria, Hafiz Ansar Rasul; Sultana, Marufa; Sunguya, Bruno Fokas; Sykes, Bryan L; Tabarés-Seisdedos, Rafael; Tabuchi, Takahiro; Tadesse, Degena Bahrey; Tarigan, Ingan Ukur; Tasew, Aberash Abay; Tefera, Yonatal Mesfin; Tekle, Merhawi Gebremedhin; Temsah, Mohamad-Hani; Tesfay I, Berhe Etsay; Tesfay, Fisaha Haile Haile; Tessema, Belay; Tessema, Zemenu Tadesse; Thankappan, Kavumpurathu Raman; Thomas, Nihal; Toma, Alemayehu Toma; Topor-Madry, Roman; Tovani-Palone, Marcos Roberto Roberto; Traini, Eugenio; Tran, Bach Xuan; Tran, Khanh Bao; Ullah, Irfan; Unnikrishnan, Bhaskaran; Usman, Muhammad Shariq; Uzochukwu, Benjamin S Chudi; Valdez, Pascual R; Varughese, Santosh; Violante, Francesco S; Vollmer, Sebastian; W/hawariat, Feleke Gebremeskel; Waheed, Yasir; Wallin, Mitchell Taylor; Wang, Yafeng; Wang, Yuan-Pang; Weaver, Marcia; Weji, Bedilu Girma; Weldesamuel, Girmay Teklay; Welgan, Catherine A; Werdecker, Andrea; Westerman, Ronny; Wiangkham, Taweewat; Wiysonge, Charles Shey; Wolde, Haileab Fekadu; Wondafrash, Dawit Zewdu; Wonde, Tewodros Eshete; Worku, Getasew Taddesse; Wu, Ai-Min; Xu, Gelin; Yadollahpour, Ali; Yahyazadeh Jabbari, Seyed Hossein; Yamada, Tomohide; Yatsuya, Hiroshi; Yeshaneh, Alex; Yilgwan, Christopher Sabo; Yilma, Mekdes Tigistu; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z; Yousefifard, Mahmoud; Yousof, Hebat-Allah Salah A; Yu, Chuanhua; Yusefzadeh, Hasan; Zadey, Siddhesh; Zaidi, Zoubida; Zaman, Sojib Bin; Zamani, Mohammad; Zandian, Hamed; Zepro, Nejimu Biza; Zerfu, Taddese Alemu; Zhang, Yunquan; Zhao, Xiu-Ju George; Ziapour, Arash; Zodpey, Sanjay; Zuniga, Yves Miel H; Hay, Simon I; Reiner, Robert C;
• Is Part Of: Lancet. Volume 8:Issue 8(2020)
• Page Start: e1038
• Page End: e1060
• Publication Date: 2020-08
• Subjects: World health -- Periodicals; 362.105
• DOI: 10.1016/S2214-109X(20)30230-8
• Languages: English
• ISSNs: 2214-109X

Abstract

Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.