Channels to Introduce Zinc for Treatment of Pediatric Diarrheas - - PowerPoint PPT Presentation

Working through Community-based Channels to Introduce Zinc for Treatment of Pediatric Diarrheas

Vicki MacDonald, MPH Abt Associates

October 31, 2011

Abt Associates | pg 2

Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Vicki MacDonald No relationships to disclose

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Overview

• Background
• Implementing diarrhea management

programs in developing countries

• Community-based programs
• Research results
• Findings and conclusions

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Pediatric diarrhea

• 2nd leading cause of

death in children under 5 years (15%)

• At least 1.3 million

deaths per year

• Dehydration is most

immediate cause of death

Source: Black et al. Lancet 2010; 375:1969-1987

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Zinc for the treatment of diarrhea: Research findings

• 25% reduction in duration of acute diarrhea
• 29% reduction in duration of persistent diarrhea
• 40% reduction in treatment failure or death in

persistent diarrhea

• Zinc supplementation for 10-14 days has

preventive effect on childhood illnesses in the 2-3 months after treatment

Bhutta ZA, Bird SM, Black RE, et al. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis

• f randomized controlled trials. Am J Clin Nutr 2000; 72(6): 1516-1522.

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WHO/UNICEF Joint Statement 2004

May 2004 WHO/UNICEF revise recommendations for the treatment of childhood diarrheas:

– 10-14 days of 10 or 20 mg zinc – Along with new low-

• smolarity oral rehydration

solution (ORS) or oral rehydration therapy (ORT)

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Program Goals

• Assure availability of quality, affordable zinc and

ORS

• Assure that zinc is accessible through both public

and private sectors

• Create demand by educating consumers and

providers through a variety of channels

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Benin

• No locally-made product available
• Imported zinc and low osmolarity oral rehydration salts and packaged together into a

diarrhea treatment kit

• Built off PSI’s Orasel brand awareness, launched diarrheal treatment kit (DTK) Oraselzinc
• Significant rural population without access to television led to need for interpersonal

approaches

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Women’s Groups & Community Health Workers Small groups &

Door to Door Activities

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Madagascar

Public Sector program initiated 2006 Two Diarrhea Treatment Kits (each containing 10 tablets of 20 mg zinc sulfate and two sachets of the new low-osmolarity ORS – HydraZinc launched and marketed through commercial pharmaceutical channels – ViaSûr launched and made available through community-based distributors (subsidized by USAID)

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Community-based distribution

• NGO supported

community-based sales agents sold ViaSur to rural households

• Agents supplied with IEC

materials and kits

• Mobile video units

supplemented promotional efforts

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Household survey methods

Structured questionnaire

– Diarrhea treatment practices – Exposure to messages and media – Knowledge, perceptions related to diarrhea and zinc

Administered to caregivers of children under 5

– Benin: youngest & next-youngest (if any) child in house (0-59 mos) – Madagascar: youngest child in house (6-59 mos)

Weighted analysis (complex sampling designs)

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Household survey details

Benin Benin Madagascar

Dates Nov 2009 July-August 2011 March-April 2010

• No. of

Households 2912 741 1200

• No. of children

3854 741 1200

• No. with

diarrhea 307 741 1000 Age range 0-59 months 0-59 months 6-59 months Design Cross-sectional Cross-sectional Cross-sectional; programs vs. comparison

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Zinc and ORS/ORT use

73 74 57.5 4 31 54.3 10 20 30 40 50 60 70 80 90 100 Madagascar Benin 2009 Benin 2011

Proportion (%) of children under 5 with diarrhea in past 2 weeks given ORS/ORT and zinc

ORS/ORT Zinc

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Benin: Source of advice on diarrhea management

10 20 30 40 50 60 Health Center Pharmacy Community Health Worker Family/Friend Proportion (%) of respondents Source of advice 2009 2011

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Benin: Rural caregivers more likely to seek advice from community resources (2009)

10 20 30 40 50 60 70 Urban Rural Proportion (%) of respondents Source of advice Health Center Pharmacy Community Health Worker Family/Friends

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Benin: Rural zinc users procured zinc from health centers and community sources while urban users procured from health centers and pharmacies (2009)

20 40 60 80 100 Urban Rural Proportion (%) of respondents Source of zinc Community Health Workers Pharmacy Health Center

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Madagascar: Primary sources of advice or treatment

0% 10% 20% 30% 40% Proportion (%) of respondents Primary Source of Advice

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Madagascar: Primary sources of advice or treatment

0% 10% 20% 30% 40% Proportion (%) of respondents Primary Source of Advice

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Madagascar: Sources of Information about Zinc (Zinc Users)

0% 5% 10% 15% 20% 25% 30% 35% Proportion (%) of respondents Source of zinc information

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Madagascar: Source of zinc

Source of zinc treatments by type of program district

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% MOH UNICEF POUZN1 POUZN2 Control Drug shop Faith-based organization Community distributor Private pharmacy Community health worker Private health clinic Public health clinic

Proportion of respondents

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Summary conclusions

• Community sources are highly sought for advice and

treatment about diarrhea

• Partnerships with community-based organizations

can increase awareness and access to products and encourage correct zinc and ORS use

• Assuring that program strategy includes

interpersonal channels of communication in Africa is essential to improving home diarrhea treatment

SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting

Vicki_MacDonald@abtassoc.com

www.shopsproject.org