Abstract
BackgroundTo address inadequate coverage of oral rehydration salts (ORS) and zinc supplements for the treatment of diarrhea among children under–five, the Diarrhea Alleviation through Zinc and ORS Treatment (DAZT) program was carried out from 2011–2013 in Gujarat and from 2011–2014 in Uttar Pradesh (UP), India. The program focused on improving the diarrhea treatment practices of public and private sector providers.MethodsWe conducted cross–sectional household surveys in program districts at baseline and endline and constructed state–specific logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period.ResultsBetween baseline and endline, zinc coverage increased from 2.5% to 22.4% in Gujarat and from 3.1% to 7.0% in UP; ORS coverage increased from 15.3% to 39.6% in Gujarat but did not change in UP. In comparison to baseline, children with diarrhea in the two–weeks preceding the endline survey had higher odds of receiving zinc treatment in both Gujarat (odds ratio, OR = 11.2; 95% confidence interval (CI) 6.4–19.3) and UP (OR = 2.4; 95% CI 1.4–3.9), but the odds of receiving ORS only increased in Gujarat (OR = 3.6; 95% CI 2.7–4.8; UP OR = 0.9; 95% CI 0.7–1.2). Seeking care outside the home, especially from a public sector source, was associated with higher odds of receiving ORS and zinc.ConclusionsDuring the duration of the DAZT program, there were modest improvements in the treatment of diarrhea among young children. Future programs should build upon and accelerate this trend with continued investment in public and private sector provider training and supply chain sustainability, in addition to targeted caregiver demand generation activities.
Highlights
Between baseline and endline, zinc coverage increased from 2.5% to 22.4% in Gujarat and from 3.1% to 7.0% in Uttar Pradesh (UP); oral rehydration salts (ORS) coverage increased from 15.3% to 39.6% in Gujarat but did not change in UP
Children with diarrhea in the two– weeks preceding the endline survey had higher odds of receiving zinc treatment in both Gujarat (odds ratio, odds ratios (OR) = 11.2; 95% confidence interval (CI) 6.4–19.3) and UP (OR = 2.4; 95% CI 1.4–3.9), but the odds of receiving ORS only increased in Gujarat (OR = 3.6; 95% CI 2.7–4.8; UP OR = 0.9; 95% CI 0.7–1.2)
Diarrhea is responsible for significant morbidity among children in low– and middle–income countries worldwide
Summary
We conducted cross–sectional household surveys in program districts at baseline and endline and constructed state–specific logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period. External evaluation of diarrhea alleviation through zinc and ORS under–five populations of approximately 41.1 million and 6.3 million, respectively [10]. In 2007, 27% of India’s under–five deaths occurred in UP compared to 5% in Gujarat [13]. Lower in Gujarat than in UP, Gujarat has the 6th highest absolute number of under–five deaths in India, outranking other states with poorer economic development and larger populations [13]. Diarrhea is a leading cause of under–five mortality in both Gujarat and UP. Prior to implementation of the DAZT program, the most recently available ORS coverage estimates of 26.3% in Gujarat and 12.5% in UP, highlighted the substantial need for focused scale–up in both states [14,15]
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