Diarrheal Disease Burden and Risk Factors Among Under-Five Children in Moro Local Government Area, Kwara State, Nigeria

Background: Diarrhea is one of the important causes of morbidity and mortality among under-five children in India. Lack of knowledge of mothers about the management of diarrheal diseases is a common problem in many developing countries. Use of oral rehydration solution (ORS) largely depends, on the level of mother’s knowledge. Objective: The objective of the study was to assess the knowledge of the mothers, from rural migrant population regarding the use of ORS in under-five children with diarrhea. Materials and Methods: A cross-sectional study was carried out from December 2016 to March 2017, among mothers of the migrant population residing and working at brick kilns and construction site in the field practice area of the rural health training center, Lavale, Pune. We included the mothers whose children were under five years of age. Those mothers, who had serious illness and had hearing and speech problems, were excluded from the study. Data were collected by interview method from mothers with the help of a pre-structured and pre-tested questionnaire. Results: A total of 54 (93.1%) mothers from brick kiln sites were included among whom, 43.10% were aware of ORS. Only 37.93% of mothers knew the use of homemade sugar salt solution for diarrhea in children. In this study, 25 (43.10%) mothers were illiterate and the study showed that knowledge regarding ORS was lower in illiterate mothers. Conclusion: Majority of the mothers were not aware regarding ORS, and as per the study, knowledge regarding ORS was lower in less educated mothers. Government schemes would help these mothers to increase the awareness which will result in a decrease in mortality rate.

The use of oral rehydration solution (ORS) has revolutionized the management of acute diarrhea. The implementation of the standard World Health Organization ORS (WHO-ORS) has resulted in decreased mortality associated with acute diarrheal illnesses in children, although in general stool volume and diarrhea durations are not reduced. Decreased morbidity and mortality have occurred because of improved hydration status. Decreased morbidity has also been described in adults who used this therapy. Various modifications to the standard ORS have been derived. These modifications have included hypo-osmolar or hyperosmolar solutions, use of rice-based ORS, zinc supplementation, and the use of amino acids, including glycine, alanine, and glutamine. Some of these variations have been successful, some have not, and others are still under investigation. ORS has been used for travelers' diarrhea and to decrease intravenous (IV) fluid requirements in patients with short bowel syndrome (SBS) who require parenteral nutrition (PN). This paper reviews the standard WHO-ORS and its mechanism of action, followed by more contemporary reduced osmolarity ORS and rice-based ORS in non-cholera diarrhea. Various modifications to improve ORS are also discussed.

Diarrhea is the second leading cause of under-five deaths claiming half a million children every year. Most of these deaths occurred in sub-Saharan Africa and South Asia. Oral rehydration solution (ORS) has been described as the most effective treatment of diarrhea. However, only 36% of children with diarrhea received ORS in sub-Saharan Africa. This study examined the factors associated with ORS use for children with diarrhea in the sub-region. Demographic and Health Surveys (DHS) data sets of 31 countries in sub-Saharan Africa were used in this study. The data involved 30,102 under-five children with diarrhea. The multivariable analysis involved binary logistic regression. Prevalence of ORS use was 38% in sub-Saharan Africa with countries such as Namibia (71.8%), Zambia (66.4%) and Malawi (63.8%) having the highest rates. Use of ORS was most common among children whose mothers had secondary or higher education (45%), were exposed to media (41%) and attended antenatal care (41%). ORS use was significantly associated with secondary or higher education (OR = 1.63; 95%CI: [1.47-1.81]; p<0.001), exposure to media (OR = 1.17; 95%CI: [1.07-1.27]; p<0.001), antenatal care attendance (OR = 2.33; 95%CI: [1.08-1.27]; p<0.001), child's age (OR = 1.46; 95%CI: [1.35-1.59]; p<0.001), child's size at birth (OR = 1.08; 95%CI: [1.00-1.17]; p<0.05), household size (OR = 1.28; 95%CI:[1.06-1.54]; p<0.05) and source of drinking water (OR = 1.18; 95%CI: [1.09-1.29]; p<0.001). This study revealed a 38% prevalence of ORS use during diarrhea episodes in sub-Saharan Africa. This is low as it is less than the 44% recorded for developing countries as a whole. While this study emphasises the need for a further study on effects of severity of diarrhea on ORS use and factors determining differences in ORS use among countries, it also calls for interventions that will increase use of ORS is sub-Saharan Africa. Such interventions should include increase in literacy rate among girls and women, increase in the proportion of women with access to media, involvement of health workers in programmes that would promote antenatal care utilization among women at community level and provision of social amenities like pipe-borne water.

BackgroundLow-osmolarity oral rehydration salt (ORS) and zinc therapy effectively manage diarrhea in children under five years of age, offering both short- and long-term benefits. Despite this, caregivers’ adherence to ORS and zinc is often unsatisfactory due to factors such as forgetfulness, resolution of symptoms, and underestimation of the disease’s severity. This study assessed the effect of mobile call reminders on ORS and zinc tablet adherence among children with acute diarrhea in a secondary-level health facility in Kwara State, Nigeria.MethodsUsing an open-label, randomized controlled trial design, this study compared caregiver-child pairs with acute diarrhea aged 6–59 months who received standard instructions (SI) alone (control group) and an intervention group (IG) who received SI plus phone call reminders on days three and seven of zinc sulfate therapy. All participants used a pictorial diary to track loose/watery stools and ORS and zinc tablet treatments for ten days. The primary outcome measures were independent and combined adherence to ORS and zinc therapy. The secondary outcomes were independent and combined adherence scores, defined as the percentage of times the ORS was given post-diarrhea and the percentage of prescribed zinc tablets administered out of ten.ResultsA total of 364/400 mother–child pairs completed the study. The percentage of mothers with full adherence in the intervention group was 82.5% for ORS, 72.1% for zinc, and 58.5% for combined use, compared to 78.8%, 60.8%, and 43.6%, respectively, in the control group. The odds of full adherence to ORS and zinc were 1.6 and 1.7 times higher among intervention mothers [ORS: OR = 1.561, 95% CI = 0.939–2.598, P = 0.085; zinc: OR = 1.671, 95% CI = 1.076–2.593, P = 0.022], and 1.8 times higher for combined use according to WHO guidelines [OR = 1.818, 95% CI = 1.200–2.754, P = 0.005]. The mean adherence scores for the intervention group were higher than those for the control group by 4.1% (95% CI = 0.60–7.60) for ORS, 7.3% (95% CI = 3.74–10.86) for zinc, and 5.7% (95% CI = 3.23–8.17) for the combined treatment.ConclusionPhone reminders can effectively improve consistency of home treatment administered by caregivers for children under five years old.Trial RegistrationThe study was registered retrospectively (17/3/2023) with the Pan African Clinical Trial Registry (PACTR202301560735856).

Oral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. To identify barriers to the optimal use of ORS for childhood diarrhoea in Nigeria and recommend appropriate interventions to improve uptake of ORS at community and facility levels. A quantitative cross-sectional survey of 400 mothers with children under 5 years of age was conducted in Nigeria to explore reasons for suboptimal utilization of ORS for childhood diarrhoea. An interviewer-administered questionnaire was used for data collection. Data were analysed using the statistical software SPSS version 21.0®. Sixty-one (15.3%) of the respondents were unaware of ORS. Of the 339 that were aware, their source of information was mainly hospital/health workers (81.1%). Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Nineteen mothers (5.6%) had difficulty getting ORS when needed, whereas 13 (3.8%) reported that it was difficult for them to remember how to prepare ORS. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. There is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. We recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged. Lay summaryOral rehydration solution (ORS) is an evidence-based intervention to reduce diarrhoea-related morbidity and mortality, but consistently low rates of ORS use have been documented in Nigeria. A quantitative cross-sectional study was carried out among 400 mothers to identify barriers to the optimal use of ORS for childhood diarrhoea and recommend appropriate interventions. Sixty-one (15.3%) of the respondents were unaware of ORS. Among mothers that affirmed they could prepare ORS, only 64 (22.1%) prepared it correctly. Level of education significantly influenced awareness of ORS as well as its correct preparation. Some mothers had difficulty getting ORS when needed, while some found it difficult to remember how to prepare it. Four in ten children took ORS reluctantly or refused it outrightly. No cultural taboo concerning the use of ORS was reported. The study showed that there is still a wide gap in the awareness of ORS and many caregivers prepared the solution incorrectly. Hence, we recommend that the method of preparation of ORS be clearly indicated on the sachets, and production of commercial 1-L water packages for ORS preparation be encouraged.

Cholera diarrhoea remains a major global health problem that has caused seven pandemics. The pathogenesis of cholera is attributable to the production of cholera toxin by the causative pathogen, Vibrio cholerae. The toxin causes increased production of cyclic adenosine monophosphate and this results in massive water and electrolyte secretion into the intestinal lumen. These changes manifest clinically as the painless defecation of voluminous stools that resemble 'rice water', leading to severe dehydration. The cornerstone in the management of cholera diarrhoea is the use of oral rehydration solutions (ORS) to replace the water and electrolytes lost as stools. The World Health Organization recommends the use of ORS of 'reduced osmolarity' for the treatment of acute non-cholera diarrhoea and the use of rice-based ORS for the management of cholera diarrhoea. Although several attempts have been made to improve ORS, studies to evaluate some of the modifications, which include the addition of amylase-resistant starch, the use of amino acids (such as glycine, alanine and glutamine) as sodium cotransporters, and zinc-supplemented ORS, are still needed.

Background: Diarrhoeal diseases remain a major cause of morbidity and mortality among children under five years of age in low- and middle-income countries, including Cameroon. Appropriate management relies on healthcare providers’ adherence to evidence-based guidelines, particularly the use of oral rehydration solution (ORS), zinc supplementation, continued feeding, vaccination, and caregiver education. This study assessed healthcare providers’ practices in the prevention and management of childhood diarrhoeal diseases in Ndop Health District, North West Region, Cameroon. Methods: A hospital-based cross-sectional study was conducted among 71 healthcare providers working in nine health areas of Ndop Health District. Data were collected using a structured, pre-tested questionnaire and an observational checklist to assess clinical practices and availability of essential commodities. Descriptive and inferential analyses were performed to determine practice levels and factors associated with good practice. Results: Overall, 74.6% of healthcare providers demonstrated good practice, while 25.4% had poor practice. Only 12.7% routinely assessed dehydration status, and consistent administration of ORS was reported by 33.8% of providers. Zinc supplementation was used in only 8.5% of cases, while antibiotics were frequently prescribed beyond guideline-based indications. Vaccination status was commonly assessed, with 85.9% and 97.2% reporting assessment of measles and rotavirus vaccination, respectively. Observational findings revealed intermittent stock-outs of ORS and zinc, limited availability of IMCI guidelines, and inconsistencies between self-reported practices and facility readiness. Conclusion: Although most healthcare providers demonstrated generally acceptable practice levels, substantial gaps persist in dehydration assessment, zinc use, rational antibiotic prescribing, and availability of essential supplies. Strengthening IMCI-based training, supportive supervision, and supply chain systems is critical to improving the quality of childhood diarrhoeal disease management and reducing preventable morbidity and mortality in Ndop Health District.

BackgroundDiarrheal disease is a leading cause of morbidity and mortality among children under five. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries. This study surveyed caregivers and health care providers in India and Kenya to gather information about perceptions and use of various diarrhea treatments, assess reasons for low ORS use, and identify opportunities for expanding ORS use.MethodsThe project team conducted two rounds of semi–structured, quantitative surveys with more than 2000 caregivers in India and Kenya in 2012. A complementary survey covered more than 500 pharmacy staff and health care workers in both countries. In Kenya, the team also surveyed rural pharmacies to gather pricing and sales data.ResultsAlthough caregivers generally had very positive perceptions of ORS, they typically ranked antibiotics ahead of ORS as the strongest medicine for diarrhea (in India 62% ranked antibiotics first and 23% ranked ORS first, n = 404; in Kenya results were 55% and 29%, n = 401). Many caregivers had misconceptions about the purpose and effectiveness of various treatments. For example, most caregivers who gave ORS at last episode expected it to stop their child’s diarrhea (65% in India, n = 190; 73% in Kenya, n = 154). There were noteworthy differences between India and Kenya in the selection and sourcing of treatments. Much of the money spent by families during the last episode of diarrhea was for inappropriate treatments. This was especially true in India, where rural households typically spent US$ 2.29 (median for the 79% of rural households that paid for health care services or treatments, n = 199) with most of this going to pay fees of private health workers and/or for antibiotics.ConclusionsCaregivers’ primary treatment goal is to stop diarrhea, and many believe that antibiotics or ORS will accomplish this goal. Inappropriate treatment – and especially overuse of antibiotics – is common. Satisfaction with ORS is high, but dosing is a challenge for caregivers. The results provide valuable insight into treatment behaviors and suggest significant opportunities to enhance use of ORS in developing countries.

Background: Zinc deficiency is associated with chronic diarrhea. This condition is generally linked to an overproduction of nitric oxide (NO), which induces secretion and cellular damage as a free radical. Use of oral rehydration solutions (ORS) is an important part of diarrhea treatment, especially early in infancy and for patients with cholera. The presence of zinc in an ORS could be a positive factor in recovery from diarrheal disease.Objective: This study was undertaken to determine whether zinc added to an ORS could regulate the synthesis of NO metabolites in the lumen of zinc deficient rat intestine, acting as a gastrointestinal protector and thus accelerating normalization of intestinal function and zinc status.Methods: The effects of zinc on NO metabolism were studied in young male rats fed a zinc deficient diet for three weeks to mimic the condition of patients with recurrent diarrheal episodes. During the fourth week of the zinc deficient feedings, experimental diarrhea was induced using cathartics (magnesium citrate plus phenolphthalein) that exacerbate NO production. A standard ORS with or without 1 mM zinc was given to the rats for the last two days. A control group received a zinc sufficient diet. Rats were killed at each stage. Intestinal nitric oxide synthase (NOS) was assayed, cecal fluid contents were analyzed for nitrates and nitrites, intestinal histology was examined, and activation of nuclear factor NF-κB DNA binding activity was determined.Results: Rats fed the zinc-deficient diet for three weeks gained less weight than rats fed a normal zinc content diet and had a lower plasma zinc than controls (51.6 ± 5.4 [n = 10] vs. 143.6 ± 7.2 μg/dL [n = 11], p < 0.05). Recovery with ORS+Zn resulted in a higher plasma zinc than with the ORS-Zn (ORS+Zn: 186.5 ± 12.2; ORS−Zn: 57.5 ± 6.6 μg/dL, p < 0.05). The zinc-deficient diet did not alter mucosal NOS, as compared to the values of rats fed a normal diet. However, those animals which received five days of cathartic fluids had a small intestinal NOS higher than that of all other groups. Either ORS+Zn or ORS−Zn normalized NOS activity, regardless of cathartic treatment. The rats fed the zinc deficient diet had generally a higher content of NO metabolites in the cecum than rats fed a normal diet. After recovery with either type of ORS, rats given the cathartic remained with higher cecal NO metabolite concentrations than rats that had no induced diarrhea. After recovery with ORS+Zn, intestinal villi showed significant expansion of the lamina propria, an indication of greater absorption of fluid, while with ORS−Zn this was not present. Small intestinal homogenates of rats recovering with ORS+Zn had a decreased NF-κB DNA binding activity than tissues from rats consuming ORS−Zn.Conclusions: The results are consistent with the hypothesis that addition of Zn to an ORS may contribute to improving the physiologic status of the small intestine and potentially reduce the risks of recurrent diarrhea episodes.

The World Health Organization recommends the use of oral rehydration solution (ORS) for the treatment of child diarrhea. In India, adherence to these guidelines remains far less than complete. To elucidate geographic variations in ORS treatment for child diarrhea between and within India's 720 districts. This repeated cross-sectional study used data from 2 rounds of India's National Family Health Survey from 2016 and 2021. Complete diarrhea data were available from 246 695 children in 2016 and 223 785 children in 2021 from all 720 districts in both waves. Data on ORS treatment were available for 22 413 children in 2016 and 15 302 children in 2021. These children lived in 716 of India's 720 districts in 2016 and in 718 districts in 2021. The data were analyzed in October 2024. The primary outcome was the district-level percentage of children who received ORS treatment if they had diarrhea in the past 2 weeks. The prevalence of diarrhea was also estimated. These values were estimated for both outcomes in 2016 and 2021 so that change over time could be estimated. The SD of the community-level prevalence of children who received ORS treatment by each district as a measure of the within-district inequality was also estimated for 2016 and 2021. The study included 246 695 children younger than 5 years (mean [SD] age, 2.0 [1.4] years; 128 098 boys and 118 597 girls) for diarrhea prevalence and 22 413 children younger than 5 years (mean [SD] age, 1.5 [1.3] years; 12 050 boys and 10 363 girls) for ORS treatment in 2016. The study also included 223 785 children younger than 5 years (mean [SD] age, 2.0 [1.4] years; 115 632 boys and 108 153 girls) for diarrhea prevalence and 15 302 children younger than 5 years (mean [SD] age, 1.6 [1.4] years; 8160 boys and 7142 girls) for ORS treatment in 2021. Of the 9.2% (95% CI, 9.1%-9.3%) of children who had diarrhea in the 2 weeks prior to the survey in 2016, 50.6% (95% CI, 50.0%-51.3%) were treated with ORS. In 2021, 7.3% (95% CI, 7.2%-7.4%) of children had diarrhea, of whom 60.7% (95% CI, 59.9%-61.5%) were treated with ORS. There was considerable between-district variation in the prevalence of ORS treatment for child diarrhea (as of 2021, the state or Union Territory with the lowest district-level prevalence of ORS treatment was Haryana [49.0%]; the state or Union Territory with the highest district-level prevalence of ORS treatment was Jammu and Kashmir [83.4%]). The prevalence of ORS treatment decreased by more than 2.49 percentage points in 185 districts between 2016 and 2021 even though, nationally, the prevalence of ORS treatment increased over the same period, from a median of 57.5% (IQR, 47.2%-66.5%) to a median of 62.4% (IQR, 56.9%-72.5%). Finally, many districts with high prevalence of child diarrhea had low prevalence of ORS treatment. And in 71 districts, the prevalence of child diarrhea increased while the prevalence of ORS treatment decreased between 2016 and 2021. This cross-sectional study of the prevalence of child diarrhea and its treatment with ORS in India found that the prevalence of ORS treatment for child diarrhea increased at a national level between 2016 and 2021, but this increase was not even between or within India's 720 districts. The findings suggest that efforts aimed at promoting ORS treatment for child diarrhea in India must address the place-based factors that might be associated with underuse of this treatment.

Background: Dehydration resulting from diarrhea is a significant cause of death of young children in developing countries. Oral rehydration solution (ORS) is useful to replace fluid and electrolyte loss. Objective: The main objective is to assess the knowledge, attitude and practice of mothers towards the use of oral rehydration solution in the treatment of acute diarrhea in children. Patients and Methods: This observational descriptive study was conducted at the pediatric medical emergency department of the Children‘s hospital and the institute of child health in Sulaimani city for a period of eight months from July 2012 till March 2013. The criteria of inclusion were mothers of children with diarrhea. A total of 200 mothers fulfilling the inclusion criteria were enrolled over the study period. Mothers were interviewed and information collected. A pre designed questionnaire was filled for each case by the investigator which included a detailed history highlighting their demographic data, presenting complaints , treatment given at home, mothers knowledge about ORS and drugs, maternal education, water sources, and socioeconomic history was taken and recorded carefully. All the data entered in SPSS and results were analyzed in percentages. Results: A total 200 mothers who visited the Pediatric Teaching Hospital in Sulaimani were interviewed. The median age of children group was 2 years, and minimum was (4 months)and maximum age was 8 years, of these 25(12.5%) were below 1 year, and 160 cases (80%) were between 1 to 5 years, and 15 cases (7.5%) more than 5 years. The most frequent age group was between 1 to 5 years, male were 101 (50.5%) and female were 99 female (49.5%), 58(29%) of mothers education were illiterate, and 105 (52.5%) of mothers education was low, and 37(18.5%) of mothers education was high. Among all the patients 172(86%) were from Sulaimani and 28(14%) from outside Sulaimani. Among all the patients the source of water used was well 103(51.5%), and 63(31.5%) was piped, and 34(17%) was tanks. Out of 200 mothers 199 (99.5%) heard about ORS and 1(0.5%) did not hear about it. Of these mothers 183(91.5%) used ORS. and 17(8.5%) did not use it. Among the mothers that usedORS, 7(3.5%) used it by themselves and 42(21%) were advised by family member and 85(42.5%) were advised by physician and 49(24.5%) were advised by health worker. The way of giving ORS wasby cup and spoonin 139(69.5%), and 44(22%) gaveORS by bottle. Of them 109(54.5%) amount of ORS given adequate amount and 74(37%) gave inadequately. And of them 107(53.5%) prepared ORS correctly and 76(38%) prepared the solution incorrectly. Among all mothers; 172(86%) used drugs and 28(14%) did not use drugs. Among those who use drugs 21(10.5%) used it by themselves and 151(75.5%) got advise by family physician. Conclusion: Although most of the mothers knew about ORS and used it at times of need, many had inadequate knowledge on the importance and appropriate use of ORS.

Introduction: Oral rehydration solution (ORS) has been a life-saving remedy in the home and hospital management of dehydration, particularly in infants and children under the age of five. The improper use has however resulted in morbidity and mortality in children. The purpose of this study is to assess proper use of ORS by mothers in the management of diarrhoea in under-five children.&#x0D; Methods: A cross-sectional study was conducted over 3 months. Mothers of children under five years of age presenting with diarrhoea at the Diarrhoea Training Unit of a tertiary hospital were interviewed using a pretested structured interviewer-administered questionnaires. Data was analysed using SPSS version 20.0.&#x0D; Results: A total of 90 mothers were interviewed. 86.7% of respondents were of a high socioeconomic class. 51.1% of children with diarrhoea were between 6-15months of age. (Mean age of 17 + 12.3 months). Although 93.3% of mothers were aware of ORS, 64.4% reported using it to treat their children. Only 40 (44.4%) respondents constituted ORS appropriately and discarded unused portions at 24 hours.&#x0D; Conclusion: Although mothers of under-five children are aware of the efficacy of ORS in the management of diarrhoea, their knowledge of its proper use is limited. Increased awareness among mothers of under-five children about the proper use of ORS is necessary to avoid debilitating complications such as dehydration, electrolyte imbalance, etc.

Assessment of knowledge, attitude, and practice of child caregivers towards oral rehydration salt and zinc for the treatment of diarrhea in under 5 children in Gondar town

Diarrhea is a significant health issue in low- and middle-income countries. There is an urgent need to identify and implement actions aimed at reducing the associated mortality and morbidity. The aim of this study was to determine the frequency and determinants of home use of oral rehydration solution (ORS) and antibiotics for the treatment of diarrheal diseases in the Far North and Littoral regions of Cameroon. This was a cross-sectional study using sentinel surveillance data collected from four health facilities in the cities of Kousseri and Douala in Cameroon. The study targeted patients seeking consultations for diarrhea at these health facilities. Patients were selected through consecutive sampling. Data were collected using a questionnaire administered face-to-face by a trained nurse, which included questions about the reason for consultation, socio-demographic characteristics, and prior exposure to ORS and antibiotics before arriving at the health facility. A total of 1,065 patients with diarrhea agreed to participate in the study, including 160 (15.0%) from Kousseri and 905 (85.0%) from Douala. Of the 1,065 participants, 215 (20.2%) and 637 (59.8%) reported using ORS and antibiotics at home as part of their diarrhea treatment prior to arriving at the health facility. The most used antibiotics were metronidazole (31.9%), amoxicillin (3.6%), doxycycline (3.6%), and ciprofloxacin (2.6%).The use of ORS was associated with place of residence (aOR = 0.20; 95% CI [0.10 - 0.40]), and duration of diarrhea (aOR = 0.51; 95% CI [0.33 - 0.78]) were associated with home use of ORS among patients with diarrhea. The city of residence (aOR = 3.06, 95% CI = 1.85 - 5.05) and the absence of ORS use at home (aOR = 2.17; 95% CI = 1.30-3.62); having diarrhea for less than 24h (aOR = 0.36, 95% CI = [0.24 - 0.54]) and traveling less than one hour to reach the health facility (aOR = 0.44, 95% CI = [0.21 - 0.91]) were associated with home use of antibiotics among patients with diarrhea. The frequency of antibiotic use in the community is significantly high, while the utilization of ORS remains low. More efforts are required to enhance community management of diarrhea effectively.

BackgroundIndia has the greatest burden of diarrhea in children under 5 years globally. The Diarrhea Alleviation through zinc and oral rehydration salts (ORS) Therapy program (2010–2014) sought to improve access to and utilization of zinc and ORS among children 2–59 months in Gujarat and Uttar Pradesh (UP), India, through public and private sector delivery channels. In this analysis, we present findings on program’s effect in reducing child–health inequities.MethodsData from cross–sectional baseline and endline surveys were used to assess disparities in key outcomes across six dimensions: socioeconomic strata, gender, caregiver education, ethnicity and geography.ResultsCareseeking outside the home for children under 5 years with diarrhea did not increase significantly in UP or Gujarat across socioeconomic strata. Declines in private sector careseeking were observed in both sites along with concurrent increases in public sector careseeking. Zinc, ORS, zinc+ORS use did not increase significantly in UP across socioeconomic strata. In Gujarat, increases in zinc use (20% overall; 33% in the Quintile 5 (Q5) strata) and zinc+ORS (18% overall; 30% in the Q5 strata) were disproportionately observed in the high income strata, among members of the most advantaged caste, and among children whose mothers had ≥1 year of schooling. ORS use increased significantly across all socioeconomic strata for children in Gujarat with diarrhea (23% overall; 33% in Q5 strata) and those with dehydration + diarrhea (33% overall; 38% in Q5 strata). The magnitude of increase in ORS receipt from the public sector was nearly twice that observed in the private sector. In Gujarat, while out of pocket spending for diarrhea was significantly higher for male children, overall costs to users declined by a mean of US$ 2; largely due to significant reductions in wages lost (–US$ 0.79; P < 0.003), and transportation costs (–US$ 0.44; P < 0.00).ConclusionsWhile significant improvements in diarrhea treatment were achieved in Gujarat, new strategies are needed in UP, particularly in the private sector. If national–level reductions in diarrheal disease burden are to be realized, improved understanding is needed of how to optimally increase coverage of zinc and ORS and decrease contraindicated treatments amongst the most disadvantaged across geographic areas and axes of gender, ethnicity, education and socioeconomic status.