Working through Community-based Channels to Introduce Zinc for Treatment of Pediatric Diarrheas Vicki MacDonald, MPH Abt Associates October 31, 2011
Presenter Disclosures Vicki MacDonald The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose Abt Associates | pg 2
Overview Background Implementing diarrhea management programs in developing countries Community-based programs Research results Findings and conclusions Abt Associates | pg 3
Pediatric diarrhea • 2 nd 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 Abt Associates | pg 4
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 of randomized controlled trials. Am J Clin Nutr 2000; 72(6): 1516-1522. Abt Associates | pg 5
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- osmolarity oral rehydration solution (ORS) or oral rehydration therapy (ORT) Abt Associates | pg 6
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 Abt Associates | pg 7
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 Abt Associates | pg 8
Small groups & Door to Door Activities Women’s Groups & Community Health Workers Abt Associates | pg 9
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) Abt Associates | pg 10
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 Abt Associates | pg 11
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) Abt Associates | pg 12
Household survey details Benin Benin Madagascar Dates Nov 2009 July-August 2011 March-April 2010 No. of 2912 741 1200 Households No. of children 3854 741 1200 No. with 307 741 1000 diarrhea Age range 0-59 months 0-59 months 6-59 months Design Cross-sectional Cross-sectional Cross-sectional; programs vs. comparison Abt Associates | pg 13
Zinc and ORS/ORT use 100 with diarrhea in past 2 weeks given Proportion (%) of children under 5 90 80 74 73 ORS/ORT and zinc 70 57.5 60 54.3 ORS/ORT 50 Zinc 40 31 30 20 10 4 0 Madagascar Benin 2009 Benin 2011 Abt Associates | pg 14
Benin: Source of advice on diarrhea management 60 Proportion (%) of respondents 50 40 30 20 10 0 Health Center Pharmacy Community Health Family/Friend Worker Source of advice 2009 2011 Abt Associates | pg 15
Benin: Rural caregivers more likely to seek advice from community resources (2009) 70 Proportion (%) of respondents 60 Health Center 50 40 Pharmacy 30 Community Health 20 Worker Family/Friends 10 0 Urban Rural Source of advice Abt Associates | pg 16
Benin: Rural zinc users procured zinc from health centers and community sources while urban users procured from health centers and pharmacies (2009) Rural Source of zinc Community Health Workers Pharmacy Health Center Urban 0 20 40 60 80 100 Proportion (%) of respondents Abt Associates | pg 17
Madagascar: Primary sources of advice or treatment 40% Proportion (%) of respondents 30% 20% 10% 0% Primary Source of Advice Abt Associates | pg 18
Madagascar: Primary sources of advice or treatment 40% Proportion (%) of respondents 30% 20% 10% 0% Primary Source of Advice Abt Associates | pg 19
Madagascar: Sources of Information about Zinc (Zinc Users) 35% Proportion (%) of respondents 30% 25% 20% 15% 10% 5% 0% Source of zinc information Abt Associates | pg 20
Madagascar: Source of zinc Source of zinc treatments by type of program district 100% 90% 80% 70% Proportion of respondents Drug shop 60% Faith-based organization Community distributor 50% Private pharmacy Community health worker 40% Private health clinic 30% Public health clinic 20% 10% 0% MOH UNICEF POUZN1 POUZN2 Control Abt Associates | pg 21
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 Abt Associates | pg 22
Vicki_MacDonald@abtassoc.com www.shopsproject.org 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
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