Limits...
Public sector scale-up of zinc and ORS improves coverage in selected districts in Bihar, India.

Walker CL, Taneja S, Lamberti LM, Black RE, Mazumder S - J Glob Health (2015)

Bottom Line: In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline.Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector.Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.

ABSTRACT

Background: In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in intervention districts.

Methods: We conducted baseline and endline household surveys among caregivers of children 2-59 months of age. We calculated summary statistics for household characteristics, knowledge, careseeking and treatments given to children with a diarrhea episode in the last 14 days and built logistic regression models to compare baseline and endline values.

Results: Caregivers named a public health center as an appropriate source of care for childhood diarrhea more often at endline (71.3%) compared to baseline (38.4%) but did not report increased careseeking to public sector providers for the current diarrhea episode. In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline. Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector.

Conclusion: Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.

No MeSH data available.


Related in: MedlinePlus

Districts included in the baseline and endline household coverage survey in Bihar.
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Figure 1: Districts included in the baseline and endline household coverage survey in Bihar.

Mentions: In all15 program districts of Bihar, India (Figure 1), the Micronutrient Initiative (MI) led an initiative to improve diarrhea treatment quality among various cadres of public sector health care providers. MI provided training for clinic–based medical officers (MOs) and auxiliary nurse midwives (ANMs) and for community–level Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWWs). Each provider received a one–day training; the training reviewed the evidence and rationale for using zinc and ORS for diarrhea management and outlined effective strategies to counsel patients and caregivers to ensure compliance. The program also included a system of supportive supervision for the ASHAs and AWWs. To address the issue of no ORS and zinc supplies in public sector facilities, MI procured and distributed diarrhea treatment kits (DTKs), which included 14 zinc tablets and 2 ORS sachets, to public sector facilities and providers at the start of the project. The initial DTK supplies were intended to treat all cases of diarrhea among children <5 years of age for a 9–12–month period in each facility. The quantity of DTKs was estimated based on past case load. The MI kits were distributed during training and lasted until mid–2013 at which point the Bihar state government took responsibility for procuring the zinc and ORS products. The shift in product procurement and distribution was part of the original program design to ensure public sector sustainability.


Public sector scale-up of zinc and ORS improves coverage in selected districts in Bihar, India.

Walker CL, Taneja S, Lamberti LM, Black RE, Mazumder S - J Glob Health (2015)

Districts included in the baseline and endline household coverage survey in Bihar.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4544234&req=5

Figure 1: Districts included in the baseline and endline household coverage survey in Bihar.
Mentions: In all15 program districts of Bihar, India (Figure 1), the Micronutrient Initiative (MI) led an initiative to improve diarrhea treatment quality among various cadres of public sector health care providers. MI provided training for clinic–based medical officers (MOs) and auxiliary nurse midwives (ANMs) and for community–level Accredited Social Health Activists (ASHAs) and Anganwadi Workers (AWWs). Each provider received a one–day training; the training reviewed the evidence and rationale for using zinc and ORS for diarrhea management and outlined effective strategies to counsel patients and caregivers to ensure compliance. The program also included a system of supportive supervision for the ASHAs and AWWs. To address the issue of no ORS and zinc supplies in public sector facilities, MI procured and distributed diarrhea treatment kits (DTKs), which included 14 zinc tablets and 2 ORS sachets, to public sector facilities and providers at the start of the project. The initial DTK supplies were intended to treat all cases of diarrhea among children <5 years of age for a 9–12–month period in each facility. The quantity of DTKs was estimated based on past case load. The MI kits were distributed during training and lasted until mid–2013 at which point the Bihar state government took responsibility for procuring the zinc and ORS products. The shift in product procurement and distribution was part of the original program design to ensure public sector sustainability.

Bottom Line: In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline.Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector.Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.

View Article: PubMed Central - PubMed

Affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.

ABSTRACT

Background: In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in intervention districts.

Methods: We conducted baseline and endline household surveys among caregivers of children 2-59 months of age. We calculated summary statistics for household characteristics, knowledge, careseeking and treatments given to children with a diarrhea episode in the last 14 days and built logistic regression models to compare baseline and endline values.

Results: Caregivers named a public health center as an appropriate source of care for childhood diarrhea more often at endline (71.3%) compared to baseline (38.4%) but did not report increased careseeking to public sector providers for the current diarrhea episode. In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline. Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector.

Conclusion: Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.

No MeSH data available.


Related in: MedlinePlus