A retrospective mixed-methods evaluation of a national ORS and zinc scale-up program in Uganda between 2011 and 2016

Lam, Felix; Kirchhoffer, Damien; Buluma, Dennis Mike; Kabunga, Lorraine; Wamala-Mucheri, Patricia; Schroder, Kate; Battu, Audrey

doi:10.7189/jogh.09.010504

Cited by 6 publications

(10 citation statements)

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“…A comprehensive program addressing policy, supply, and demand barriers have been proven successful in other contexts as well, such as Bangladesh, India, Nepal, Nigeria, and Uganda. [16-21] In particular, introduction of co-packaged ORS and zinc in public sector facilities likely accelerated uptake of the combined treatment. The combination of ORS and zinc is the optimal treatment for diarrhea, and co-packaging is a novel approach to increase the likelihood that both treatments are offered together.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016

Lam

Wentworth

Cherutich

et al. 2019

Journal of Global Health

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Background In Kenya, diarrheal disease is the second leading cause of death among children under five. The Government of Kenya launched a national plan to increase coverage of oral rehydration solution (ORS) and zinc by addressing demand and supply-side barriers. This study evaluates progress of ORS and zinc uptake in Kenya according to the national plan from 2011 to 2016. Methods In 2016, we conducted a nationally representative population-based household survey to estimate coverage of ORS and zinc for treatment of diarrhea cases among children under five. We also used ORS and zinc coverage data from the two most recent Kenya Demographic and Health Surveys in 2008/09 and 2014 to estimate annual changes in coverage rates during the program period. Based on these inputs, we used the Lives Saved Tool to estimate the number of diarrhea deaths averted between 2011 and 2016 due to increased use of ORS and zinc. Results The 2016 survey results showed that ORS coverage was 42% (95% confidence interval (CI) = 38%, 47%) and zinc coverage was 18% (95% CI = 15%, 23%). The estimated coverage for the combined use of ORS and zinc was 15% in 2016 (95% CI = 12%, 19%). Compared to 2011, an additional 3340 (sensitivity bounds = 2 670, 3 920) diarrhea deaths among children under five were averted due to increases in ORS and zinc coverage. Conclusions Kenya was successful in catalyzing uptake of combined treatment with ORS and zinc, which rose from 0.8% in 2011 to 15% in 2016. Ongoing efforts are necessary to further build on these gains.

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Section: Discussionmentioning

confidence: 99%

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016

Lam

Wentworth

Cherutich

et al. 2019

Journal of Global Health

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“…Design , quality and packaging (intervention characteristics) . Our research uncovered studies citing both negative and positive factors relating to the design and packaging of ORS [ 40 , 41 , 45 , 71 , 73 ] and its method of packaging [ 41 , 71 , 73 ], respectively. Concerning the design of the product, studies in Papua New Guinea and Nicaragua cited taste as a barrier [ 40 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…These 2 studies mentioned children’s aversion to ORS; its unpleasant taste negatively impacted its uptake [ 40 , 45 ]. In contrast, 3 studies cited the method of packaging of the product as a facilitator to its implementation of ORS [ 41 , 71 , 73 ]. When ORS is packaged either separately or co-packaged with zinc in pouches, all containing instructional messages for the intended user, it ensues various benefits to the user, and is therefore a facilitator.…”

Section: Resultsmentioning

confidence: 99%

“…When ORS is packaged either separately or co-packaged with zinc in pouches, all containing instructional messages for the intended user, it ensues various benefits to the user, and is therefore a facilitator. Benefits of this packaging method include higher dissemination of information, better adherence to the treatment course, and increases in product uptake [ 41 , 71 , 73 ], which are also associated with lower utilization of unnecessary drugs and fluids [ 73 ].…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review

et al. 2021

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Background Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. Methods A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. Conclusion A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. Registration A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).

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“…Apart from the WelTel initiative, other public mobile health programs in Kenya include the Integrated Disease Surveillance Response that monitors disease occurrence in remote settings. The Clinton Health Access Initiative that focuses on increasing accessibility to mHealth technologies for individuals affected by HIV (Lam et al, 2019). The AMREF Jamii Smart initiative aims at developing mobile health devices and applications to improve maternal and child healthcare.…”

Section: Existing Methods Used To Integrate Mobile Wearable Devices and Cloud Computing In Health Carementioning

confidence: 99%

Integration of Smart Wearable Devices and Cloud Computing in the Kenyan Public Health Care System

2021

IKM

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The utilization of smart wearable devices and cloud computing in the Kenyan public health care system will facilitate real-time patient monitoring and management. The shortage of certified healthcare professionals and the limited access to quality specialized care for individuals in remote settings has prompted the adoption of wearable devices and cloud computing strategies in Kenya. However, there lacks a clear framework design of integrating the technologies in the public health sector. This article evaluates the current status of healthcare systems in Kenya. It also investigates the existing mobile health and cloud computing services in the country while evaluating the main legal concerns inherent to the utilization of the technologies. The document further outlines a framework design for a mobile application named GB Health. The application incorporates cloud computing and smart wearable devices in the Kenyan public health care system. The design will enhance workflow and patient outcomes in the sector.

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A retrospective mixed-methods evaluation of a national ORS and zinc scale-up program in Uganda between 2011 and 2016

Cited by 6 publications

References 12 publications

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016

Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review

Integration of Smart Wearable Devices and Cloud Computing in the Kenyan Public Health Care System

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