Community Case Management of Childhood Diarrhea in a Setting with Declining Use of Oral Rehydration Therapy: Findings from Cross-Sectional Studies among Primary Household Caregivers, Kenya, 2007

Olson, Christine K.; Blum, Lauren S.; Patel, Kinnery; Oria, Prisca A.; Feikin, Daniel R.; Laserson, Kayla F.; Wamae, Annah; Bartlett, Alfred V.; Breiman, Robert F.; Ram, Pavani K.

doi:10.4269/ajtmh.2011.11-0178

Cited by 31 publications

(33 citation statements)

References 22 publications

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“…This information helps to explain findings from the cross-sectional study carried out in the same sites, which showed that caregivers who gave ORT were more likely to have sought care from a health facility than caregivers who did not give ORT. 21 In sharp contrast, in countries such as Bangladesh where more than 75% of children with diarrhea are reported to be given ORS, caregivers take initiative to obtain ORS from informal providers such as chemists and shopkeepers and to administer ORT independently and manage diarrhea episodes at home. 23 Our data highlight that because of the perceived seriousness of diarrhea illnesses in young children, the first priority of caregivers was to stop the diarrhea.…”

Section: Discussionmentioning

confidence: 99%

“…In-depth interviews were carried out with the primary caregivers of children less than five years old who had recently experienced diarrhea and were interviewed in a cross-sectional survey also implemented in Asembo and Kibera. 21 Using the positive/negative deviance approach, we used purposive sampling to identify caregivers who had used ORT and continued feeding (positive behavior) and those who did not administer ORT and did not continue feeding (negative behavior) when caring for a child during a recent diarrheal episode. Diarrhea was defined as experiencing three or more watery or loose stools over a 24-hour period.…”

Section: Methodsmentioning

confidence: 99%

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Examining the Use of Oral Rehydration Salts and Other Oral Rehydration Therapy for Childhood Diarrhea in Kenya

Blum¹,

Oria²,

Olson³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Reductions in the use of oral rehydration therapy (ORT) in sub-Saharan Africa highlight the need to examine caregiver perceptions of ORT during diarrheal episodes. Qualitative research involving group discussions with childcare providers and in-depth interviews with 45 caregivers of children < 5 years of age who had experienced diarrhea was conducted in one rural and urban site in Kenya during July–December 2007. Diarrhea was considered a dangerous condition that can kill young children. Caregivers preferred to treat diarrhea with Western drugs believed to be more effective in stopping diarrhea than ORT. Inconsistent recommendations from health workers regarding use of oral rehydration solution (ORS) caused confusion about when ORS is appropriate and whether it requires a medical prescription. In the rural community, causal explanations about diarrhea, beliefs in herbal remedies, cost, and distance to health facilities presented additional barriers to ORS use. Health communication is needed to clarify the function of ORT in preventing dehydration.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Examining the Use of Oral Rehydration Salts and Other Oral Rehydration Therapy for Childhood Diarrhea in Kenya

Blum¹,

Oria²,

Olson³

et al. 2011

The American Society of Tropical Medicine and Hygiene

Self Cite

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“…Some studies have found that maternal perception of the causes of diarrhea, perception of ORT usefulness, barriers regarding its preparation were associated with ORT use [14-16]. Other studies indicated the relationship of ORT use with maternal education, residence, income of the household and age of the patient [15,17-19]. …”

Section: Introductionmentioning

confidence: 99%

Predictors of Oral Rehydration Therapy use among under-five children with diarrhea in Eastern Ethiopia: a community based case control study

2012

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BackgroundRehydration therapy is a critical intervention to save the lives of children during the episodes of diarrhea. However, millions of children die every year due to failure to replace fluid effectively. The objective of this study was to identify the predictors of Oral Rehydration Therapy use among under-five children with diarrhea.MethodA community based unmatched case control study was conducted in Kersa district, Eastern Ethiopia, in February, 2011. The cases were 241 under-five children with diarrhea in the preceding two weeks before the survey and who had received Oral Rehydration Therapy while the controls were 253 under-five children with diarrhea in the preceding two weeks before the survey and who had not received Oral Rehydration Therapy. The cases and the controls were compared to find out the factors that were associated with the utilization of Oral Rehydration Therapy.ResultThe study revealed that caregivers’ previous experience of Oral Rehydration Therapy use (AOR = 4.05, 95% CI = 2.63–6.22), seeking advice or treatment from health facilities, (AOR = 3.25, 95% CI = 2.06–5.11) and knowledge of Oral Rehydration Therapy (AOR = 3.09, 95% CI = 1.97–4.85) were found to be the positive determinants of Oral Rehydration Therapy use. Perception of teething as a cause of diarrhea was negatively associated with the utilization of Oral rehydration Therapy (AOR = 0.61, 95% CI = 0.37–0.98).ConclusionHealth education should be strengthened on the benefit, preparation, early initiation of Oral Rehydration Therapy and the causes of diarrhea. Attention should be given to those who do not have previous experience of Oral Rehydration Therapy use and have less frequent contacts with the health facilities.

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“…Previous studies have indicated that caregivers sometimes use more than one intervention for treating diarrhea, and zinc has joined a number of interventions available to caregivers [5]. As with other interventions, zinc is not always used in isolation or just with ORS.…”

mentioning

confidence: 99%

Survey of caregivers in Kenya to assess perceptions of zinc as a treatment for diarrhea in young children and adherence to recommended treatment behaviors

Simpson¹,

Zwisler²,

Moodley³

2013

J Glob Health

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BackgroundIn 2004, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) revised their recommendations for management of acute diarrhea in children to include zinc treatment as well as oral rehydration solution (ORS). Little is known about how caregivers in low–resource settings perceive and use zinc treatment.MethodsUsing a semi–structured quantitative survey, we interviewed Kenyan caregivers who had used zinc to treat children aged 6–60 months with an episode of diarrhea during the previous 6 months. The survey asked about experience using zinc, compliance with course and dosing regimens, and the attributes of zinc compared with other treatments. We surveyed a quota sample of 100 women from several communities where zinc treatment was available, primarily through public sector providers.ResultsThe mean duration of the reference diarrhea episode was 5.3 days (95% confidence interval (CI) 4.7–5.9). Eighty–two respondents had used zinc tablets, and 18 had given zinc syrup. Among those who used tablets, 62% reported giving zinc for fewer than the recommended 10 days, with a mean of 6.8 days (95% CI 6.1–7.4 days), and 50% said they had been instructed to give zinc for 5 days or less. Also, only 55% gave the correct daily dose. When asked about other treatments, 64% of the respondents reported using antibiotics, 59% ORS, and 56% a homemade remedy. Among the zinc tablet users, 55% provided zinc as the 3rd or 4th treatment for the reference episode. Also, 75% of respondents reported receiving the zinc treatment free of charge. Caregivers reported a very high level of satisfaction with zinc treatment, with 88% indicating that zinc (either in tablet or syrup form) was their most preferred treatment.ConclusionsDespite the potential benefits of zinc for children with acute diarrhea in low–resource settings, treatment regimens remain unwieldy and unrealistic, perhaps unnecessarily. Furthermore, the availability of zinc is limited primarily to public–sector providers. Increasing access to this treatment beyond the public clinic or hospital may accelerate uptake and sustained use.

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Community Case Management of Childhood Diarrhea in a Setting with Declining Use of Oral Rehydration Therapy: Findings from Cross-Sectional Studies among Primary Household Caregivers, Kenya, 2007

Cited by 31 publications

References 22 publications

Examining the Use of Oral Rehydration Salts and Other Oral Rehydration Therapy for Childhood Diarrhea in Kenya

Examining the Use of Oral Rehydration Salts and Other Oral Rehydration Therapy for Childhood Diarrhea in Kenya

Predictors of Oral Rehydration Therapy use among under-five children with diarrhea in Eastern Ethiopia: a community based case control study

Survey of caregivers in Kenya to assess perceptions of zinc as a treatment for diarrhea in young children and adherence to recommended treatment behaviors

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