National Scale-up of Zinc Promotion in Nepal: Results from a Post-project Population-based Survey

Abstract

The World Health Organization and the United Nations Children's Fund recommend using a new oral rehydration solution (ORS) plus zinc supplementation for 10-14 days for the treatment of diarrhoea in children aged less than five years. The Social Marketing Plus for Diarrhoeal Disease Control: Point of Use Water Disinfection and Zinc Treatment (POUZN) project in Nepal was one of the first zinc-promotion projects to move beyond pilot efforts into a scaled-up programme with national-level reach. This study used data from a survey conducted in 26 districts in Nepal in 2008 to examine zinc-use behaviour, knowledge, and beliefs of caregivers of children aged less than six years, other diarrhoea-treatment practices, and recollection of project communication messages. The results of the survey indicated that, by six months following the onset of a zinc-promotion campaign, the majority (67.5%) of children (n=289), aged less than six years, with diarrhoea were treated with ORS, and 15.4% were treated with zinc. Over half (53.1%) of all caregivers (n=3,550) interviewed had heard about zinc products; most (97.1%) of those who had heard of zinc knew that zinc should be used for the treatment of diarrhoea. Zinc-related knowledge and behaviours were positively associated with recall of communication messages. Children whose caregivers recalled the mass-media message that zinc should be used for 10 days [odds ratio (OR)=2.02, 95% confidence interval (CI) 1.85-2.19] and whose caregivers perceived that zinc is easy to obtain (OR=1.76, 95% CI 1.49-2.09) were more likely to be treated with zinc for 10 days, along with ORS. The findings demonstrated that mass media play an important role in increasing caregivers’ knowledge about zinc and encouraging trial and correct use. Future efforts should also focus on understanding the factors that motivate providers to continue recommending antibiotics and antidiarrhoeals instead of zinc. These findings are being used for informing the design and implementation of zinc programmes in other developing countries with a high prevalence of diarrhoea.

High Dose Zinc Supplementation Induces Hippocampal Zinc Deficiency and Memory Impairment with Inhibition of BDNF Signaling

“…To prevent the occurrence of zinc deficit, zinc fortification and supplementation is widely used, especially in the youth in developed countries [3]. Zinc supplement is also prevalent in the treatment of diarrhea and pneumonia in the children [4], [5], [6]. Thus, in condition when mean dietary zinc intake derived from food alone is higher than the minimum recommendation [7], [8], young zinc supplement users may be at a risk for excessive intake of zinc.…”

Zinc Supplementation in Public Health

“…Challenges included: (1) the caregiver's perception of diarrhea - in contrast to malaria - as a mild illness for which local remedies already exist, and (2) the confusion with malaria when diarrhea infections were accompanied by fever. Childhood illnesses often present with more than one symptom, for instance diarrhea and fever or diarrhea and cough, and this has to be taken into account [47]. A post-project survey of a large-scale zinc promotion project in Nepal (POUZN) and the final report of the multi-country initiative also highlight the need to change caregiver attitudes, the demand side of the provider-client relation [47,48].…”

“…Childhood illnesses often present with more than one symptom, for instance diarrhea and fever or diarrhea and cough, and this has to be taken into account [47]. A post-project survey of a large-scale zinc promotion project in Nepal (POUZN) and the final report of the multi-country initiative also highlight the need to change caregiver attitudes, the demand side of the provider-client relation [47,48]. Other large-scale programs have tested other strategies such as diarrhea treatment kits including zinc supplements in Cambodia [49].…”

Role of Zinc in childhood diarrhea management: a case of Nepal

“…Another study on zinc promotion in Nepal reported that 67.5% of children aged less than six years with diarrhea were treated with ORS, and 15.4% were treated with zinc after six month of campaign. [17] …”