Program evaluation of an ORS and zinc scale-up program in 8 Nigerian states

Abstract

Background In Nigeria, diarrhea is the second leading killer of children under five. Between 2012-2017, the Clinton Health Access Initiative, Inc. (CHAI) and the Government of Nigeria implemented a comprehensive program in eight states aimed at increasing the percentage of children under five with diarrhea who were treated with zinc and oral rehydration solution (ORS). The program addressed demand, supply, and policy barriers to ORS and zinc uptake through interventions in both public and private sectors. The interventions included: (1) policy revision and partner coordination; (2) market shaping to improve availability of affordable, high-quality ORS and zinc; (3) provider training and mentoring; and (4) caregiver demand generation. Methods We conducted cross–sectional household surveys in program states at baseline, midline, and endline and constructed logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period. Results In descriptive analysis, we found 38% (95% CI = 34%-42%) received ORS at baseline and 4% (95% CI = 3%-5%) received both ORS and zinc. At endline, we found 55% (95% CI = 51%-58%) received ORS and 30% (95% CI = 27%-33%) received both ORS and zinc. Adjusting for other covariates, the odds of diarrhea being treated with ORS were 1.88 (95% CI = 1.46, 2.43) times greater at endline. The odds of diarrhea being treated with ORS and zinc combined were 15.14 (95% CI = 9.82, 23.34) times greater at endline. When we include the interaction term to investigate whether the odds ratios between the endline and baseline survey were modified by source of care, we found statistically significant results among diarrhea episodes that sought care in the public and private sector. Among cases that sought care in the public sector, the predictive probability of treatment with ORS increased from 57% (95% CI = 50%-65%) to 83% (95% CI = 79%-87%). Among cases that sought care in the private sector, the predictive probability increased from 41% (95% CI = 34%-48%) to 58% (95% CI = 54%-63%). Conclusions Use of ORS and combined ORS and zinc for treatment of diarrhea significantly increased in program states during the program period.

Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

“…11,45 Studies have also shown that improvements in ORS coverage can be driven by changes in government policies, media campaigns, and community culture and beliefs. 2,23,24 According to our results, Sierra Leone had some of the highest ORS coverage in western sub-Saharan Africa in 2017. Sierra Leone has previously been described as an example of how community mobilisation can promote access to and awareness of ORS, even after a devastating civil war.…”

“…Furthermore, policies related to diarrhoea treatment set at the national level do not affect all subnational areas equally, and interventions are often implemented at the subnational level, such as those currently done in Nigeria and India. 23,24 Local-level estimates of ORS and RHF coverage are thus needed to identify vulnerable subpopulations most in need of increased efforts to prevent child mortality. Yet, to our knowledge, no study has estimated ORS coverage subnationally across multiple regions or has used geospatial modelling techniques to estimate ORS coverage in locations with sparse data, and no study has compared ORS coverage to patterns in RHF coverage.…”

Progress in the use of ORS and zinc for the treatment of childhood diarrhea

“…The Clinton Health Access Initiative (CHAI) during 2012 to 2016 engaged with governments, heath care providers, and communities to improve diarrhea treatment in Kenya, Uganda and selected high-mortality states of India and Nigeria [15]. The CHAI program enhanced and scaled-up the DAZT program to the 22 districts in Gujarat and 39 districts of Uttar Pradesh, as well as the entire state of Madhya Pradesh.…”

“…In the three African countries where the CHAI activities were implemented, ORS coverage at baseline ranged from 38% to 44% [15] but zinc use was negligible. The CHAI interventions included improving knowledge about appropriate treatment for caregivers via schools and community health workers and for providers via education and mentorship as well as drug detailing.…”

Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS and Zinc Scale-up Program in Eight States Across Nigeria 

“…Details on the survey design have been published elsewhere (22). Brie y, data were collected using populationbased household surveys among caregivers of children under ve and employing a random two-stage cluster sampling methodology.…”