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

Simpson, Evan; Zwisler, Greg; Moodley, Melissa

doi:10.7189/jogh.03.010405

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…Although most Kenyan health care workers disagreed that antibiotics are the most effective treatment, approximately half of the antibiotics used by Kenyan caregivers at last episode were obtained from public facilities like those where most of the health care workers interviewed in Kenya were employed. The difficulties experienced by provider–training initiatives on treatment of pediatric diarrhea in developing countries [19] are consistent with our conclusions. Profitability also plays a role but to a lesser extent than is often imagined; for example, in Kenya the public sector provided about half of the antibiotics used to treat recent episodes of pediatric diarrhea.…”

Section: Discussionsupporting

confidence: 90%

Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

Zwisler¹,

Simpson²,

Moodley³

2013

J Glob Health

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BackgroundDiarrheal disease is a leading cause of morbidity and mortality among children under five. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries. This study surveyed caregivers and health care providers in India and Kenya to gather information about perceptions and use of various diarrhea treatments, assess reasons for low ORS use, and identify opportunities for expanding ORS use.MethodsThe project team conducted two rounds of semi–structured, quantitative surveys with more than 2000 caregivers in India and Kenya in 2012. A complementary survey covered more than 500 pharmacy staff and health care workers in both countries. In Kenya, the team also surveyed rural pharmacies to gather pricing and sales data.ResultsAlthough caregivers generally had very positive perceptions of ORS, they typically ranked antibiotics ahead of ORS as the strongest medicine for diarrhea (in India 62% ranked antibiotics first and 23% ranked ORS first, n = 404; in Kenya results were 55% and 29%, n = 401). Many caregivers had misconceptions about the purpose and effectiveness of various treatments. For example, most caregivers who gave ORS at last episode expected it to stop their child’s diarrhea (65% in India, n = 190; 73% in Kenya, n = 154). There were noteworthy differences between India and Kenya in the selection and sourcing of treatments. Much of the money spent by families during the last episode of diarrhea was for inappropriate treatments. This was especially true in India, where rural households typically spent US$ 2.29 (median for the 79% of rural households that paid for health care services or treatments, n = 199) with most of this going to pay fees of private health workers and/or for antibiotics.ConclusionsCaregivers’ primary treatment goal is to stop diarrhea, and many believe that antibiotics or ORS will accomplish this goal. Inappropriate treatment – and especially overuse of antibiotics – is common. Satisfaction with ORS is high, but dosing is a challenge for caregivers. The results provide valuable insight into treatment behaviors and suggest significant opportunities to enhance use of ORS in developing countries.

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Section: Discussionsupporting

confidence: 90%

Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

Zwisler¹,

Simpson²,

Moodley³

2013

J Glob Health

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“…Its recommend that under-five years old children should receive 10–14 days of zinc treatment for diarrhea [ 11 ]. However, an increasing number of studies are showing that adherence to zinc is unsatisfactory [ 12 – 16 ]. A study in Kenya reported that among mothers who received diarrhea treatment for their children, 62 % reported giving zinc for fewer than the recommended 10 days [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The effectiveness bundling of zinc with Oral Rehydration Salts (ORS) for improving adherence to acute watery diarrhea treatment in Ethiopia: cluster randomised controlled trial

Gebremedhin¹,

Mamo²,

Gezahign³

et al. 2016

BMC Public Health

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BackgroundPresumably bundling/co-packaging of zinc with ORS encourages the combined use of the products for diarrhea treatment; however, empirical evidences are scarce. The purpose of this work is to evaluate whether co-packing using a plastic pouch can enhance the joint adherence to the treatment or not. The study also compares the cost effectiveness (CE) of two co-packaging options: ‘central’ and ‘health center (HC)’ level bundling.MethodsThis cluster-randomised controlled trial was conducted in 2015 in eight districts of Ethiopia. Thirty two HCs were randomly assigned to one of the following four intervention arms: (i) ‘Central bundling’ (zinc and ORS bundled using a pouch that had instructional message, distributed to HCs); (ii) ‘HC level bundling’ (zinc, ORS and a similar pouch distributed to the HCs and bundled by health workers); (iii) ‘Bundling without message’ (zinc, ORS and plain pouch distributed and bundled by the health workers); and, (iv) ‘Status quo’ (zinc and ORS co-administered without bundling). In each of the four arms, 176 children 6–59 months of age, presented with acute diarrhea were enrolled. Twelve days after enrollment, level of adherence was assessed. A composite scale of adherence was developed and modeled using mixed effects linear regression analysis. The unit costs associated with the arms were estimated using secondary data sources. Incremental CE analysis was made by taking the cost and level of adherence in fourth arm as a base value.ResultsThe follow-up rate was 95.6 %. As compared with the ‘status quo’ arm, the joint adherences in the ‘central’ and ‘HC level’ bundling arms raised substantially by 14.8 and 15.7 percentage points (PP), respectively (P < 0.05). No significant difference was observed between ‘bundling without message’ and the ‘status quo’ arms. The unit cost incurred by the ‘central bundling’ is relatively higher (USD 0.658/episode) as compared with the ‘HC level bundling’ approach (USD 0.608/episode). The incremental CE ratio in the ‘central bundling’ modality was two times higher than in the ‘HC based bundling’ approach.ConclusionBundling zinc with ORS using a pouch with instructional messages increases adherence to the treatment. ‘HC level bundling’ is more CE than the ‘central bundling’ approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3126-6) contains supplementary material, which is available to authorized users.

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“…In communities in Mali in which a zinc scale–up project was underway, adherence to 14 days of therapeutic zinc was 64% and though compliance with dosage instructions was generally good (94%), one infant received more than the age appropriate daily dose of zinc [ 14 ]. A cross–sectional study of caregivers of children under–five in Kenya reported low compliance with the guidelines on both zinc treatment duration (38%) and dosage (55%), with 32% of caregivers administering more than the age appropriate daily zinc dose [ 13 ].…”

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confidence: 99%

Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under–five in Uttar Pradesh, India

Lamberti

Walker

Taneja

et al. 2015

Journal of Global Health

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BackgroundThere is limited evidence on adherence to the recommended dose and duration of zinc supplementation for diarrheal episodes in children under five years of age. In selected districts of Uttar Pradesh, India, we sought to assess adherence to the nationally advised zinc treatment regimen (ie, 10 mg/day for ages 2–6 months and 20 mg/day for ages 7–59 months for 14 days) among caregivers of zinc–prescribed children.MethodsWe identified and conducted follow–up visits to children advised zinc for the treatment of diarrhea. At the initial visit, we collected data on the treatment instructions received from providers. Caregivers were asked to record treatments administered on a pictorial tracking form and were asked to retain all packaging for collection at follow–up. We quantified the average dose and duration of zinc therapy and built logistic regression models to assess the factors associated with caregiver adherence to national guidelines.ResultsCaregivers administered zinc for an average of 10.7 days (standard deviation (SD) = 3.9 days; median = 13 days), and 47.8% continued treatment for the complete 14 days. Among children receiving zinc syrups and tablets respectively, the age appropriate dose was received by 30.8% and 67.3%. Adherence to age appropriate dose and continuation of zinc for 14 days were highly associated with having received appropriate provider instructions.ConclusionsOur results indicate moderate–to–good adherence to national zinc treatment guidelines for diarrhea among caregivers in rural India. Our findings also highlight the importance of provider guidance in ensuring adherence to zinc dose and duration. Programs aiming to scale–up zinc treatment for childhood diarrhea should train providers to successfully communicate dosing instructions to caregivers, while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

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

Cited by 11 publications

References 8 publications

Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

The effectiveness bundling of zinc with Oral Rehydration Salts (ORS) for improving adherence to acute watery diarrhea treatment in Ethiopia: cluster randomised controlled trial

Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under–five in Uttar Pradesh, India

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