Enhancing the Uptake of ORS and Zinc

Enhancing the uptake of ORS and zinc for the treatment of diarrhea among children under-five in Bihar, Gujarat and Uttar Pradesh, India.

Diarrhea is the second leading cause of mortality among Indian children under-five. Despite recommendations by WHO/UNICEF and the Government of India, national coverage of ORS and zinc supplementation for the treatment of childhood diarrhea remains low. In the fall of 2010, the Bill and Melinda Gates Foundation funded a program with the overall goal of reducing childhood morbidity and mortality attributable to diarrhea in selected districts of Gujarat and Uttar Pradesh (UP). The Children’s Investment Fund Foundation pledged support for a parallel program in selected districts of Bihar. Both programs were designed to scale-up ORS and zinc through provider training, supply chain support and demand generation. Program activities targeted the public sector in Bihar and both the public and private sectors in Gujarat and UP. Micronutrient Initiative and FHI360 were tasked with implementation in the public and private sectors, respectively. IIP was made responsible for the program evaluation.

IIP evaluation activities have included cross-sectional household coverage surveys at baseline, midline and endline to assess the knowledge and coverage of ORS and zinc treatment for diarrhea among caregivers of children under-five. Coverage surveys were also designed to evaluate costing and equity in the states of Gujarat and UP. The evaluation team also conducted provider assessments in all three states. These were designed to gauge the ORS and zinc knowledge, attitudes and practices of public and private sector providers using direct observations of treatment consultations and questionnaires. A longitudinal sub-study is currently ongoing to measure zinc adherence among caregivers of children prescribed zinc for the treatment of diarrhea.