Zinc Programs and the Antimicrobial Dilemma: Continued Inappropriate Treatment of Uncomplicated Pediatric Diarrhea in Benin, Ghana, and Uganda
Kathryn Banke *
Abt Associates Inc., Bethesda, MD, USA.
Vicki MacDonald
Abt Associates Inc., Bethesda, MD, USA.
Emily Sanders
Abt Associates Inc., Bethesda, MD, USA.
Marianne El-Khoury
Abt Associates Inc., Bethesda, MD, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: WHO/UNICEF recommend zinc plus oral rehydration solution as the first-line treatment for uncomplicated pediatric diarrhea. We conducted research in Benin, Ghana, and Uganda to determine the magnitude of incorrect management of uncomplicated pediatric diarrhea and examine possible reasons for this ongoing challenge to zinc programs.
Methods: USAID's SHOPS project used a multi-stage sampling approach to survey caregivers of children under five with diarrhea in Benin (n=392), Ghana (n=754), and Uganda (n=803). We also surveyed convenience samples of providers in Benin (n=60) and Uganda (n=71).
Results: Many children were incorrectly treated with antimicrobials (20% in Benin, 62% in Ghana, and 36% in Uganda). Even children correctly treated with zinc often received antimicrobials (29% in Benin; 21% in Uganda). The majority (59.8%) of caregivers in Ghana who gave antimicrobials incorrectly to their children stated that it was because a provider gave them. In Uganda, over half (52.5%) of caregivers who treated with antimicrobials said it was because the provider recommended them. However, providers reported that caregivers frequently request antimicrobials (58% in Uganda and 36% in Benin), and 21% of Ugandan providers who do not recommend zinc said that it was because of caregiver preference for antimicrobials. Many providers in Benin (53%) and Uganda (35%) stated they believed zinc is only a nutritional supplement and not an effective diarrhea treatment.
Conclusions: Both caregivers and providers likely play roles in the continuing incorrect use of antimicrobials to treat uncomplicated pediatric diarrhea. Zinc programs must explore ways to reduce both consumer demand and provider recommendation/prescription of antimicrobials.