Increasing Use of Zinc for Pediatric Diarrhea Treatment in Benin: The Vital Role of Health Providers
Emily Sanders *
Abt Associates Inc, Bethesda, MD, USA.
Kathryn Banke
Abt Associates Inc, Bethesda, MD, USA.
Vicki MacDonald
Abt Associates Inc, Bethesda, MD, USA.
Julie Williams
Abt Associates Inc, Bethesda, MD, USA.
Njara Rakotonirina
Population Services International, Washington, DC, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Treatment of uncomplicated pediatric diarrhea with zinc sulfate plus ORS could avert over 20 percent of worldwide childhood deaths. Results from two household surveys evaluating 3 years of program implementation in Benin highlight the important role of caregiver-health provider interactions and contribute to a significant gap in global literature on programmatic experiences in introducing zinc.
Methods: Population-based surveys were conducted to assess caregivers' knowledge, attitudes, and practices related to pediatric diarrhea treatment at one and three years following implementation of demand and supply-side interventions accompanying the introduction of OraselZinc, a diarrhea treatment kit (containing zinc sulfate plus ORS), in Benin in 2008. A multi-stage sampling approach was used to select caregivers of children under 5 with diarrhea in the past 2 weeks in 28 communes in 2009 (n=294) and 2011 (n=392).
Results: Zinc use increased from 31% in 2009 to 54% in 2011 (p<0.01). Most zinc users in 2011 (62%) treated with zinc because a provider recommended it. Logistic regressions showed that speaking to health personnel about zinc (p<0.05) and seeking treatment from a professional health provider (p<0.05) were significantly associated with zinc use.
Conclusions: Providers are an important source of treatment information and can play a major role in encouraging use of zinc among caregivers. Educating providers about correct pediatric diarrhea treatment is vital for programs seeking to increase correct use among caregivers. Demand generation campaigns can sensitize caregivers and providers to zinc as an effective diarrhea treatment, influencing both care-seeking and prescribing behavior.