Dataset Information

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016.

ABSTRACT:

Background

In Kenya, diarrheal disease is the second leading cause of death among children under five. The Government of Kenya launched a national plan to increase coverage of oral rehydration solution (ORS) and zinc by addressing demand and supply-side barriers. This study evaluates progress of ORS and zinc uptake in Kenya according to the national plan from 2011 to 2016.

Methods

In 2016, we conducted a nationally representative population-based household survey to estimate coverage of ORS and zinc for treatment of diarrhea cases among children under five. We also used ORS and zinc coverage data from the two most recent Kenya Demographic and Health Surveys in 2008/09 and 2014 to estimate annual changes in coverage rates during the program period. Based on these inputs, we used the Lives Saved Tool to estimate the number of diarrhea deaths averted between 2011 and 2016 due to increased use of ORS and zinc.

Results

The 2016 survey results showed that ORS coverage was 42% (95% confidence interval (CI)?=?38%, 47%) and zinc coverage was 18% (95% CI?=?15%, 23%). The estimated coverage for the combined use of ORS and zinc was 15% in 2016 (95% CI?=?12%, 19%). Compared to 2011, an additional 3340 (sensitivity bounds?=?2 670, 3 920) diarrhea deaths among children under five were averted due to increases in ORS and zinc coverage.

Conclusions

Kenya was successful in catalyzing uptake of combined treatment with ORS and zinc, which rose from 0.8% in 2011 to 15% in 2016. Ongoing efforts are necessary to further build on these gains.

SUBMITTER: Lam F

PROVIDER: S-EPMC6608604 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Publications

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016.

Lam Felix F Wentworth Leslie L Cherutich Peter P Migiro Santau S Abdala Khadija K Musyoka Michael M Ogolla Samuel S Obudho McDonald M Mwangi Zachary Z Kihoto Rosemary R Cheruiyot Collins C Wariari Betty B Battu Audrey A Schroder Kate K

Journal of global health 20190601 1

<h4>Background</h4>In Kenya, diarrheal disease is the second leading cause of death among children under five. The Government of Kenya launched a national plan to increase coverage of oral rehydration solution (ORS) and zinc by addressing demand and supply-side barriers. This study evaluates progress of ORS and zinc uptake in Kenya according to the national plan from 2011 to 2016.<h4>Methods</h4>In 2016, we conducted a nationally representative population-based household survey to estimate cover ...[more]

PMID: 31293782

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Project description:Background:The Clinton Health Access Initiative implemented a program from 2012-2016 to increase use of oral rehydration salts (ORS) and zinc to treat diarrhea in children under five in three states in India: Gujarat, Madhya Pradesh, and Uttar Pradesh. The program interventions included detailing and development of a rural supply chain to reach private rural health care providers, training of Accredited Social Health Activists (ASHAs), technical support to the state governments, and a mass media campaign targeted at caregivers. In Gujarat and Uttar Pradesh, some of the program activities, such as detailing and ASHA trainings, were targeted to high-burden focal districts, thus providing an opportunity to study their effect compared to statewide activities that covered all districts, such as the mass media campaign. Our study aimed to estimate the effect of activities on ORS and zinc use. Methods:Household surveys were conducted at two points during the program and in both focal and non-focal districts. We used a difference-in-difference quasi-experimental approach to estimate the effect of the enhanced activities in focal districts and mass media campaign on the odds of a child being treated with ORS and zinc. Findings:Focal district interventions were associated with a significant increase in the odds of a diarrhea episode receiving ORS in Gujarat and Uttar Pradesh. Living in focal districts increased the odds of receiving ORS in Gujarat and Uttar Pradesh by factors of 3.42 (95% CI?=?1.39-8.33) and 2.29 (95% CI?=?1.19-4.39), respectively. Focal district interventions were also associated with 15.02 (95% CI?=?2.97-75.19) greater odds of receiving both ORS and zinc in Gujarat. In Uttar Pradesh, where the mass media campaign was focused, exposure to the campaign further modified the odds of receiving ORS and combined ORS and zinc by 1.38 (95% CI?=?1.04-1.84) and 1.57 (95% CI?=?1.01-2.46), respectively. Conclusion:Comprehensive public and private provider interventions combined with mass media are effective strategies for increasing ORS and zinc use.

Project description:AimThis paper aims to identify factors that systematically predict why some countries that have tried to scale up oral rehydration solution (ORS) have succeeded, and others have not.MethodsWe examined ORS coverage over time, across countries, and through case studies. We conducted expert interviews and literature and data searches to better understand the history of ORS scale-up efforts and why they failed or succeeded in nine countries. We used qualitative, pairwise (or three-country) comparisons of geographically or otherwise similar countries that had different outcomes in terms of ORS scale-up. An algorithm was developed which scored country performance across key supply, demand and financing activities to quantitatively assess the scale-up efforts in each country.ResultsThe vast majority of countries have neither particularly low nor encouragingly high ORS use rates. We observed three clearly identifiable contrasts between countries that achieved and sustained high ORS coverage and those that did not. Key partners across sectors have critical roles to play to effectively address supply- and demand-side barriers. Efforts must synchronize demand generation, private provider outreach and public sector work. Many donor funds are either suspended or redirected in the event of political instability, exacerbating the health challenges faced by countries in these contexts. We found little information on the cost of scale-up efforts.ConclusionsWe identified a number of characteristics of successful ORS scale-up programs, including involvement of a broad range of key players, addressing supply and demand generation together, and working with both public and private sectors. Dedicated efforts are needed to launch and sustain success, including monitoring and evaluation plans to track program costs and impacts. These case studies were designed to inform programmatic decision-making; thus, rigorous academic methods to qualitatively and quantitatively evaluate country ORS scale-up programs might yield additional, critical insights and confirm our conclusions.

Project description:BackgroundIn Bangladesh, pharmacy-purchased oral rehydration solution (ORS) is often used to treat diarrhea, including cholera. Over-the-counter sales have been used for epidemiologic surveillance in the past, but rarely, if ever, in low-income countries. With few early indicators for cholera outbreaks in endemic areas, diarrhea-related product sales may serve as a useful surveillance tool.Methodology/principal findingsWe tracked daily ORS sales at 50 pharmacies and drug-sellers in an urban Bangladesh community of 129,000 for 6-months while simultaneously conducting surveillance for diarrhea hospitalizations among residents. We developed a mobile phone based system to track the sales of ORS and deployed it in parallel with a paper-based system. Our objectives were to determine if the mobile phone system was practical and acceptable to pharmacists and drug sellers, whether data were reported accurately compared to a paper-based system, and whether ORS sales were associated with future incidence of cholera hospitalizations within the community. We recorded 47,215 customers purchasing ORS, and 315 hospitalized diarrhea cases, 22% of which had culture-confirmed cholera. ORS sales and diarrhea incidence were independently associated with the mean daily temperature; therefore both unadjusted and adjusted models were explored. Through unadjusted cross-correlation statistics and generalized linear models, we found increases in ORS sales were significantly associated with increases in hospitalized diarrhea cases up to 9-days later and hospitalized cholera cases up to one day later. After adjusting for mean daily temperature, ORS was significantly associated with hospitalized diarrhea two days later and hospitalized cholera one day later.Conclusions/significancePharmacy sales data may serve as a feasible and useful surveillance tool. Given the relatively short lagged correlation between ORS sales and diarrhea, rapid and accurate sales data are key. More work is needed in creating actionable algorithms that make use of this data and in understanding the generalizability of our findings to other settings.

Dataset Information

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016.

Background

Methods

Results

Conclusions

Publications

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016.

Similar Datasets

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