Effectiveness of Adding Zinc to the Current Case Management Package of Diarrhea in a Primary Health Care Setting
Condition: Diarrhea; Hospitalization
MeSH terms: Diarrhea
Study type: Interventional
Phase: Phase 1

Summary: 
      Use of zinc in diarrhea may be an effective intervention to reduce hospitalizations and child
      mortality as it could reach the most vulnerable children in a community and reduce severity
      of not only diarrhea but also of associated infections. It might also potentially reduce
      antibiotic use.

      We conducted a pilot study prior to conducting a community based controlled effectiveness
      trial to assess whether addition of zinc as a therapeutic modality for diarrhea delivered
      through existing channels, reduces visits to health care providers, antibiotic and other drug
      use, and increases ORS use during diarrhea.
    

Detailed description: 
      The pilot study was conducted in a primary health centre (population ~33000) in Faridabad
      district of the state of Haryana in India. Formative research identified perceptions of
      caregivers regarding childhood diarrhea, causation and management, care seeking sources and
      caregivers expectations from healthcare providers. Caregivers in households with children
      under 5 years old were interviewed in a cross sectional survey to ascertain family
      characteristics, ORS prescription and use rates, drug prescription rates by healthcare
      providers and other variables of interest.

      In partnership with the local government, channels for distribution of zinc and ORS packets
      were defined. The channels included physicians (at PHC and private practitioners), auxiliary
      nurse midwives (ANMs) and Anganwadi workers (AWWs)of the Integrated Child Development
      Services (ICDS) scheme. Recommendations were developed and translated into local vernacular.
      A poster, which incorporated the recommendations and pictures of zinc strip and ORS packets,
      was designed. These posters were put up at different places in the study area. All channels
      were trained and provided with the supplies of zinc strips and ORS packets except the private
      practitioners who received only zinc strips and advised caregivers to take ORS packets from
      government channels. Effectiveness of this pilot program was assessed through 2 cross
      sectional surveys, 3 and 6 months post training.

      The cross sectional surveys revealed that the prescription of syrups, tablets, powders and
      injections during diarrhea and cost of treatment decreased significantly. Prescription and
      use of ORS increased markedly. Zinc tablets were prescribed and used in about half the
      episodes 6 months after start of intervention. It was feasible to train various government
      and community channels to promote zinc as treatment of acute diarrhea through the primary
      health care system.
    

Intervention name(s): Zinc and ORS
Intervention type(s): Drug
Intervention description(s): One strip containing 14 dispersible zinc tablets (20 mg each) along with 2 ORS packets were prescribed to all children aged 1 month to 5 years visiting that channel with diarrhea.
Infants aged less than 6 months were advised half a zinc tablet in a teaspoonful of breast milk; older children were advised 1 tablet in breast milk or clean water.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: zinc; diarrhea; hospitalization; programme