Nutrition News for Africa
Abstract - November 15, 2006
A short report entitled “Prescription and administration
of a 14-day regimen of zinc treatment for childhood diarrhea
in Mali” was published by Winch et al. in the American
Journal of Tropical Medicine and Hygiene 74(5), 2006, pp880-883.
Globally diarrhea accounts for approximately 18% of childhood
deaths. The World Health Organization and UNICEF currently
recommend a 10 to 14-day course of zinc treatment in addition
to oral rehydration salts (ORS) for the treatment of acute
childhood diarrhea. Concerns have been raised regarding the
10- to 14-day course of zinc treatment, which is longer than
most treatment regimens. This report characterizes administration
of zinc treatment in the home in a small scale pilot study
examining operational issues associated with the introduction
of this new treatment. This report focuses on the Mali part
of a multi-center study with a pilot phase conducted in Mali,
Pakistan and India.
The project covered two health zones in Bougouni District
in Southern Mali and studied the operational impacts of zinc
introduction in health centers and in drug kits managed by
community health workers (CHW).The project trained health
center staff and CHWs in diarrhea case management, counseling
parents and recording routine data. Labels attached to the
14-count blister packages provided pictorial and written instructions
on zinc administration in Bambara, the local language. Instructions
for caretakers of children under 6 months of age were to cut
the tablet in half. The cost of zinc to the patients was 100
francs CFA (~0.19USD) for the full blister package and half
of that amount for a half-pack for children under 6-months
of age. Follow-up interviews were conducted at the home on
days 3 and 14 over a period of 8 weeks in June-August 2004.
Semi-structured qualitative interviews were also conducted
with 37 caretakers and 18 CHWs and 2 health facility nurses.
A total of 123 children received zinc, 21 at health centers
and 102 from CHWs.
The correct dose of zinc for the child’s age was prescribed
and sold by health center staff and CHWs in the majority of
cases based on interviews with parents. More than 90% of caretakers
reported that CHWs and health center staff sufficiently explained
the quantity of zinc needed, duration of treatment and alternatives
for administering the tablets. Ninety-five percent of caretakers
dissolved the zinc tablets in a small amount of water and
gave it to a child in a spoon, 4% dissolved it in a few drops
of breastmilk and only 1% reported putting the tablet directly
in the child’s mouth.
Adherence to the full 14-day regimen was high (63.6%) and
dosing was generally appropriate (94.3%). Overall, 89.3% of
children followed received at least 10 days of zinc treatment.
Community reaction to the zinc treatment was very favorable.
The authors report that the levels of correct prescription,
counseling and administration observed are higher than those
expected in a programmatic context as zinc was a newly introduced
treatment under conditions of closer than usual observation.
The authors also state that interviewers visiting households
for follow-up could also have increased the level of compliance.
The next phase of the research will examine factors affecting
administration of zinc such as who purchases the zinc, counseling
received from the health care provider, educational level
of the parents, concomitant symptoms and medications, and
side effects.
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