Proper Treatment for Diarrhea

Transcription

1 ACCELERATOR BEHAVIORS Proper Treatment for Diarrhea Caregivers provide appropriate treatment for children with diarrhea at onset of symptoms. Photo Credit: K4Health Photoshare KEY FACT: Timely and appropriate treatment for diarrhea can prevent 93% of diarrheal deaths among children. 1 WHAT IS TIMELY AND APPROPRIATE TREATMENT FOR DIARRHEA? Appropriately treating a child with diarrhea is an occasional behavior that needs to be practiced without hesitation at the onset of diarrhea. Proper treatment involves timely and correct use of oral rehydration salts (ORS) to prevent dehydration throughout the diarrheal episode, and daily zinc supplementation for 10 to 14 days 2,3 to reduce the severity and duration of the diarrheal episode. 4 In place of purchasing ORS, a home-based treatment of oral rehydration therapy (ORT), correctly prepared in the home, may also be used. The key steps to the practice of this behavior are: 1. Recognize the onset of diarrhea as a situation that could become a serious health risk. 2. Know the importance of ORS/ORT with a zinc supplement. 3. Know where to get ORS and zinc. In place of ORS, know how to prepare ORT at home. 4. Receive support from others in the household to obtain ORS/ORT and zinc, including transport and other logistics. 5. Obtain ORS/ORT and a full course of zinc. 6. Give the child ORS/ORT throughout the episode of diarrhea. 7. Give the child a daily zinc supplement (usually for 10 to 14 days). USAID ACCELERATOR BEHAVIORS: DIARRHEA TREATMENT Page 1

2 WHY DO WE CARE ABOUT TIMELY AND APPROPRIATE TREATMENT FOR CHILDREN WITH DIARRHEA? Diarrhea is a leading cause of mortality of children under age five. Timely and appropriate treatment for diarrhea can prevent 93% of these deaths among children. 5 Zinc, in addition to reducing the severity and duration of the diarrheal episode, also reduces the likelihood of the child experiencing another diarrheal episode for two to three months. When children with diarrhea are appropriately treated at the onset of symptoms, families experience both direct health benefits and other benefits. DIRECT HEALTH BENEFITS Diarrheal deaths Can prevent 93% of diarrheal deaths among children Pneumonia incidence Providing zinc supplements to children with diarrhea may reduce their risk of pneumonia 6 Nutritional status Reductions in the severity and duration of diarrheal episodes increases the likelihood of healthy growth in children, and use of zinc can alleviate deficiency 7 Productivity Cost savings Well-being OTHER BENEFITS Reduces the number of work days and school days missed due to illness or caring for ill children Reduces family spending on treatment, particularly when cases are addressed before they become severe Children may experience fewer episodes of diarrhea Reduces stress on the family as a result of less severe illnesses and fewer future episodes WHAT DO THE DATA TELL US? Despite its lifesaving potential, appropriate treatment for children with diarrhea at the onset of symptoms with the combination of ORS and zinc supplements is very low. USAID ACCELERATOR BEHAVIORS: DIARRHEA TREATMENT Page 2

3 INDICATOR The percentage (%) of children under five who had diarrhea in the two weeks preceding the survey and received ORS in conjunction with zinc. Please note: Until recently, most surveys did not collect data on the provision of zinc. WHY DON T CHILDREN RECEIVE TIMELY AND APPROPRIATE TREATMENT FOR DIARRHEA? Despite the life-threatening nature of diarrheal episodes in early childhood and investments in the promotion of ORS, the routine practice of appropriate treatment for diarrhea lags behind expected results. Although the challenges to practicing this behavior differ by context, a few of the more common reasons preventing proper treatment for diarrhea are: Lack of perceived benefits Caregivers do not believe that ORS is effective. Instead, they look for antibiotics or other local remedies. 8,9 Caregivers perceptions are often reinforced by doctors who treat diarrhea with intravenous fluids or antibiotics. Lack of knowledge Caregivers are unsure how to correctly prepare ORT or dispense ORS 10 and are unclear about the purpose of zinc. Social norms The commonplace occurrence of diarrhea in young children leads to caregivers acceptance and wait-and-see approach to treating diarrhea. USAID ACCELERATOR BEHAVIORS: DIARRHEA TREATMENT Page 3

4 Poor quality of care Providers do not promote the effectiveness of ORS and zinc supplements and instead dispense inappropriate treatment interventions, such as rapid intravenous rehydration or antibiotics. 11 Poor service delivery Lack of availability of ORS and zinc when caregivers want to use it leads to an unwillingness to consider it as an option for the next diarrheal episode. 12 HOW CAN WE ENABLE TIMELY AND APPROPRIATE TREATMENT FOR DIARRHEA? Enabling caregivers to seek timely and appropriate treatment for diarrhea requires programming to overcome context-specific challenges like those above. The solutions to these challenges can come from actors at different levels. The key is to enact solutions that respond to the challenges efficiently and effectively for the most people. Below are examples of actions that might enable successful practice for this behavior: Communicate using mass and interpersonal communications to highlight the importance of timely treatment, and demonstrate the use of ORS with zinc. Engage the community to promote and monitor the use of ORS and zinc for diarrhea, especially during seasons when incidence is high. Package ORS and zinc together and provide well tested pictorial instructions for mixing and administering the ORS and reminders for daily zinc supplements. Train providers to use ORS with zinc to treat diarrhea cases brought to the health facility. Put ORS with zinc on the essential medicines list to ensure a supply at public facilities. Support private pharmacies to carry and keep a stock of ORS and zinc. USAID ACCELERATOR BEHAVIORS: DIARRHEA TREATMENT Page 4

5 PROGRAM EXAMPLE: Shifting perceptions about the efficacy of a treatment and employing trusted providers to do so can improve practice remarkably. In Benin, USAID s Point-of-Use Water Disinfection and Zinc Treatment (POUZN) Project ( ) found that use of ORS and zinc supplements was lowest among caregivers who were not convinced of their effectiveness. The project implemented a multi-channel campaign (mass media and interpersonal communication) to promote the effectiveness of ORS and zinc supplements and information on their availability. From 2009 to 2011, the project recorded an increased use of ORS (40 to 58 percent) and zinc supplements (32 to 58 percent) to treat diarrhea. Usage rates for both products were highest among caregivers who could recall campaign messaging. Sixty-two percent of caregivers who gave zinc supplements to their children did so based on the recommendation of a health service provider. 13 SELECTED RESOURCES Declaration on Scaling Up Treatment of Diarrhea and Pneumonia: Launched in September 2005, the 5-year-long Point-of-Use Water Disinfection and Zinc Treatment Project works globally to mobilize the private sector to introduce low-cost point-of-use (POU) water treatment products for diarrhea prevention and zinc together with oral rehydration fluids for the treatment of diarrhea among children under five. Credit: Vicki MacDonald WHO/UNICEF Joint Statement on Clinical Management of Acute Diarrhea: CDC Factsheet on Global Diarrhea: 1 Munos M, Fischer Walker C.L., Black R.E. (2010). The effect of oral rehydration solution and recommended home fluids on diarrhea mortality. Int J Epidemiol; 39(1): i75 i Zinc Investigators Collaborative Group. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr 2000;72: Ibid. i. 6 Bhutta ZA, Black RE, Brown KH, et al. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr Dec; 135(6): USAID ACCELERATOR BEHAVIORS: DIARRHEA TREATMENT Page 5

6 7 Caulfield, LE, Richard, SA, Rivera, JA et al. Stunting, Wasting, and Micronutrient Deficiency Disorders. In: Philip Musgrove, and Robert E. Black.Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): World Bank; Zwisler G, Simpson E, Moodley M (2013). Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics and other therapies in Kenya and India. J of Global Health; June 2013, 3(1). 9 Stene A, MacDonald V, Mitchell S, Bishop A. (Nov. 2010). Social Marketing Plus for Diarrheal Disease Control: Point-of-Use Water Disinfection and Zinc Treatment (POUZN) Project Bethesda, MD: Point-of-Use Water Disinfection and Zinc Treatment (POUZN) Project, Abt Associates. 10 Understanding the Role of mhealth and Other Media Interventions for Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries: An Evidence Review, Elizabeth S. Higgs, Allison B. Goldberg, Alain B. Labrique, Stephanie H. Cook, Carina Schmid, Charlotte F. Cole, Rafael A. Obregón; Journal of Health Communication, Vol. 19, Iss. sup1, Caregiver Behavior Change for Child Survival and Development in Low- and Middle-Income Countries: An Examination of the Evidence John P. Elder, Willo Pequegnat, Saifuddin Ahmed, Gretchen Bachman, Merry Bullock, Waldemar A. Carlo, Venkatraman Chandra-Mouli, Nathan A. Fox, Sara Harkness, Gillian Huebne, Joan Lombardi, Velma McBride Murry, Allisyn Moran, Maureen Norton, Jennifer Mulik, Will Parks, Helen H. Raikes, Joseph Smyser, Caroline Sugg, Michael Sweat; Journal of Health Communication, Vol. 19, Iss. sup1, Charyeva, Z., Cannon, M., Oguntunde, O., et al. Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria. Journal of Health, Population and Nutrition Sanders, Emily, Kathryn Banke, Julie Williams, and Vicki MacDonald Introducing Zinc through the Private Sector in Benin: Evaluation of Caregiver Knowledge, Attitudes and Practices, 2009 and Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates. ACCELERATE is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and is implemented under Task Order No. AID-OAA-TO by The Manoff Group, Inc. in association with Howard Delafield International, OneWorld UK, Social Impact, Inc., and Sonjara, Inc. ACCELERATE is issued through the Transform IDIQ (Contract No. AID-OAA-I ). The information on this website does not necessarily represent the views of USAID or the United States Government. USAID ACCELERATOR BEHAVIORS: DIARRHEA TREATMENT Page 6