BackgroundDiarrheal disease is a leading cause of morbidity and mortality among children under five. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries. This study surveyed caregivers and health care providers in India and Kenya to gather information about perceptions and use of various diarrhea treatments, assess reasons for low ORS use, and identify opportunities for expanding ORS use.MethodsThe project team conducted two rounds of semi–structured, quantitative surveys with more than 2000 caregivers in India and Kenya in 2012. A complementary survey covered more than 500 pharmacy staff and health care workers in both countries. In Kenya, the team also surveyed rural pharmacies to gather pricing and sales data.ResultsAlthough caregivers generally had very positive perceptions of ORS, they typically ranked antibiotics ahead of ORS as the strongest medicine for diarrhea (in India 62% ranked antibiotics first and 23% ranked ORS first, n = 404; in Kenya results were 55% and 29%, n = 401). Many caregivers had misconceptions about the purpose and effectiveness of various treatments. For example, most caregivers who gave ORS at last episode expected it to stop their child’s diarrhea (65% in India, n = 190; 73% in Kenya, n = 154). There were noteworthy differences between India and Kenya in the selection and sourcing of treatments. Much of the money spent by families during the last episode of diarrhea was for inappropriate treatments. This was especially true in India, where rural households typically spent US$ 2.29 (median for the 79% of rural households that paid for health care services or treatments, n = 199) with most of this going to pay fees of private health workers and/or for antibiotics.ConclusionsCaregivers’ primary treatment goal is to stop diarrhea, and many believe that antibiotics or ORS will accomplish this goal. Inappropriate treatment – and especially overuse of antibiotics – is common. Satisfaction with ORS is high, but dosing is a challenge for caregivers. The results provide valuable insight into treatment behaviors and suggest significant opportunities to enhance use of ORS in developing countries.
This study looked at the effects of select behavior change interventions on the purchase and the correct and consistent use of a locally fabricated top-lit updraft (TLUD) stove in Uganda. Behavior change interventions included training of community sales agents and village health team volunteers on household air pollution and correct use, referral of interested community members to sales agents, community cooking demonstrations, information flyers, and direct sales of TLUDs and processed wood. Qualitative and quantitative research methods shaped interventions and were used to understand attitudes and practices related to TLUD stove acquisition and use. Results showed that TLUDs were appreciated because they use wood efficiently, cook quickly, reduce smoke, and produce charcoal. However, the substantial purchase price barrier, combined with the cost of processed wood, effectively eliminated the cost savings from its significant fuel efficiency. This made it difficult for the TLUD to be a meaningful part of most households' cooking practices.
BackgroundIn 2004, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) revised their recommendations for management of acute diarrhea in children to include zinc treatment as well as oral rehydration solution (ORS). Little is known about how caregivers in low–resource settings perceive and use zinc treatment.MethodsUsing a semi–structured quantitative survey, we interviewed Kenyan caregivers who had used zinc to treat children aged 6–60 months with an episode of diarrhea during the previous 6 months. The survey asked about experience using zinc, compliance with course and dosing regimens, and the attributes of zinc compared with other treatments. We surveyed a quota sample of 100 women from several communities where zinc treatment was available, primarily through public sector providers.ResultsThe mean duration of the reference diarrhea episode was 5.3 days (95% confidence interval (CI) 4.7–5.9). Eighty–two respondents had used zinc tablets, and 18 had given zinc syrup. Among those who used tablets, 62% reported giving zinc for fewer than the recommended 10 days, with a mean of 6.8 days (95% CI 6.1–7.4 days), and 50% said they had been instructed to give zinc for 5 days or less. Also, only 55% gave the correct daily dose. When asked about other treatments, 64% of the respondents reported using antibiotics, 59% ORS, and 56% a homemade remedy. Among the zinc tablet users, 55% provided zinc as the 3rd or 4th treatment for the reference episode. Also, 75% of respondents reported receiving the zinc treatment free of charge. Caregivers reported a very high level of satisfaction with zinc treatment, with 88% indicating that zinc (either in tablet or syrup form) was their most preferred treatment.ConclusionsDespite the potential benefits of zinc for children with acute diarrhea in low–resource settings, treatment regimens remain unwieldy and unrealistic, perhaps unnecessarily. Furthermore, the availability of zinc is limited primarily to public–sector providers. Increasing access to this treatment beyond the public clinic or hospital may accelerate uptake and sustained use.
BackgroundInnovations that improve the affordability, accessibility, or effectiveness of health care played a major role in the Millennium Development Goal achievements and will be critical for reaching the ambitious new Sustainable Development Goal (SDG) health targets. Mechanisms to identify and prioritize innovations are essential to inform future investment decisions.MethodsInnovation Countdown 2030 crowdsourced health innovations from around the world and engaged recognized experts to systematically assess their lifesaving potential by 2030. A health impact modeling approach was developed and used to quantify the costs and lives saved for select innovations identified as having great promise for improving maternal, newborn, and child health.ResultsPreventive innovations targeting health conditions with a high mortality burden had the greatest impact in regard to the absolute number of estimated lives saved. The largest projected health impact was for a new tool for small-scale water treatment that automatically chlorinates water to a safe concentration without using electricity or moving parts. An estimated 1.5 million deaths from diarrheal disease among children under five could be prevented by 2030 by scaling up use of this technology. Use of chlorhexidine for umbilical cord care was associated with the second highest number of lives saved.ConclusionsThe results show why a systematic modeling approach that can compare and contrast investment opportunities is important for prioritizing global health innovations. Rigorous impact estimates are needed to allocate limited resources toward the innovations with great potential to advance the SDGs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-017-0074-7) contains supplementary material, which is available to authorized users.
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