Emulating value-chains of fast-moving consumer goods to improve uptake of co-packaged ORS and zinc for childhood diarrhoea: evaluation of the ColaLife trial

Abstract

IntroductionOral rehydration salts (ORS) and zinc comprise the globally recommended treatment for diarrhoea in children aged <5 years. However, limited access contributes to low uptake of this treatment and subsequently high rates of morbidity and mortality among this age group in low-income and middle-income countries. We adopted approaches used for private-sector value-chains of fast-moving consumer-goods, involving the simultaneous stimulation of supply and demand. These approaches were applied to the introduction of an innovative co-packaged diarrhoea-treatment kit (ORSZ co-pack) to increase ORS and zinc coverage at the community level in Zambia.MethodsWe tested our approach using an observational pre–post test study design in two intervention districts in rural Zambia (Kalomo and Katete), each with a matched comparator (Monze and Petauke, respectively). We assessed the effect on coverage, of ORS and zinc as well as ORS alone, by conducting household surveys of a total of 2458 and 2477 caregivers of children aged <5 years at baseline and endline, respectively, across the four districts. We also assessed whether the source of ORS (public or private sector) changed following the intervention.ResultsBoth intervention districts experienced significant increases in coverage of ORS and zinc from <1% at baseline to 46.9% and 46.3% in Kalomo and Katete, respectively. Uptake in the comparator districts remained low at 1.7% and 0.6% in Monze and Petauke, respectively. For the secondary outcome examining ORS coverage (with or without zinc), the intervention was associated with a significant increase in Kalomo versus Monze, but not in Katete versus Petauke. There was a clear shift from the public to the private sector, and specifically to the use of the ORSZ co-pack.ConclusionImplementation of a value-chain creation approach for an innovative, over-the-counter, co-packaged diarrhoea-treatment kit can significantly improve the coverage of ORS and zinc.

Design thinking to improve rational use of oral rehydration salts: lessons from an innovative co-packaged diarrhoea treatment kit

“…Co-packaging of ORS and zinc currently remains very limited: around 43% of diarrhoea cases globally receive ORS, but only around 7% receive both ORS and zinc 16. In Zambia, estimates made prior to our intervention demonstrated zinc coverage was <1%, while coverage of sachet-based ORS was 64% 1 17. Inclusion of zinc in the novel co-packaged design process was thus essential, to align with international recommendations that children with acute diarrhoea receive both therapies3 and that ORS and zinc be co-packaged in diarrhoea treatment kits 2.…”

“…This study formed part of a broader trial and was conducted across four remote, rural districts in the Southern and Eastern Provinces of Zambia. Two districts served as intervention arms (Kalomo and Katete); each had a matched comparator district (Monze and Petauke, respectively), based on various relevant criteria (rurality, caregiver’s age/education, diarrhoea burden and access to treatment) 1…”

“…With support from the Ministry of Health, approximately 30 community health workers from the two intervention districts were trained in the product’s benefits, in giving product demonstrations, and tasked with sign-posting caregivers to participating shops. Staff in 50 and 46 village shops in Kalomo and Katete, respectively, were similarly trained 1…”

“…ORS are fundamental for the treatment of acute diarrhoea in children, restoring electrolyte balance by stimulating the intestinal sodium/glucose transporter SGLT1 and inducing fluid absorption 4. This discovery was described as potentially the most important medical advance of the 20th century and has helped save millions of lives 5 6…”

Social innovation in health: concepts and practice

“…Crowdsourcing has a group of people solve all or part of a problem, then implements or shares solutions with the public 36. Another research study used a private sector delivery system to increase coverage of oral rehydration salts and zinc for children with diarrhoea in rural Zambia 37. Finally, a research study applied a user-centred design process to iteratively cocreate a large mobile health communication programme in partnership with the British Broadcasting Corporation 38…”