Impact Monitoring of the National Scale Up of Zinc Treatment for Childhood Diarrhea in Bangladesh: Repeat Ecologic Surveys

Abstract

Charles Larson and colleagues find that 23 months into a national campaign to scale up zinc treatment for diarrhea in children under age 5 years, only 10% of children with diarrhea in rural areas and 20%–25% in urban/municipal areas were getting the treatment.

Diarrhea no more: does zinc help the poor? Evidence on the effectiveness of programmatic efforts to reach poorest in delivering zinc and ORS at scale in UP and Gujarat, India

“…However, findings are similar to those reported from efforts to deliver zinc at scale in Bangladesh through the Scaling Up of Zinc for Young Children (SUZY) Project [23]. SUZY activities in Bangladesh were implemented over a 3–year period (2003–2006) through public and private delivery channels, resulting in increased awareness and zinc use in four populations: city slum, city non–slum, municipal, and rural [23]. Across socioeconomic strata, SUZY activities were similarly associated with a pro–rich bias, reaching a peak of just under 30% among the least poor vs ~ 7% amongst the poorest at 7–10 months of implementation [23,24].…”

“…However, findings are similar to those reported from efforts to deliver zinc at scale in Bangladesh through the Scaling Up of Zinc for Young Children (SUZY) Project [23]. SUZY activities in Bangladesh were implemented over a 3–year period (2003–2006) through public and private delivery channels, resulting in increased awareness and zinc use in four populations: city slum, city non–slum, municipal, and rural [23].…”

“…In contrast to many analyses, which focus on one dimension of equity defined by socioeconomic status and measured by wealth quintiles [12–14], we additionally considered the distributional impacts according to gender, education, ethnicity and geography at a sub–national level by comparing UP with Gujarat ( Figure 1 ). Elsewhere the importance geography at a sub–national level [6] has been noted for diarrhea in Bangladesh. However, the constraints of DAZT program implementation to rural areas at sub–state level limited our inclusion of this added dimension.…”

“…Overall use rates mask wide disparities across wealth groups, with only 19% of the poorest and poor in India receiving ORS as compared to 43% in the highest wealth groups [4]. Further disparities in treatment and health outcomes by age, sex, education, and geography have been reported for diarrhea management in Bangladesh [6] and other child health outcomes in India [7]. …”

Bangladesh Health System and the Millennium Development Goals: Strategic Policy Options for Sustained Progress in Maternal and Child Health

“…A third priority is reducing childhood diarrhea and pneumonia through improved family and community hygiene and care practices and expanded access to appropriate treatment. Although Bangladesh is the birthplace of oral rehydration treatment (ORT), the use of zinc to treat diarrhea has been slow to develop, with only one in ten children in poor households and one in three children in wealthy households receiving both ORT and zinc [21]. Similarly, only one in four children living in the poorest households is brought to a health facility or skilled service provider when showing symptoms of an acute respiratory infection or pneumonia.…”