A recent article published in the Journal of Global Health reported that the worldwide deaths from childhood diarrhea have declined over the past decades, but still accounts for a total of half a million per year. A major contributor to this decline has been the use of oral rehydration solution (ORS) to both treat and prevent dehydration from diarrhea.

The authors stated that it was in 1968, that the scientific basis of glucose facilitated sodium absorption that led to ORS was first published. Ten years later in 1978, the World Health Organization (WHO) launched the global diarrheal control program with ORS at its heart, and ORS was hailed as “potentially the most important medical advance” of the 20th century. After rapid scale-up of ORS use from 1980 with support from the WHO and other international agencies, ORS is now used for treatment in about one-third of diarrhea episodes.

A second advance in diarrhea treatment was the demonstration that oral zinc would shorten the duration and severity of diarrhea. The use of zinc for treatment of all childhood diarrhea was recommended by WHO and UNICEF in 2004. Although, nearly all low-income and lower-middle income countries have incorporated zinc in their national diarrhea treatment guidelines, the use in these countries has been low. There lies an opportunity for greater reduction in childhood diarrhea mortality, if greater coverage of ORS and zinc for diarrhea treatment could be achieved.

Recent efforts to promote use of ORS and zinc for diarrhea treatment in some countries show that substantial progress is possible and provide important lessons for other countries. In six districts in the state of Gujarat and twelve district of Uttar Pradesh, a pilot program – Diarrhea Alleviation through Zinc Therapy (DAZT), during 2011-2014 trained and supported public sector providers; made individual educational visits (”drug detailing”) to private providers—including the informal rural practitioners who provide the majority of care; and worked to ensure a supply of ORS and zinc at community level. In the Gujarat districts, ORS use increased from 15% to 40% and use of both ORS and zinc increased from 2% to 18%. Whereas, in the districts of Uttar Pradesh, ORS use remained at only 20% and zinc use only increased to 7%.

The CHAI program enhanced and scaled-up the DAZT program to the 22 districts in Gujarat and 39 districts of Uttar Pradesh, as well as the entire state of Madhya Pradesh. In particular, the program expanded the drug detailing to providers, established a more efficient and profitable supply chain for ORS and zinc and worked with the public sector in training and support of diarrhea treatment in health facilities and in the community. Importantly, CHAI also implemented a multi-channel mass media campaign targeting caregivers, filling a gap in demand creation in the previous program. This program was able to increase combined ORS and zinc use to 28% in Gujarat, 32% in Madhya Pradesh, and to a lesser extent in Uttar Pradesh where combined use reached 12% (although ORS use did increase to 44%).

This article summarized that experiences in India show the value of integrated approaches targeting public and private sectors involving both creation of demand for treatment and supply throughtrained and motivated providers and available commodities. The findings build on an existing body of evidence in what works in scaling up zinc and ORS.

Source: Journal of Global Health. 2019 Jun; 9(1): 010101. Published online 2019 Jan 22. doi: 10.7189/09.010101