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Program evaluation of an ORS and zinc scale-up program in 8 Nigerian states

Authors :
Mohammed Abubakar
Obinna Ajeroh
Owens Wiwa
Kate Schroder
Nancy Goh
Melinda Stanley
Jason Houdek
Felix Lam
Adewale Akinjeji
Olajumoke Adekeye
Ahmad Abdulwahab
Marta R. Prescott
Nnenna Ihebuzor
Tiwadayo Braimoh
Source :
Journal of Global Health
Publication Year :
2018
Publisher :
International Global Health Society, 2018.

Abstract

Background In Nigeria, diarrhea is the second leading killer of children under five. Between 2012-2017, the Clinton Health Access Initiative, Inc. (CHAI) and the Government of Nigeria implemented a comprehensive program in eight states aimed at increasing the percentage of children under five with diarrhea who were treated with zinc and oral rehydration solution (ORS). The program addressed demand, supply, and policy barriers to ORS and zinc uptake through interventions in both public and private sectors. The interventions included: (1) policy revision and partner coordination; (2) market shaping to improve availability of affordable, high-quality ORS and zinc; (3) provider training and mentoring; and (4) caregiver demand generation. Methods We conducted cross-sectional household surveys in program states at baseline, midline, and endline and constructed logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period. Results In descriptive analysis, we found 38% (95% CI = 34%-42%) received ORS at baseline and 4% (95% CI = 3%-5%) received both ORS and zinc. At endline, we found 55% (95% CI = 51%-58%) received ORS and 30% (95% CI = 27%-33%) received both ORS and zinc. Adjusting for other covariates, the odds of diarrhea being treated with ORS were 1.88 (95% CI = 1.46, 2.43) times greater at endline. The odds of diarrhea being treated with ORS and zinc combined were 15.14 (95% CI = 9.82, 23.34) times greater at endline. When we include the interaction term to investigate whether the odds ratios between the endline and baseline survey were modified by source of care, we found statistically significant results among diarrhea episodes that sought care in the public and private sector. Among cases that sought care in the public sector, the predictive probability of treatment with ORS increased from 57% (95% CI = 50%-65%) to 83% (95% CI = 79%-87%). Among cases that sought care in the private sector, the predictive probability increased from 41% (95% CI = 34%-48%) to 58% (95% CI = 54%-63%). Conclusions Use of ORS and combined ORS and zinc for treatment of diarrhea significantly increased in program states during the program period.

Details

ISSN :
20472986 and 20472978
Volume :
9
Database :
OpenAIRE
Journal :
Journal of Global Health
Accession number :
edsair.doi.dedup.....e3842060963f809099b662eb658f2231
Full Text :
https://doi.org/10.7189/jogh.09.010502