Environmental Engineering Reference
In-Depth Information
Chapter 15
Bangladesh
Charles P. Larson, Unnati Rani Saha, and Hazera Nazrul
INTRODUCTION
Zinc treatment of childhood diarrhea has the potential to save 400,000 under-five
lives per year in lesser developed countries. In 2004 the World Health Organization
(WHO)/UNICEF revised their clinical management of childhood diarrhea guidelines
to include zinc. The aim of this study was to monitor the impact of the first national
campaign to scale up zinc treatment of childhood diarrhea in Bangladesh.
Between September, 2006 and October, 2008 seven repeated ecologic surveys were
carried out in four representative population strata: mega-city urban slum and urban
nonslum, municipal, and rural. Households of approximately 3,200 children with an
active or recent case of diarrhea were enrolled in each survey round. Caretaker aware-
ness of zinc as a treatment for childhood diarrhea by 10 months following the mass
media launch was attained in 90%, 74%, 66%, and 50% of urban nonslum, municipal,
urban slum, and rural populations, respectively. By 23 months into the campaign, ap-
proximately 25% of urban nonslum, 20% of municipal and urban slum, and 10% of
rural under-fi ve children were receiving zinc for the treatment of diarrhea. The scale-
up campaign had no adverse effect on the use of oral rehydration salt (ORS).
Long-term monitoring of scale-up programs identifi es important gaps in coverage
and provides the information necessary to document that intended outcomes are be-
ing attained and unintended consequences avoided. The scale-up of zinc treatment of
childhood diarrhea rapidly attained widespread awareness, but actual use has lagged
behind. Disparities in zinc coverage favoring higher income, urban households were
identifi ed, but these were gradually diminished over the 2 years of follow-up monitor-
ing. The scale up campaign has not had any adverse effect on the use of ORS.
About 1.9 million children under the age of 5 year annually die from diarrhea,
accounting for 19% of all under-fi ve mortality [1]. Clinical trials of zinc treatment in
children 6 months to 5 year of age have consistently demonstrated its ability to reduce
disease duration and severity as well as the likelihood of a repeat episode [2-4]. It has
been estimated that the successful scaling up of zinc treatment for childhood diarrhea
could potentially save 400,000 under-fi ve deaths per year [5]. In response to the cura-
tive and preventive evidence in support of zinc treatment, in 2004 WHO/UNICEF
revised their clinical management of childhood diarrhea guidelines to include zinc
treatment of any episode [6]. The present challenge is the scale up of zinc treatment
and other life-saving interventions within resource-deprived health systems with lim-
ited capacity to absorb additional services. As has been pointed out by others, efforts
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