Environmental Engineering Reference
In-Depth Information
management decisions, treatment recommendations made by providers, the infl uence
of drug salesmen, and knowledge of zinc and other micronutrients; (3) the accept-
ability of the dispersible tablets and adherence to preparation instructions [12]; and (4)
a national survey in rural, urban slum, and nonslum populations to determine current
childhood diarrhea management practices, health seeking behaviors, and expenditures
[13]. These studies enabled us to reassure stakeholders that zinc treatment is safe, but
associated with a low risk of nausea and vomiting. The results from the formative stud-
ies guided the preparation of messages for caregivers and providers. On the basis of
these interviews and focus group discussions we created a frequently asked questions
data bank and a uniform set of responses (available at www.icddrb.org). From the
surveys we learned that over 90% of parents sought help from private sector provid-
ers and over 70% of the time it was with an unregulated provider (village doctor or
drug vendor). It was this information that led to the decision to focus the campaign
on caretaker decision making and availability of the zinc tablets in the private sector.
Nevertheless, all public sector district health and family welfare centers were provided
zinc tablets free of charge.
Prior to and following the national launch of the scale-up campaign, training ses-
sions in diarrhea management in line with the revised WHO/UNICEF guidelines were
conducted. These were tailored for pediatricians, general MBBS physicians, medi-
cal schools, and unregulated providers. For the latter, a 30-min training video was
prepared. The ACME drug salesmen provided verbal information and distributed a
specially prepared pamphlet to private providers.
Because the large majority of parents interviewed identifi ed TV as their primary
source of information, the marketing campaign focused on this medium, but also pre-
pared messages for radio, newspapers, billboards, and buses. In rural settings zinc
promotion additionally included the sponsoring of cultural events and courtyard meet-
ings. Four 30-sec TV advertisements were prepared, the fi rst being a “teaser” and the
other three informing listeners of Baby Zinc treatment of diarrhea. These advertise-
ments were broadcasted on Bangladesh National Television, which reaches all parts
of Bangladesh. The messages included in the mass media promotions included aware-
ness of zinc treatment for childhood diarrhea and its sanctioning by health providers
in Bangladesh. All promotional activities linked zinc treatment to the continued use of
ORS. Furthermore, as ORS is stopped once the diarrhea subsides, an additional mes-
sage to continue the zinc for a full 10 day was included. Children 6 months to 5 years
of age were targeted.
Survey Interviews
Twelve trained field research assistants divided into two teams carried out the house-
hold interviews and completed a 36-40 item questionnaire, depending upon the survey
round. Specific household management practices were documented first, followed by
knowledge questions, including the question “Prior to this illness were you aware that
zinc can be used to treat diarrhea in your child?” The recommended zinc treatment
is 20 mg/day for 10 days, either as a dispersible tablet or 5-cc syrup formulation. In
addition to asking whether zinc was used, we asked for how many days. Interviewers
carried a laminated chart with photos of all syrup and tablet formulations being sold
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