Zinc Treatment for Childhood Diarrhea in Bangladesh - Recent Advances and Issues in Environmental Science - page 215

mass media campaign was able to achieve high levels of awareness and probably
interest among all segments of the Bangladeshi population. Where it has fallen short
is in the transition from awareness to practice (trial and adoption). This gap highlights
an important limitation of electronic media, which does not benefi t from interpersonal
communication, thus showing the need to link mass media messages with personal
messages coming from health providers or other infl uential members of a community.
The content of the initial commercials aired in this campaign repeatedly focused on
awareness and health provider sanctioning of zinc treatment and not on household
decision making. Towards the end of the second year of the campaign the media mes-
sages were altered to encourage household level decision making and enhancing self-
effi cacy to try zinc [18]. This strategy and interpersonal communication with early
adopters of zinc treatment are expected to further increase coverage. The choice of
electronic media in this scale-up campaign was, in part, based on its previous success
in promoting the use of oral rehydration therapies (ORT) [19]. Nonetheless, ORTs and
zinc share several characteristics that make them amenable to scaling up through mass
media promotion. Both are fairly simple interventions that are easily learned and ap-
plied in the home. They are also relatively inexpensive and within the range of typical
household diarrheal illness expenditures among Bangladeshi households [13].
Early adopters of new innovations are known to be better educated, of higher in-
come status, and have greater access to mass media [17, 20]. We were able to moni-
tor adoption of zinc treatment by household wealth asset quintiles. Throughout the 2
years of follow up children from higher wealth asset households were more likely to
receive zinc treatment. At the outset of the campaign children in the highest quintile,
when compared to the lowest quintile households, were seven times more likely to
receive zinc. At the end of the second year this disparity had been reduced to less than
three times as likely. This reduction in income disparity is further illustrated by the
change in the concentration index curves from the beginning to the end of the follow-
up monitoring.
Given the preventive effects of zinc are likely to require 8-10 days of treatment,
the observation that over half of the children are receiving less than the required
amount remains an important, unmet challenge. The mass media messages did include
a parent directed reminder to give zinc for 10 days. Unfortunately, in Bangladesh drug
vendors commonly sell antibiotics and other curative medications to cover only a few
days. If a child remains ill, they return to purchase additional, often alternative, medi-
cation. Parents have little or no experience with continuing medications once their
child appears to be cured. This behavioral change challenge currently lacks adequate
scientifi c guidance.
All mass media messages in this campaign linked zinc to the use of oral saline.
This connection is important, because zinc is an adjunct to and not a replacement
for oral saline or other approved rehydration therapies. Future studies need to clarify
whether linking zinc to oral saline may lead to caregiver misunderstanding, given
they are instructed to discontinue the latter once the diarrhea subsides. Adherence
would also be improved if it could be demonstrated that shorter duration zinc treat-
ment schedules have equivalent clinical effi cacies.