Zinc Treatment for Childhood Diarrhea in Bangladesh - Recent Advances and Issues in Environmental Science - page 221

EDITORS' SUMMARY
Background
Diarrheal disease is a significant global health problem with approximately 4 billion
cases and 2.5 million deaths annually. The overwhelming majority of cases are in de-
veloping countries where there is a particularly high death rate among children under 5
years of age. Diarrhea is caused by bacterial, parasitic, or viral pathogens, which often
spread in contaminated water. Poor hygiene and sanitation, malnutrition, and lack of
medical care all contribute to the burden of this disease. Replacing lost fluids and salts
is a cheap and effective method to rehydrate people following dehydration caused by
diarrhea. Clinical trials show that zinc, as part of a treatment for childhood diarrhea,
not only helps to reduce the severity and duration of diarrhea but also reduces the like-
lihood of a repeat episode in the future. Zinc is now included in the guidelines by the
WHO/UNICEF for treatment of childhood diarrhea.
Why was This Study Done?
Zinc treatment together with traditional ORS therapy following episodes of diarrhea
could potentially benefit millions of children in areas where diarrheal disease is preva-
lent. The “Scaling Up of Zinc for Young Children” (SUZY) project was established
in 2003 to provide zinc treatment for diarrhea in all children under 5 years of age in
Bangladesh. The project was supported by a partnership of public, private, nongovern-
mental organization, and multinational sector agencies during its scale up to a national
campaign across Bangladesh. The partners helped to develop the scale-up campaign,
produce and distribute zinc tablets, train health professionals to provide zinc treat-
ment, and create media campaigns (such as advertisements in TV, radio, and news-
papers) to raise awareness and promote the use of zinc for diarrhea. The researchers
wanted to monitor how effective and successful the national campaign was at promot-
ing zinc treatment for childhood diarrhea. Also, they wanted to highlight any potential
problems during the implementation of health care initiatives in areas with deprived
health systems.
What Did the Researchers Do and Find?
The researchers set up survey sites to monitor results from the first 2 years of the
SUZY campaign. Four areas, each representing different segments of the population
across Bangladesh were surveyed; urban slums, urban nonslums, municipal (small
city), and rural. There are approximately 1.5 million children under the age of five
across these sites. Households in each survey site were selected at random, and seven
surveys were conducted at each site between September, 2006 and October, 2008—
about 3,200 children with diarrhea for each survey. Over 90% of parents used private
sector providers of drug treatment so the campaign focused on distribution of zinc
tablets in the private sector. They were also available free of charge in the public health
sector. The TV and radio campaigns for zinc treatment rapidly raised awareness across
Bangladesh. Awareness was less than 10% in all communities prelaunch and peaked
10 months later at 90%, 74%, 66%, and 50% in urban nonslum, municipal, urban slum,
and rural sites, respectively. However, after 23 months only 25% of urban nonslum,