Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111782

Peter Winch, MD MPH¹, Kate E. Gilroy, ScM², Seydou Doumbia, MD, PhD³, Zana Daou⁴, Eric A. Swedberg, MPH⁵, Amy E. Patterson, MHS⁶, Maureen Cunningham, MPH⁷, and Robert Black, MD MPH⁶. (1) Department of International Health/Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5030, Baltimore, MD 21205, (410) 955-9854, pwinch@jhsph.edu, (2) Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, (3) Faculty of Medicine, Pharmacy and Odonto-stomatology, University of Bamako, BP 1805, Bamako, Mali, (4) Bougouni Office, Health Sector, Save the Children, U.S., B.P. 84, Bougouni, Mali, (5) Office of Health, Save the Children, US, 54 Wilton Rd, Westport, CT 06880, (6) Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, (7) Save the Children/USA, Sahel Field Office, Bamako, Mali

BACKGROUND: In a pilot study in 2004 in Bougouni District, Mali, community health workers (CHWs) who presumptively treat sick children with fever were trained on the treatment of diarrhea with zinc and ORS. This paper describes how zinc introduction affected treatment practices for febrile illnesses. METHODS: Cross-sectional household surveys were conducted in April and September 2004. Children receiving zinc were followed on days 3 and 14 in their homes. Qualitative interviews were conducted with CHWs and parents. RESULTS: Of 351 children sick during the past two weeks, 80.4% were reported to have fever, 9.4 % symptoms of lower respiratory infections, and 62.7% diarrhea. Over 80% of children with diarrhea also had fever, ARI symptoms or both. Notebooks kept by the CHWs and household follow-up of children showed many children with both fever and diarrhea were not sold an antimalarial and only received zinc treatment and ORS. Refresher training for the CHWs was immediately organized to reinforce the need to treat both fever and diarrhea. Qualitative research showed many parents and CHWs feel there is effective traditional treatment for malaria, but not for diarrhea, leading some to purchase zinc but not the antimalarial. CONCLUSIONS: Introduction of zinc treatment for diarrhea may decrease the proportion of children with fever who receive an antimalarial. The intervention package for zinc introduction in Mali is being redesigned to stress integrated management of malaria, diarrhea and pneumonia. Integrated approaches to management of sick children in the community are critical when zinc treatment is introduced.

Learning Objectives: At the conclusion of this session, the participant in this session will be able to

• Describe the benefits of zinc for the treatment of acute diarrhea in young children.
• Describe methods for monitoring the impact at the household and community levels of the introduction of zinc treatment for diarrhea.
• Explain how introduction of zinc treatment for diarrhea at the community level can affect other interventions seeking to improve the management of fever and acute respiratory infections.

Keywords: Child Health, Diarrhea

Related Web page: faculty.jhsph.edu/?F=Peter&L=Winch

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.