Scaling up zinc for the tratment of childhood diarrhea: The Bangladesh experience

There exist several low cost and technology appropriate life saving interventions that are not coming close to meeting their potential because they have not successfully been brought to scale in developing countries. One such intervention is zinc treatment of childhood diarrhea, which has been estimated to have the potential to save 400,000 lives per year in children under five years of age. In December, 2006 the first nationwide promotion campaign of zinc as a treatment of childhood diarrhea was launched in Bangladesh. This follows the WHO/UNICEF revised recommendation to include zinc treatment in the management of any childhood diarrhea episode in populations known to have marginal or zinc deficient diets, which is the case for over one-half the world's under-five population. This campaign was supported by the Scaling Up of Zinc for Young Children (SUZY) Project. The SUZY Project included three years of pre-launch preparation that involved creating alliances with key players in the public and private sectors, technology transfer and eventual local production of a dispersible zinc tablet formulation, formative and operations research, preparation of provider and mass media promotional and training materials, and on-going national surveys to monitor impact. The research included a safety study in over 24,000 cases, documentation of diarrhea management practices, and ethnographic studies. Baseline studies found that 92% of the time a private (licensed or unlicensed) provider was sought for care of childhood diarrhea. Having this information, a strong private sector strategy with the support of the Ministry of Health and Family Welfare and the Bangladesh Pediatric Association was put in place. By 10 months following the campaign launch over 90% of urban, large city dwellers and 50% of rural caretakers were aware of zinc as a diarrhea treatment. Disparities in the actual use of zinc have been identified, with up 30% of urban, but only 10 to 15% of rural children actually receiving zinc for a diarrheal illness. There has been no negative impact on the use of ORS following the introduction of the zinc campaign. These and more updated results, as well as lessons learned will be presented.