207402 What influences utilization of zinc: Results from Nepal

Sunday, November 8, 2009

Wenjuan Wang , Demographic and Health Research Division, ICF Macro, Calverton, MD
Vicki M. MacDonald, MPH , International Health, Abt Associates, Inc., Bethesda, MD
Susan Mitchell, MBA , International Health Area, Abt Associates, Bethesda, MD

Childhood diarrhea continues to be major cause of childhood morbidity and mortality in Nepal, affecting approximately 12% of the under five population. The most recent DHS data indicates that appropriate treatment was not given and 35% were not treated at all. Since 2006, the county launched several pilots promoting the WHO/UNICEF-recommended zinc treatment protocol. Through the USAID's POUZN project, communication campaign was implemented to increase zinc use by changing the community's knowledge, attitudes and practices related to the diarrhea treatment.

The study objectives include estimating the zinc coverage in project districts, identifying barriers of using zinc at the household level, and assessing the impact of the communication campaign in changing behaviors.


A probability sample of 3550 households was selected in 30 target districts. Caregivers of children under-five were interviewed. Rates of correct zinc use were estimated by adjusting for the sample weight to be representative the target population. Multivariate regression analysis identified influencing factors of the zinc usage. Propensity score matching was used to assess the impact of the communication campaign by reducing the selection bias.


Ninety-five percent of households had access to an improved drinking water source. Diarrhea prevalence among under-five children in the study region was lower (5.6%) than the national level (11.9%). Compared to the baseline of 0.4%, there was substantially increased level of zinc use. Among children who had diarrhea in the last two weeks, 15.4% were treated with zinc, with slightly more than half of users administering zinc treatment correctly. Community's knowledge to zinc was moderate while reacting largely positive to the effect of the zinc treatment.

Exposure to the communication messages highly increased caregivers' knowledge, favorable reactions and likelihood of using zinc. Respondents who were exposed to relevant messages were two times more likely to use zinc correctly. Favorable attitudes and better awareness of zinc sources were significantly associated with the use of zinc.


The large-scale promotion of zinc treatment needs advocacy efforts targeting diverse stakeholders. Developing effective communication behavior change strategies should be emphasized in the promotion activities.

Learning Objectives:
•To identify barriers to zinc implementation at household level •To assess the impact of communication campaign in improving child caregivers’ knowledge, attitudes and practices related to appropriate childhood diarrhea treatment •To contribute the development of an effective strategy to promote zinc as a high quality essential diarrhea treatment

Keywords: Diarrhea, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Wenjuan Wang, PhD, MHS, a researcher on international health issues works in Abt Associates Inc. She has about six years of research experience focusing on Child health, family planning and reproductive health. The health projects she has worked cover countries: Nepal, Ethiopia, Pakistan, India, Zambia, Côte d’Ivoire, Tanzania, Nigeria and China.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.