What influences utilization of zinc: Results from Nepal

Background:

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.

Method:

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.

Results:

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.

Recommendation:

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.