Increasing use of zinc in the treatment of pediatric diarrhea in Benin: Lessons learned for global programs

Treatment of uncomplicated pediatric diarrhea with 10-14 days of zinc sulfate plus oral rehydration solution (ORS) could avert over 20 percent of worldwide childhood deaths. OraselZinc, a diarrhea treatment kit (zinc plus ORS), was introduced in Benin in 2008 through private sector channels. Abt Associates and Population Services International conducted population-based surveys to assess caregivers' knowledge, attitudes, and practices related to pediatric diarrhea treatment both before and following implementation of several demand and supply-side interventions. A multi-stage sampling approach was used to select caregivers of children under 5 with diarrhea in the past 2 weeks in 28 communes in Benin in 2009 (n=307) and 2011 (n=392). Zinc use increased from 31% in 2009 to 54% in 2011 (p<0.01); however, use of antibiotics also increased both overall and among zinc users. Most zinc users in 2011 (62%) treated with zinc because a provider recommended it. Zinc use was significantly correlated with recall of generic diarrhea treatment and branded OraselZinc messages. TV was a major source of messages (76% in 2011). Logistic regressions showed that exposure to OraselZinc messages (p<0.05), speaking to someone about zinc (and specifically speaking to health personnel) (p<0.05), seeking treatment from a professional health provider (p<0.05), and ability to obtain OraselZinc kits nearby (p<0.05) were significantly associated with zinc use. Few programs in the world have achieved such high zinc use rates. To maximize success, future global zinc programs should combine demand generation, provider sensitization and addressing supply side barriers to impact caregiver and provider behavior.