MI’s approach to treating childhood diarrhoea in India: awareness, treatment and supply

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A child shows the MI-designed combi-pack containing 2 ORS sachets and 14 tablets of zinc. His mother (behind) holds the MI-developed Compliance Card for managing childhood diarrhoea.

Vibha Bharti knows she is racing against time.

The public health nurse hopes the thousands of women who visit her health centre about 20 kilometres outside the village of Ghatkusumbha in the Bihar state get to her before the rainy season. If they do, they have a far better chance of saving their children from the diarrhoea and malnutrition that too often claims lives during the heavy rains, and throughout the year.

About 200,000 Indian children under the age of five die each year due to diarrhoea, and about 23,000 of those deaths are in the Bihar state.

Local health providers like Vibha are part of the country’s Childhood Diarrhoea Management Program, developed and originally piloted by the Micronutrient Initiative and the State Government of Bihar in 15 districts, to ensure all children have access to zinc and oral rehydration salts when they suffer from diarrhoea.

Through the program, MI provides zinc and ORS to families with sick children in the region, and builds capacity by training local service providers like Vibha to deliver treatment at the village level.

MI also provides technical and logistical support to the government to manage demand and distribution of the supplements, and works to increase local awareness of the benefits of the treatment.

This logistical support is especially important when the health centres run out of supplies, as mothers in Ghatkusumbha in the Shiekhpura district know all too well.

When Rita Devi’s infant daughter Pritam fell ill with diarrhoea, the local Accredited Social Health Activist (ASHA) was able to provide two packs of oral rehydration salts and a bottle of zinc syrup, as well as guidance on how to prepare and administer the treatment.

“I was aware that the ASHA keeps medicines for treating childhood diarrhoea. Of the syrup she gave, I gave half a spoon, and the powder I mixed in a litre of water and made her drink as many times as she wanted,” says Rita Devi.

A month later, Rita’s neighbour Suhaagi Devi’s three-year-old daughter Funtoosh also got sick, but they were not so lucky. The oral rehydration salts used to treat the diarrhoea were out of stock, so Funtoosh was treated only with zinc to help boost her immunity and prevent a relapse. The ASHA could only advise Suhaagi to give Funtoosh extra fluids and feed her easily-digestible foods.

That local ORS stock depletion lasted nearly three months, a situation that simply could not continue. The Childhood Diarrhoea Management Program is helping prevent these stock shortages through MI’s efforts to streamline the zinc and ORS supply chain, and the results are encouraging.

A survey released by Johns Hopkins School of Public Health in September 2014 showed that since the program began, more people in Bihar now understand that zinc and ORS are effective in combatting diarrhoea, and as a result, more are seeking treatment. Between August 2011 and May 2014, more than 1,580,000 cases of childhood diarrhoea were reported in the 15 initial districts, and 86% of those cases were treated with zinc and ORS.

At the same time they’re tackling the supply challenges, MI is working with the health system to ramp up local awareness of the effectiveness of the treatment.

ASHA Anju Sinha says this is working, as more mothers are bringing their children to her for treatment – particularly from the more impoverished villages. She says due to the program, people now know that diarrhoea treatment is available in the village free of cost, and they come to her.

For Vibha, this increased awareness means today is a good day.

She is delighted to see the steady flow of women coming to the health centre, and leaving again with powerful little zinc and ORS packets tucked into the folds of their vibrant saris.