Study proves childhood diarrhoea management pilot in Bihar, India, is working


The Accredited Social Health Activist (ASHA) explains the importance and correct dosage of Zinc & ORS for children in a mother’s meet; while the Anganwadi Worker displays MI-developed Flipcards to help mothers understand pictorially.

BIHAR, INDIA – In collaboration with State Government of Bihar, the Micronutrient Initiative has successfully piloted the Childhood Diarrhoea Management Program to ensure all children have access to zinc and oral rehydration salts (ORS) when they suffer from diarrhoea.

Using zinc and ORS to treat diarrhoea has been recognized as a critical strategy by the World Health Organization, and is supported by the Government of India’s policy on child health.

An estimated 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, an alarmingly high death rate.

The state of Bihar in northern India is among the poorest in the country, and is the most densely populated, with the majority of its citizens (85%) live in villages.

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

MI also provides technical and logistical support to the government to manage demand, procurement, distribution and inventory of the zinc and ORS. The Childhood Diarrhoea Management Program was originally introduced in 15 of 38 districts in Bihar.

In September 2014, MI and its partners proudly announced that the program is working. A survey conducted in the original 15 demonstration districts by Johns Hopkins School of Public Health showed more people in Bihar now understand that zinc and ORS are effective in combatting diarrhoea, and as a result, more will seek treatment.

Between August 2011 and May 2014, more than 1,580,000 cases of childhood diarrhoea were reported in those 15 districts, and 86% of those cases were treated with zinc and ORS. At the start of the project in August 2011, a mere 747 cases of diarrhoea were treated this way.

The study also showed:

  • 82% of parents seek care for their children with diarrhoea now, compared to 79% before the program;
  • Caregivers seeking treatment for childhood diarrhoea from the public sector has increased from 7% to 13%;
  • 20% of the population got zinc, up from 4%, and 26% of the population got ORS, up from 17%.

Micronutrient Initiative India country director Sucharita Dutta credits this change in part to the training and deployment of accredited social health activists (ASHA), who worked directly with diarrhoea cases in the 15 districts.

One of those health activists, Anju Sinha, says she sees more people coming to her to get their children treated – 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 zinc and ORS.

MI is supporting the government of Bihar to scale up the program for the entire state of Bihar, so as to see this success applied region-wide.

MI now provides technological support, training for healthcare workers and enhanced monitoring and reporting of the Childhood Diarrhoea Management Program in all 38 districts of the state of Bihar, and helps the local government ensure an ongoing supply of zinc and oral rehydration salts.

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