Clinton Health Access Initiative, Boston, Massachusetts, USA.
Northern Arizona University, Center for Health Equity, Flagstaff, Arizona, USA.
J Glob Health. 2019 Jun;9(1):010501. doi: 10.7189/jogh.09.010501.
BACKGROUND: The Clinton Health Access Initiative implemented a program from 2012-2016 to increase use of oral rehydration salts (ORS) and zinc to treat diarrhea in children under five in three states in India: Gujarat, Madhya Pradesh, and Uttar Pradesh. The program interventions included detailing and development of a rural supply chain to reach private rural health care providers, training of Accredited Social Health Activists (ASHAs), technical support to the state governments, and a mass media campaign targeted at caregivers. In Gujarat and Uttar Pradesh, some of the program activities, such as detailing and ASHA trainings, were targeted to high-burden focal districts, thus providing an opportunity to study their effect compared to statewide activities that covered all districts, such as the mass media campaign. Our study aimed to estimate the effect of activities on ORS and zinc use. METHODS: Household surveys were conducted at two points during the program and in both focal and non-focal districts. We used a difference-in-difference quasi-experimental approach to estimate the effect of the enhanced activities in focal districts and mass media campaign on the odds of a child being treated with ORS and zinc. FINDINGS: Focal district interventions were associated with a significant increase in the odds of a diarrhea episode receiving ORS in Gujarat and Uttar Pradesh. Living in focal districts increased the odds of receiving ORS in Gujarat and Uttar Pradesh by factors of 3.42 (95% CI = 1.39-8.33) and 2.29 (95% CI = 1.19-4.39), respectively. Focal district interventions were also associated with 15.02 (95% CI = 2.97-75.19) greater odds of receiving both ORS and zinc in Gujarat. In Uttar Pradesh, where the mass media campaign was focused, exposure to the campaign further modified the odds of receiving ORS and combined ORS and zinc by 1.38 (95% CI = 1.04-1.84) and 1.57 (95% CI = 1.01-2.46), respectively. CONCLUSION: Comprehensive public and private provider interventions combined with mass media are effective strategies for increasing ORS and zinc use.
背景：克林顿健康倡议组织于 2012 年至 2016 年期间在印度的古吉拉特邦、中央邦和北方邦三个邦实施了一项计划，旨在增加五岁以下儿童使用口服补液盐（ORS）和锌来治疗腹泻的比例。该计划的干预措施包括详细规划和发展农村供应链，以覆盖私人农村医疗服务提供者，培训认证社会卫生活动家（ASHAs），为邦政府提供技术支持，以及开展针对照顾者的大众媒体宣传活动。在古吉拉特邦和北方邦，一些计划活动，如详细规划和 ASHA 培训，针对高负担的重点地区，因此提供了一个机会来研究这些活动与覆盖所有地区的全州范围的活动（如大众媒体宣传活动）相比的效果。我们的研究旨在评估这些活动对 ORS 和锌使用的影响。
方法：在项目实施期间的两个时间点以及在重点和非重点地区进行了家庭调查。我们使用了一种差异中的差异准实验方法来估计重点地区的强化活动和大众媒体宣传活动对儿童接受 ORS 和锌治疗的可能性的影响。
发现：在古吉拉特邦和北方邦，重点地区的干预措施与腹泻患儿接受 ORS 的可能性显著增加有关。在古吉拉特邦和北方邦，居住在重点地区使接受 ORS 的可能性分别增加了 3.42 倍（95%CI=1.39-8.33）和 2.29 倍（95%CI=1.19-4.39）。重点地区的干预措施还使古吉拉特邦接受 ORS 和锌的可能性增加了 15.02 倍（95%CI=2.97-75.19）。在北方邦，大众媒体宣传活动的重点是，接触该宣传活动进一步改变了接受 ORS 和同时接受 ORS 和锌的可能性，分别为 1.38 倍（95%CI=1.04-1.84）和 1.57 倍（95%CI=1.01-2.46）。
结论：全面的公共和私人提供者干预措施与大众媒体相结合是增加 ORS 和锌使用的有效策略。
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