Clinton Health Access Initiative, Boston, Massachusetts, USA.
Clinton Health Access Initiative, Abuja, Nigeria.
J Glob Health. 2019 Jun;9(1):010502. doi: 10.7189/jogh.09.010502.
BACKGROUND: In Nigeria, diarrhea is the second leading killer of children under five. Between 2012-2017, the Clinton Health Access Initiative, Inc. (CHAI) and the Government of Nigeria implemented a comprehensive program in eight states aimed at increasing the percentage of children under five with diarrhea who were treated with zinc and oral rehydration solution (ORS). The program addressed demand, supply, and policy barriers to ORS and zinc uptake through interventions in both public and private sectors. The interventions included: (1) policy revision and partner coordination; (2) market shaping to improve availability of affordable, high-quality ORS and zinc; (3) provider training and mentoring; and (4) caregiver demand generation. METHODS: We conducted cross-sectional household surveys in program states at baseline, midline, and endline and constructed logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period. RESULTS: In descriptive analysis, we found 38% (95% CI = 34%-42%) received ORS at baseline and 4% (95% CI = 3%-5%) received both ORS and zinc. At endline, we found 55% (95% CI = 51%-58%) received ORS and 30% (95% CI = 27%-33%) received both ORS and zinc. Adjusting for other covariates, the odds of diarrhea being treated with ORS were 1.88 (95% CI = 1.46, 2.43) times greater at endline. The odds of diarrhea being treated with ORS and zinc combined were 15.14 (95% CI = 9.82, 23.34) times greater at endline. When we include the interaction term to investigate whether the odds ratios between the endline and baseline survey were modified by source of care, we found statistically significant results among diarrhea episodes that sought care in the public and private sector. Among cases that sought care in the public sector, the predictive probability of treatment with ORS increased from 57% (95% CI = 50%-65%) to 83% (95% CI = 79%-87%). Among cases that sought care in the private sector, the predictive probability increased from 41% (95% CI = 34%-48%) to 58% (95% CI = 54%-63%). CONCLUSIONS: Use of ORS and combined ORS and zinc for treatment of diarrhea significantly increased in program states during the program period.
背景：在尼日利亚，腹泻是五岁以下儿童的第二大死因。2012 年至 2017 年期间，克林顿健康倡议组织（CHAI）和尼日利亚政府在八个州实施了一项综合方案，旨在提高腹泻儿童接受锌和口服补液盐（ORS）治疗的比例。该方案通过在公共和私营部门采取干预措施，解决了 ORS 和锌的采用所面临的需求、供应和政策障碍。这些干预措施包括：（1）政策修订和伙伴协调；（2）市场塑造，以提高负担得起的高质量 ORS 和锌的供应；（3）提供者培训和指导；（4）照顾者需求的产生。 方法：我们在方案州进行了基线、中程和终期的横断面家庭调查，并构建了逻辑回归模型，采用广义估计方程来评估方案期间 ORS 和锌治疗的变化。 结果：在描述性分析中，我们发现 38%（95%CI=34%-42%）在基线时接受了 ORS，4%（95%CI=3%-5%）接受了 ORS 和锌的联合治疗。在终期，我们发现 55%（95%CI=51%-58%）接受了 ORS，30%（95%CI=27%-33%）接受了 ORS 和锌的联合治疗。在调整其他协变量后，腹泻接受 ORS 治疗的几率在终期时增加了 1.88 倍（95%CI=1.46，2.43）。腹泻接受 ORS 和锌联合治疗的几率在终期时增加了 15.14 倍（95%CI=9.82，23.34）。当我们包括交互项来调查护理来源是否改变了终期和基线调查之间的比值比时，我们发现公共和私营部门寻求护理的腹泻发作有统计学意义的结果。在公共部门寻求护理的病例中，接受 ORS 治疗的预测概率从 57%（95%CI=50%-65%）增加到 83%（95%CI=79%-87%）。在私营部门寻求护理的病例中，预测概率从 41%（95%CI=34%-48%）增加到 58%（95%CI=54%-63%）。 结论：在方案期间，方案州接受 ORS 和 ORS 联合锌治疗腹泻的比例显著增加。
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