Clinton Health Access Initiative, Boston, Massachusetts, USA.
Clinton Health Access Initiative, Kampala, Uganda.
J Glob Health. 2019 Jun;9(1):010504. doi: 10.7189/jogh.09.010504.
BACKGROUND: In Uganda, diarrhoea was the third leading cause of mortality among children under the age of five in 2010. To address this issue, the Ministry of Health (MOH) formed a national Diarrhoea and Pneumonia Coordination Committee (DPCC) in 2011. One of the objectives of the DPCC for reducing diarrhoea mortality was to increase the use of oral rehydration salts (ORS) and zinc. This study aimed to describe and evaluate efforts by the DPCC to increase ORS and zinc coverage. METHODS: We conducted a retrospective mixed-methods evaluation to describe the activities conducted under the DPCC and evaluate the extent to which the committee's goal of increasing ORS and zinc use was achieved. We conducted secondary analysis using Uganda's Demographic and Health Survey from 2011 and 2016, analyzed cross-sectional private medicine outlet surveys from 2014 and 2016, analyzed ORS and zinc distribution data from the Uganda National Medical Stores, and reviewed program documents from DPCC partners. RESULTS: Nationally, the proportion of children under five with diarrhoea treated with ORS and zinc increased from 1% (95% confidence interval (CI) = 1%, 2%) in 2011 to 30% (95% CI = 27%, 32%) in 2016. Among private medicine outlets, the adjusted odds of having any zinc in-stock was 1.5 (95% CI = 1.14, 1.97) times higher in 2016 than in 2014, and the retail price for a complete treatment (2 ORS sachets and 10 zinc tablets) declined by $0.19 (95% CI = -0.31, -0.06), or 14%. CONCLUSIONS: Use of combined ORS and zinc for treatment of diarrhoea in children under five significantly increased in Uganda during the program period. The range of activities conducted by the various members of the DPCC likely contributed to the increase in the use of combined ORS and zinc.
背景:2010 年,在乌干达,五岁以下儿童死亡率中,腹泻是第三大死因。为了解决这一问题,卫生部(MOH)于 2011 年成立了国家腹泻和肺炎协调委员会(DPCC)。DPCC 降低腹泻死亡率的目标之一是增加口服补液盐(ORS)和锌的使用。本研究旨在描述和评估 DPCC 为增加 ORS 和锌的覆盖率所做的努力。
方法:我们进行了回顾性混合方法评估,以描述 DPCC 开展的活动,并评估委员会增加 ORS 和锌使用的目标实现程度。我们利用 2011 年和 2016 年乌干达的人口与健康调查进行二次分析,分析了 2014 年和 2016 年的横断面私立医疗机构调查,分析了乌干达国家医药商店的 ORS 和锌分布数据,并审查了 DPCC 合作伙伴的项目文件。
结果:在全国范围内,2011 年有腹泻症状的五岁以下儿童中,用 ORS 和锌治疗的比例从 1%(95%置信区间(CI)= 1%,2%)增加到 2016 年的 30%(95% CI= 27%,32%)。在私立医疗机构中,与 2014 年相比,2016 年有任何锌库存的调整后几率增加了 1.5 倍(95% CI= 1.14,1.97),完整治疗(2 袋 ORS 和 10 片锌片)的零售价格下降了 0.19 美元(95% CI= -0.31,-0.06),降幅为 14%。
结论:在项目实施期间,乌干达五岁以下儿童使用 ORS 和锌联合治疗腹泻的比例显著增加。DPCC 各成员开展的各种活动可能有助于增加 ORS 和锌的联合使用。
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