Beam Keith, Hsu Nicole, Kanagaratnam Amandari, Larson Charles, Koehlmoos Tracey
Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
United States Air Force School of Aerospace Medicine, Fairborn, Ohio, United States of America.
PLOS Glob Public Health. 2025 Feb 10;5(2):e0004265. doi: 10.1371/journal.pgph.0004265. eCollection 2025.
Oral zinc is a proven effective treatment for diarrheal illness, and long-term monitoring is key to evaluating the success of efforts to scale up zinc treatment. We examine zinc coverage for diarrheal illness in Bangladesh since the conclusion of the Scaling Up Zinc for Young Children (SUZY) project in 2008 and provide an overview of other countries' zinc scale-up programs to compare the long-term effectiveness of SUZY. We used data from the Bangladesh Demographic and Health Surveys from 2005-2022 to examine the proportion of children under five receiving zinc treatment for diarrheal illness and evaluate disparities in zinc coverage by urbanicity and wealth quintile. We used a qualitative framework synthesis to compare the SUZY project with national or large-scale zinc scale-up programs in other low- and middle-income countries (Ghana, India, Kenya, Nepal, Nigeria, Uganda). This method for synthesizing qualitative and quantitative data was used to break down components of the SUZY project and other national or large-scale zinc scale-up programs. In Bangladesh, zinc coverage has continued to increase since the conclusion of the SUZY project, disparities in coverage between urban and rural areas and across wealth quintiles have been resolved, and the prevalence of diarrheal illness has decreased from 10·8% in 2007 to 4·8% in 2022. The countries with the highest zinc coverage (Bangladesh, Kenya, Uganda) had national rather than regional scale-up campaigns. Our findings demonstrate the long-term success of the SUZY project and provide insights into best practices for impactful zinc scale-up programs including significant pre-launch implementation research addressing key knowledge gaps and partnering with research organizations. Long-term monitoring of scale-up campaigns is important to determine if these interventions can become socially embedded and self-sustaining, improving health outcomes in the long run.
口服锌是治疗腹泻病的一种经证实有效的疗法，长期监测是评估扩大锌治疗规模努力是否成功的关键。我们研究了自2008年扩大幼儿锌治疗规模（SUZY）项目结束以来，孟加拉国腹泻病的锌治疗覆盖率，并概述了其他国家的锌扩大治疗项目，以比较SUZY项目的长期效果。我们使用了2005年至2022年孟加拉国人口与健康调查的数据，来研究五岁以下儿童接受腹泻病锌治疗的比例，并评估城市和农村以及财富五分位数之间锌治疗覆盖率的差异。我们使用定性框架综合法，将SUZY项目与其他低收入和中等收入国家（加纳、印度、肯尼亚、尼泊尔、尼日利亚、乌干达）的国家或大规模锌扩大治疗项目进行比较。这种综合定性和定量数据的方法被用于剖析SUZY项目以及其他国家或大规模锌扩大治疗项目的组成部分。在孟加拉国，自SUZY项目结束以来，锌治疗覆盖率持续上升，城乡之间以及不同财富五分位数之间的覆盖率差异已得到解决，腹泻病患病率从2007年的10.8%降至2022年的4.8%。锌治疗覆盖率最高的国家（孟加拉国、肯尼亚、乌干达）开展的是全国性而非地区性的扩大治疗运动。我们的研究结果证明了SUZY项目的长期成功，并为有效的锌扩大治疗项目的最佳实践提供了见解，包括在项目启动前开展重要的实施研究以解决关键知识空白，以及与研究组织合作。对扩大治疗运动进行长期监测对于确定这些干预措施能否融入社会并实现自我维持、从长远改善健康结果至关重要。
