Predictors of antibiotic usage in childhood diarrhoea after controlling area and time variation.^*

<p>*All analyses were adjusted for cluster effect.</p>#<p>Variables (age of child, type of diarrhoea, duration of diarrhoea, age of mother, father education, mother education, mother occupation, ORS usage and antibiotic usage) significant (p<0.05) in bivariate analysis (simple logistic regression) were included in multiple logistic regression analyses.</p><p>Predictors of antibiotic usage in childhood diarrhoea after controlling area and time variation.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0112308#nt105" target="_blank">*</a>}</p

Predictors of zinc usage in childhood diarrhoea after controlling area and time variation.^*

<p>*All analyses were adjusted for cluster effect.</p>#<p>Variables (age of child, type of diarrhoea, duration of diarrhoea, age of mother, Father's year of schooling, Mother's year of schooling, mother occupation, ORS usage and antibiotic usage) significant (p<0.05) in bivariate analysis (simple logistic regression) were used in multiple logistic regression analyses.</p><p>Predictors of zinc usage in childhood diarrhoea after controlling area and time variation.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0112308#nt103" target="_blank">*</a>}</p

Training Package for health care providers in the intervention area.

<p>Training Package for health care providers in the intervention area.</p

Health seeking behaviour during diarrhoeal illness among children 6–59 months by type of service providers.

<p>Health seeking behaviour during diarrhoeal illness among children 6–59 months by type of service providers.</p

ORS, zinc and antibiotic usage in Control and Intervention areas.^*

<p>*Cluster adjusted analyses of all variable.</p><p>ORS, zinc and antibiotic usage in Control and Intervention areas.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0112308#nt102" target="_blank">*</a>}</p

Village-Randomized Clinical Trial of Home Distribution of Zinc for Treatment of Childhood Diarrhea in Rural Western Kenya

<div><p>Background</p><p>Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities.</p><p>Methods</p><p>We randomized 16 Kenyan villages (1,903 eligible children) to receive a 10-day course of zinc and two oral rehydration solution (ORS) sachets every two months at home and 17 villages (2,241 eligible children) to receive ORS at home, but zinc at the health–facility only. Children’s caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI) reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children’s age.</p><p>Results</p><p>There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed), 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001). There were no differences in ORS use between zinc (59.6%) and comparison villages (58.8%). Among children with fever or cough without diarrhea, zinc use was low (<0.5%). There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46–0.99), but not presenting at clinic.</p><p>Conclusions</p><p>In this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00530829?term=NCT00530829&rank=1" target="_blank">NCT00530829</a></p></div

Socio-demographic characteristics of the Control and Intervention areas.^*

<p>*Cluster adjusted analyses of all variables.</p><p>Socio-demographic characteristics of the Control and Intervention areas.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0112308#nt101" target="_blank">*</a>}</p

Trial profile.

<p>Village randomization and number of children enrolled at the initial enrollment in December 2007 and during the ongoing enrollment during the study period from February 2008–March 2009. Children and person-time contribution given for the analysis of clinic-based surveillance and household morbidity surveillance – see methods. PBIDS = Population-based Infectious Disease Surveillance.</p

Trial Flowchart.

<p>Trial Flowchart.</p

Baseline characteristics for participants in home zinc and comparison villages, western Kenya, February 2008–March 2009.

<p>*p value controls for cluster design by village.</p>†<p>Poorer household is defined as the lowest two quintiles using multiple component analysis.</p