Zinc for the treatment of childhood diarrhoea was introduced in a pilot
area in southern Mali to prepare for a cluster-randomized effectiveness
study and to inform policies on how to best introduce and promote zinc
at the community level. Dispersible zinc tablets in 14-tablet blister
packs were provided through community health centres and drug kits
managed by community health workers (CHWs) in two health zones in
Bougouni district, Mali. Village meetings and individual counselling
provided by CHWs and head nurses at health centres were the principal
channels of communication. A combination of methods were employed to
(a) detect problems in communication about the benefits of zinc and its
mode of administration; (b) identify and resolve obstacles to
implementation of zinc through existing health services; and (c)
describe household-level constraints to the adoption of appropriate
home-management practices for diarrhoea, including administration of
both zinc and oral rehydration solution (ORS). Population-based
household surveys with caretakers of children sick in the previous two
weeks were carried out before and four months after the introduction of
zinc supplementation. Household follow-up visits with children
receiving zinc from the health centres and CHWs were conducted on day 3
and 14 after treatment for a subsample of children. A qualitative
process evaluation also was conducted to investigate operational
issues. Preliminary evidence from this study suggests that the
introduction of zinc does not reduce the use of ORS and may reduce
inappropriate antibiotic use for childhood diarrhoea. Financial access
to treatments, management of concurrent diarrhoea and fever, and high
use of unauthorized drug vendors were identified as factors affecting
the effectiveness of the intervention in this setting. The introduction
of zinc, if not appropriately integrated with other disease-control
strategies, has the potential to decrease the appropriate presumptive
treatment of childhood malaria in children with diarrhoea and fever in
malaria-endemic areas