ZINC TABLETS: ACCEPTABILITY SURVEY

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SUZY PROJECT SUPPORTED RESEARCH
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Zinc Studies in Progress

• Behavioral/Formative studies
• Incidence Cases Study
• Coverage Surveys
• Safety Monitoring
• Tablets vs Syrup formulations
• Acceptability Compliance

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PROTOCOLS UNDER DEVELOPMENT

• Zinc treatment of pneumonia efficacy trial in
  Kamalapur
• Duration of treatment efficacy trial in Matlab
• Zinc treatment and immune function
• Value added of zinc supplementation
• after treatment field trial in Mirpur
• Morbidity (?Mortality) study in Kenya

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ZINC TABLETSACCEPTABILITY SURVEY

• Community-based survey
• ICDDRB-SMC
• SMC Sales Officers (n4)
• Drug Sellers (5 urban,
  5 rural)
• Caretakers
  (n300)

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Conduct of Survey

• 4 sub-districts Mirpur (Dhaka), Gazipur,
• Narayanganj, Manikganj
• February to April, 2004
• Prescribed to children 3 to 59 months with ACD
• Caretakers interviewed after 10 days in their
  home

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Survey Population

• 321 children prescribed zinc
• 17 cured or suspicious
• 304 given zinc
• 3-11 months 32
• 12-23 months 35
• 24-59 months 33

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Acceptance

• Taste In comparison to other medicines, what is
  your impression of how your child found the taste
  of the zinc tablets?
• Better 26
• Same/comparable 67
• Worse 7

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Drug Seller Instructions

• Received instructions
• how to prepare 98.7
• how long 97 knew 10 days
• Correctly prepared 92.7

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Adherence Length of Treatment

• days
• given N
• 1-3 days 41 13.5
• 4-6 days 51 16.8
• 7-9 days 43 14.1
• 10 days 169 55.6

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Length of Treatment

• mean
  given
• days (sd) 10
  days
• Age 3-23 mo. 7.7 (3.0) 53
• 24-59 mo. 8.0 (2.9) 60
• Gender male 7.6 (3.0) 52
• female 8.0 (2.9) 61

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Why Discontinued?

• 135/304 (44) stopped before 10 days
• Primary Reason
• Child no longer ill 15
• Vomiting 13
• Not improving 6
• Forgot to give 5
• Disliked taste 1
• Other 4

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Incident Case Studies

• Aim To document impact over time of the zinc
  scale up
• campaign
• Outcomes
• Prevalence of diarrhea
• Utilization of services
• Practices (caretakers and providers)
• zinc, ORS, antibiotics, metronidazole
• other treatments
• Adherence to zinc treatment instructions
• Acceptability, problems encountered

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Methods

• Study population
• children 6-59 months of age
• within past 2 weeks an episode of diarrhea
• of at least 2 days duration
• Census household survey of randomly selected
  wards (Mirsarai and Kamalapur)
• Caretaker (usually mother) interviewed, then
  linked with first provider seen

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Baseline Findings

• Rural
  Urban
• Mirsarai
  Kamalapur
• n958
  n886
• 2 week point
• prevalence (gt2 days)
• Oct Dec 2003 13.3
  17.9

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Baseline Practices

• Rural
  Urban
• Mirsarai
  Kamalapur
• Practice n958
  n886
• ORS 55
  44
• ORT/SSS 18
  4
• Antibiotics 30
  29
• Metronidazole 27
  44
• Zinc 0.9
  0.3

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Coverage Surveys

• Aim To monitor the success/impact of the
• zinc scale up exercise across all of
• Bangladesh
• Zinc coverage
• Expenditures
• Utilization of health services/providers
• Equity (income, gender, geography)

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Expenditures

• Household expenditures on a childhood diarrheal
  illness episode
• Asset Median Expenditure
• Quartile Urban Rural
• 1 40
  35
• 2 51
  37
• 3 60
  45
• 4 100
  42

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Expenditures

• Median expenditures by gender (Tk)
• Asset
• Quartile Male Female
• 1 38 36
• 2 50 35
• 3 55 41
• 4 60 52
  

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Zinc Safety Monitoring

• ICDDR,B Hospital SSW
• PSKP out-patient clinic
• Protocol Zinc give to children who
• have been rehydrated
• demonstrated they can hold down ORS
• no vomiting over past hour

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Safety Monitoring Early Results

• 379 children monitored
• gt 80 of children coming to hospital had vomited
  in past 24 hrs (25-30 in community)
• Events within 1 hour following zinc
• 16 vomited 5 regurgitation
  
• 2 vomiting regurgitation
• Of those who vomited, 73 had a history of
  vomiting within the past 3 hours

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Hospital Protocols

• Context A hospital-based population
• No urgency to give zinc
• If a history of vomiting,
• rehydrate with ORS first
• if a history of vomiting in past 3 hours or
  dehydrated, wait. ?how long
• Parent feedback/perceptions needed