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Social Marketing Zinc to Improve Diarrhea Treatment Practices - Findings and Lessons Learned from Cambodia

Diarrhea is one of the main causes of childhood morbidity and mortality in low-income settings and Cambodia is no exception. Data from the Cambodia Demographic and Health Survey (CDHS) in 2005 indicate that 20% of children under the age of five had diarrhea in the two weeks preceding the survey, similar to the prevalence found in the 2000 CDHS. In early 2004, the World Health Organization (WHO) and UNICEF published a Joint Statement recommending the use of a new formulation of oral rehydration salts (ORS) along with therapeutic doses of zinc for the treatment of children under five during diarrhea episodes. The new ORS formulation has a lower level of salt and glucose than the standard ORS, resulting in a lower osmolarity of the solution and thereby reducing stool output and decreasing the likelihood of vomiting and hospital admission for intravenous therapy due to dehydration. Based on this recommendation, the Cambodian Ministry of Health (MOH) and Population Services International (PSI), an international social marketing nongovernmental organization working in Cambodia, decided to introduce the new low-osmolarity ORS and zinc in the private sector. In March 2006, the MOH and PSI, in coordination with WHO and with financial support from the U.S. Agency for International Development (USAID), launched a demonstration project to introduce a diarrhea treatment kit (DTK), branded as OraselKIT®, in selected districts of two provinces of Cambodia. This report details the results and lessons learned during an assessment of this pilot program. The assessment was jointly conducted by the USAID-funded Social Marketing Plus for Diarrheal Disease Control: Point-of-Use Water Disinfection and Zinc Treatment (POUZN) Project implemented by Abt Associates Inc., USAID, and WHO. This assessment was conducted from January 28 to February 9, 2007.