This document discusses promoting the prevention and treatment of diarrhea through increased availability and use of oral rehydration salts (ORS) and zinc. It provides an overview of diarrhea as a major killer of children globally and in India. It outlines the components of effective diarrhea management with ORS and zinc, and some field challenges in Uttar Pradesh like widespread diarrhea prevalence, low ORS and zinc use, and inappropriate antibiotic use. The document then discusses interventions in Uttar Pradesh like training healthcare providers, improving supply chains, generating evidence, and establishing partnerships to promote ORS and zinc for diarrhea treatment. It highlights a social marketing initiative in Lalitpur using community empowerment, health education, and enhanced distribution to increase access and affordability

1. Promoting prevention and treatment of Diarrhoea:Increasing availability and USE of ORS and ZincDr. Gaurav AryaHealth Specialist, UNICEFOctober 30, 2010

2. Overview of the presentationNeed for talking about diarrhoeaComponents of effective management of diarrhoea using ORS and ZincField challengesEvidence on availability and useInterventions for improving diarrhoea management in Uttar PradeshBrief introduction to the social marketing initiative in Lalitpur

3. Why are we talking about diarrhoeaDiarrhoea is the second largest killer and accounts for nearly 2 million child-deaths globally

4. In India, only 26% children suffering from Diarrhoea are treated with oral rehydration therapy (ORT) and the proportion is only 13% in Uttar Pradesh (NFHS-3) – This is despite the fact that ORT was introduced as the treatment of choice for diarrhoea more than 3500 years ago.

5. More than one-quarter did not receive any kind of treatment

6. 16% received antibiotics, which are not normally recommended for treating childhood diarrhoeaComponents of effective management of diarrhoea using ORS and ZincReduced mortality of children due to diarrhoea

7. These are the field challengesDiarrhoea is still a widely prevalent disease in UP (NFHS-3)Most Childhood diarrhea cases first treated by rural practitioners and chemists (World Bank survey 1997)Very low use of ORS and Zinc for management of diarrhoeaRural Practitioners & Chemists use antibiotics extensively and have inadequate knowledge about the use of ORS & ZincLow compliance of Zinc for 14 daysThere is no data on availability of ORS and Zinc through the private channelsPublic health and distribution system has frequent outages and low reliabilityThere is continued and widespread use of anti-diarrheals Govt. & professional bodies unwilling to educate or include the RMP’s

8. Data shows…There are multiple drug modalities being practicedThere are multiple drug therapies being used

9. Data shows…The general prescription pattern of service providers is inappropriateMany of the retailers/ pharmacists have never retailed ORS and Zinc

10. Pictures Show…Here is where a large proportion of the population goes: RMPs

11. Pictures Show…And this is what they use for treatment:

12. What are we doing in Uttar PradeshCapacity Development

13. Training of public healthcare providers in CCSP/IMNCI districts

14. Training of private and public sector pediatricians through IAP

15. Training of private physicians and pediatricians in Lalitpur through HLFPPT