Impact of NGO training and support intervention on diarrhoea management practices in a rural community of Bangladesh: an uncontrolled, single-arm trial.
OBJECTIVE
The evolving Non-Governmental Organization (NGO) sector in Bangladesh provides health services directly, however some NGOs indirectly provide services by working with unlicensed providers. The primary objective of this study was to examine the impact of NGO training of unlicensed providers on diarrhoea management and the scale up of zinc treatment in rural populations.


METHODS
An uncontrolled, single-arm trial for a training and support intervention on diarrhoea outcomes was employed in a rural sub-district of Bangladesh during 2008. Two local NGOs and their catchment populations were chosen for the study. The intervention included training of unlicensed health care providers in the management of acute childhood diarrhoea, particularly emphasizing zinc treatment. In addition, community-based promotion of zinc treatment was carried out. Baseline and endline ecologic surveys were carried out in intervention and control villages to document changes in treatments received for diarrhoea in under-five children.


RESULTS
Among surveyed household with an active or recent acute childhood diarrhoea episode, 69% sought help from a health provider. Among these, 62.8% visited an unlicensed private provider. At baseline, 23.9% vs. 22% of control and intervention group children with diarrhoea had received zinc of any type. At endline (6 months later) this had changed to 15.3% vs. 30.2%, respectively. The change in zinc coverage was significantly higher in the intervention villages (p<0.01). Adherence with giving zinc for 10 days or more was significantly higher in the intervention households (9.2% vs. 2.5%; p<0.01). Child's age, duration of diarrhoea, type of diarrhoea, parental year of schooling as well as oral rehydration solution (ORS) and antibiotic usage were significant predictors of zinc usage.


CONCLUSIONS
Training of unlicensed healthcare providers through NGOs increased zinc coverage in the diarrhoea management of under-five children in rural Bangladesh households.


BACKGROUND
ClinicalTrials.gov NCT02143921.
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Ahmed S
AS
Rahman
CCEB, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
Mohammad Rafiqul
MR
Islam
Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America.
Tracey P
TP
Koehlmoos
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Mohammad Jyoti
MJ
Raihan
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Mohammad Mehedi
MM
Hasan
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Tahmeed
T
Ahmed
Department of Pediatrics, University of British Columbia and Centre for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada.
Charles P
CP
Larson
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001459:Bangladesh; D002675:Child, Preschool; D003710:Demography; D003967:Diarrhea / Q000188:drug therapy*; D005260:Female; D006282:Health Personnel; D006801:Humans; D007223:Infant; D008297:Male; D009938:Organizations; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D013997:Time Factors; D015032:Zinc / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015032:Zinc