title: Public sector scale-up of zinc and ORS improves coverage in selected districts in Bihar, India.
abstract: BACKGROUND
  In Bihar, India, a new initiative to enhance diarrhea treatment with zinc and ORS in the public sector was rolled out in selected districts. We conducted an external evaluation to measure changes in diarrhea careseeking and treatment in intervention districts.
  
  
  METHODS
  We conducted baseline and endline household surveys among caregivers of children 2-59 months of age. We calculated summary statistics for household characteristics, knowledge, careseeking and treatments given to children with a diarrhea episode in the last 14 days and built logistic regression models to compare baseline and endline values.
  
  
  RESULTS
  Caregivers named a public health center as an appropriate source of care for childhood diarrhea more often at endline (71.3%) compared to baseline (38.4%) but did not report increased careseeking to public sector providers for the current diarrhea episode. In logistic regression analyses, the odds of receiving zinc, with or without oral rehydration salts (ORS), increased at endline by more than 2.7 as compared to baseline. Children who were taken to the public sector for care were more likely to receive zinc (odds ratio, OR = 3.93) and zinc in addition to ORS (OR = 6.10) compared to children who were not taken to the public sector.
  
  
  CONCLUSIONS
  Coverage of zinc and ORS can improve with public sector programs targeted at training and increasing product availability, but demand creation may be needed to increase public sector careseeking in areas where the private sector has historically provided much of the care.
authors: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors: Christa L Fischer
authors: CL
authors: Walker
authors: Center for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors: Sunita
authors: S
authors: Taneja
authors: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors: Laura M
authors: LM
authors: Lamberti
authors: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors: Robert E
authors: RE
authors: Black
authors: Center for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors: Sarmila
authors: S
authors: Mazumder