title: Adherence to zinc supplementation guidelines for the treatment of diarrhea among children under-five in Uttar Pradesh, India.
abstract: BACKGROUND
  There is limited evidence on adherence to the recommended dose and duration of zinc supplementation for diarrheal episodes in children under five years of age. In selected districts of Uttar Pradesh, India, we sought to assess adherence to the nationally advised zinc treatment regimen (ie, 10 mg/day for ages 2-6 months and 20 mg/day for ages 7-59 months for 14 days) among caregivers of zinc-prescribed children.
  
  
  METHODS
  We identified and conducted follow-up visits to children advised zinc for the treatment of diarrhea. At the initial visit, we collected data on the treatment instructions received from providers. Caregivers were asked to record treatments administered on a pictorial tracking form and were asked to retain all packaging for collection at follow-up. We quantified the average dose and duration of zinc therapy and built logistic regression models to assess the factors associated with caregiver adherence to national guidelines.
  
  
  RESULTS
  Caregivers administered zinc for an average of 10.7 days (standard deviation (SD) = 3.9 days; median = 13 days), and 47.8% continued treatment for the complete 14 days. Among children receiving zinc syrups and tablets respectively, the age appropriate dose was received by 30.8% and 67.3%. Adherence to age appropriate dose and continuation of zinc for 14 days were highly associated with having received appropriate provider instructions.
  
  
  CONCLUSIONS
  Our results indicate moderate-to-good adherence to national zinc treatment guidelines for diarrhea among caregivers in rural India. Our findings also highlight the importance of provider guidance in ensuring adherence to zinc dose and duration. Programs aiming to scale-up zinc treatment for childhood diarrhea should train providers to successfully communicate dosing instructions to caregivers, while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Lamberti
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors.forename: Christa L Fischer
authors.initials: CL
authors.lastname: Walker
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D017028:Caregivers; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy*; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D019983:Guideline Adherence; D006801:Humans; D007194:India; D007223:Infant; D016015:Logistic Models; D008297:Male; D017410:Practice Guidelines as Topic; D012424:Rural Population; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D015032:Zinc