title: An external evaluation of the Diarrhea Alleviation through Zinc and ORS Treatment (DAZT) program in Gujarat and Uttar Pradesh, India.
abstract: BACKGROUND
  To address inadequate coverage of oral rehydration salts (ORS) and zinc supplements for the treatment of diarrhea among children under-five, the Diarrhea Alleviation through Zinc and ORS Treatment (DAZT) program was carried out from 2011-2013 in Gujarat and from 2011-2014 in Uttar Pradesh (UP), India. The program focused on improving the diarrhea treatment practices of public and private sector providers.
  
  
  METHODS
  We conducted cross-sectional household surveys in program districts at baseline and endline and constructed state-specific logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period.
  
  
  RESULTS
  Between baseline and endline, zinc coverage increased from 2.5% to 22.4% in Gujarat and from 3.1% to 7.0% in UP; ORS coverage increased from 15.3% to 39.6% in Gujarat but did not change in UP. In comparison to baseline, children with diarrhea in the two-weeks preceding the endline survey had higher odds of receiving zinc treatment in both Gujarat (odds ratio, OR = 11.2; 95% confidence interval (CI) 6.4-19.3) and UP (OR = 2.4; 95% CI 1.4-3.9), but the odds of receiving ORS only increased in Gujarat (OR = 3.6; 95% CI 2.7-4.8; UP OR = 0.9; 95% CI 0.7-1.2). Seeking care outside the home, especially from a public sector source, was associated with higher odds of receiving ORS and zinc.
  
  
  CONCLUSIONS
  During the duration of the DAZT program, there were modest improvements in the treatment of diarrhea among young children. Future programs should build upon and accelerate this trend with continued investment in public and private sector provider training and supply chain sustainability, in addition to targeted caregiver demand generation activities.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health. Department of International Health, Baltimore, MD, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Lamberti
authors.affiliation: Society for Applied Studies, Centre for Health Research and Development, New Delhi, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Society for Applied Studies, Centre for Health Research and Development, New Delhi, India.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
authors.affiliation: Johns Hopkins Bloomberg School of Public Health. Department of International Health, Baltimore, MD, USA.
authors.forename: Amnesty
authors.initials: A
authors.lastname: LeFevre
authors.affiliation: Johns Hopkins Bloomberg School of Public Health. Department of International Health, Baltimore, MD, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Johns Hopkins Bloomberg School of Public Health. Department of International Health, Baltimore, MD, USA.
authors.forename: Christa L Fischer
authors.initials: CL
authors.lastname: Walker
mesh_terms: D017028:Caregivers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000188:drug therapy / Q000628:therapy*; D019587:Dietary Supplements; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007194:India; D016015:Logistic Models; D008297:Male; D017149:Private Sector; D017150:Public Sector; D011795:Surveys and Questionnaires; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D015032:Zinc