title: Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria.
abstract: BACKGROUND
  In Nigeria, diarrhea remains one of the leading causes of death among children under five years old. Oral Rehydration Therapy (ORT) corners were introduced to health facilities in Bauchi and Sokoto states to serve as points of treatment for sick children and equip caregivers with necessary skills in case management of diarrhea and diarrhea prevention.
  
  
  OBJECTIVE
  The operations research study examined the effect of facility-based ORT corners on caregivers' knowledge and skills in management of simple and moderate diarrhea at home, as well as caregivers' and service providers' perceived facilitators and barriers to utilization and delivering of ORT corner services. It also examined whether ORT activities were conducted according to the established protocols.
  
  
  METHODS
  This quantitative study relied on multiple sources of information to provide a complete picture of the current status of ORT corner services, namely surveys with ORT corner providers (N = 21), health facility providers (N = 23) and caregivers (N = 229), as well as a review of service statistics and health facility observations. Frequency distribution and binary analysis were conducted.
  
  
  RESULTS
  The study revealed that ORT corner users were more knowledgeable in diarrhea prevention and management and demonstrated better skills for managing diarrhea at home than ORT corner non-users. However, the percentage of knowledgeable ORT users is not optimal, and providers need to continue to work toward improving such knowledge. ORT corner providers identified a lack of supplies as the major barrier for providing services. Furthermore, the study revealed a lack of information, education and communication materials, supportive supervision, and protocols and guidelines for delivering ORT corner services, as well as inadequate documentation of services provided at ORT corners.
  
  
  CONCLUSIONS
  Recommendations for ORT corners program planners and implementers include ensuring all ORT corners have oral rehydration salt (ORS) packages and salt, sugar, and zinc tablets in stock, a secured commodity supply chain to avoid stockouts, and adequate policies and procedures in place.
authors.affiliation: Futures Group, 401 Meadowmont Village Circle, Chapel Hill, NC, 27517, USA. zcharyeva@futuresgroup.com.
authors.forename: Zulfiya
authors.initials: Z
authors.lastname: Charyeva
authors.affiliation: Futures Group, 401 Meadowmont Village Circle, Chapel Hill, NC, 27517, USA. mcannon@futuresgroup.com.
authors.forename: Molly
authors.initials: M
authors.lastname: Cannon
authors.affiliation: USAID/TSHIP Project, Abuja, Nigeria. ooguntunde@futuresgroup.com.
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Oguntunde
authors.affiliation: E4A\DFID Nigeria, Abuja, Nigeria. gmagashi@gmail.com.
authors.forename: Aminu Magashi
authors.initials: AM
authors.lastname: Garba
authors.affiliation: JSI Inc., USAID/TSHIP Project, Abuja, Nigeria. William.sambisa@gmail.com.
authors.forename: William
authors.initials: W
authors.lastname: Sambisa
authors.affiliation: USAID/TSHIP Project, Abuja, Nigeria. bassiap@gmail.com.
authors.forename: Amos Paul
authors.initials: AP
authors.lastname: Bassi
authors.affiliation: USAID/TSHIP Project, Abuja, Nigeria. mibrahim@tshipnigeria.org.
authors.forename: Mohammed Auwal
authors.initials: MA
authors.lastname: Ibrahim
authors.affiliation: USAID/TSHIP Project, Abuja, Nigeria. sdanladi@tshipnigeria.org.
authors.forename: Saba'atu Elizabeth
authors.initials: SE
authors.lastname: Danladi
authors.affiliation: USAID/TSHIP Project, Abuja, Nigeria. nurudeenlawal1410@gmail.com.
authors.forename: Nurudeen
authors.initials: N
authors.lastname: Lawal
mesh_terms: D017028:Caregivers / Q000193:education; D002662:Child Health Services; D002675:Child, Preschool; D017281:Cost of Illness; D019049:Developed Countries; D003967:Diarrhea / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D003968:Diarrhea, Infantile / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D006126:Group Processes; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation; D006699:Home Care Services; D006801:Humans; D007223:Infant; D008297:Male; D008507:Medically Underserved Area; D020380:Needs Assessment; D009549:Nigeria; D009874:Operations Research; D012720:Severity of Illness Index; D000078329:Workforce
references.citation: Afr J Reprod Health. 2010 Mar;14(1):21-32
references.pmid: 20695136
references.citation: Lancet. 2006 Sep 23;368(9541):1067-76
references.pmid: 16997661
references.citation: Indian J Pediatr. 1991 Nov-Dec;58(6):783-7
references.pmid: 1818872
references.citation: Am J Clin Nutr. 1980 Mar;33(3):637-63
references.pmid: 6766662
references.citation: Matern Child Health J. 2009 Jul;13(4):550-8
references.pmid: 18607704
references.citation: Lancet. 2010 Jun 5;375(9730):1969-87
references.pmid: 20466419
references.citation: Lancet. 1990 Feb 10;335(8685):334-8
references.pmid: 1967778
references.citation: J Diarrhoeal Dis Res. 1999 Mar;17(1):17-21
references.pmid: 10892492
references.citation: J Clin Invest. 2008 Apr;118(4):1277-90
references.pmid: 18382740
references.citation: Arch Dis Child. 1985 Sep;60(9):856-60
references.pmid: 3901934
references.citation: Arch Med Res. 2002 Jul-Aug;33(4):351-5
references.pmid: 12234524
references.citation: Bull World Health Organ. 2003;81(3):197-204
references.pmid: 12764516
references.citation: PLoS Med. 2009 Mar 10;6(3):e41
references.pmid: 19278292
references.citation: Am J Dis Child. 1983 Aug;137(8):730-4
references.pmid: 6869329
references.citation: Health Educ Q. 1988 Winter;15(4):351-77
references.pmid: 3068205
references.citation: BMJ. 2007 Jan 6;334 Suppl 1:s14
references.pmid: 17204754
references.citation: J Pediatr Gastroenterol Nutr. 2008 Aug;47(2):260-5
references.pmid: 18664885
references.citation: Lancet. 2010 Mar 13;375(9718):870-2
references.pmid: 19833382