title: Economic costs to caregivers of diarrhoea treatment among children below 5 in rural Gujarat India: findings from an external evaluation of the DAZT programme.
abstract: BACKGROUND
  Diarrhoea is a leading cause of mortality among young children in India although few receive the recommended treatment. The diarrhoea alleviation through zinc and oral rehydration salts (ORS) therapy (DAZT) team initiated a programme in Gujarat from 2011 to 2013 to increase coverage of these interventions through public and private providers at scale. This study evaluates the economic impact of diarrhoea to caregivers before and after the introduction of zinc and ORS at scale through the DAZT programme.
  
  
  METHODS
  The DAZT programme evaluation took a before-and-after study design using a two-stage clustered cross-sectional survey. Factors associated with the odds of caregivers incurring economic costs and their amounts were evaluated in a two-part modelling approach.
  
  
  RESULTS
  The DAZT programme lowered unadjusted economic costs to caregivers of treating a diarrhoeal episode from $4.04 to $2.49 in 2 years. Controlling for covariates, analysis showed no association between the programme and a change in odds of incurring an economic cost but did show an association with a reduction in economic cost of $2.15 (95% confidence interval (CI) $1.20-$3.11) per diarrhoea episode. A more than 4-fold increase in care-seeking from public community health workers, reduction in care-seeking from higher levels of the health system and reduced spending on drugs besides ORS and zinc may explain these results.
  
  
  CONCLUSIONS
  This study found an association between zinc introduction and a reduction in economic burden of diarrhoea treatment to caregivers in underserved rural areas of Gujarat through more efficient patterns of care-seeking and content of care.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Shillcutt
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA aelefevre@jhu.edu.
authors.forename: Amnesty E
authors.initials: AE
authors.lastname: LeFevre
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Christa L
authors.initials: CL
authors.lastname: Fischer Walker
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, 45 KaluSarai, New Delhi 110016, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, 45 KaluSarai, New Delhi 110016, India.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
mesh_terms: D017028:Caregivers; D002675:Child, Preschool; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000188:drug therapy* / Q000191:economics; D005440:Fluid Therapy / Q000191:economics* / Q000379:methods; D006801:Humans; D007194:India; D007223:Infant; D015397:Program Evaluation / Q000706:statistics & numerical data; D012424:Rural Population; D015032:Zinc / Q000191:economics / Q000627:therapeutic use*
chemical_list: D015032:Zinc
keywords: Cost; India; developing countries; diarrhoea; implementation science; oral rehydration therapy; zinc