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. 2019 Jun;9(1):010505.
doi: 10.7189/jogh.09.010505.

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016

Felix Lam  1 , Leslie Wentworth  1 , Peter Cherutich  2 , Santau Migiro  3 , Khadija Abdala  3 , Michael Musyoka  4 , Samuel Ogolla  4 , McDonald Obudho  4 , Zachary Mwangi  4 , Rosemary Kihoto  5 , Collins Cheruiyot  5 , Betty Wariari  5 , Audrey Battu  1 , Kate Schroder  1
Affiliations

An evaluation of a national oral rehydration solution and zinc scale-up program in Kenya between 2011 and 2016

Felix Lam et al. J Glob Health. 2019 Jun.

Abstract

Background: In Kenya, diarrheal disease is the second leading cause of death among children under five. The Government of Kenya launched a national plan to increase coverage of oral rehydration solution (ORS) and zinc by addressing demand and supply-side barriers. This study evaluates progress of ORS and zinc uptake in Kenya according to the national plan from 2011 to 2016.

Methods: In 2016, we conducted a nationally representative population-based household survey to estimate coverage of ORS and zinc for treatment of diarrhea cases among children under five. We also used ORS and zinc coverage data from the two most recent Kenya Demographic and Health Surveys in 2008/09 and 2014 to estimate annual changes in coverage rates during the program period. Based on these inputs, we used the Lives Saved Tool to estimate the number of diarrhea deaths averted between 2011 and 2016 due to increased use of ORS and zinc.

Results: The 2016 survey results showed that ORS coverage was 42% (95% confidence interval (CI) = 38%, 47%) and zinc coverage was 18% (95% CI = 15%, 23%). The estimated coverage for the combined use of ORS and zinc was 15% in 2016 (95% CI = 12%, 19%). Compared to 2011, an additional 3340 (sensitivity bounds = 2 670, 3 920) diarrhea deaths among children under five were averted due to increases in ORS and zinc coverage.

Conclusions: Kenya was successful in catalyzing uptake of combined treatment with ORS and zinc, which rose from 0.8% in 2011 to 15% in 2016. Ongoing efforts are necessary to further build on these gains.

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Conflict of interest statement

Competing interests: FL, LW, RK, CC, BW, AB, and KS were employed by the Clinton Health Access Initiative and received funding to implement aspects of the program described. PC, SM, and KA are employed by the Ministry of Public Health and Sanitation and were involved in the program design and implementation. The authors declare no additional conflict of interest. The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no other conflicts of interest.

Figures

Figure 1
Figure 1
Retail price of full treatment course* before and after price negotiation. *Full treatment course = four 500mL oral rehydration solution sachets and 10 zinc tablets
Figure 2
Figure 2
Percent of private pharmacies with both ORS and zinc in-stock on the day of the visit in 2014 and 2015. ORS – oral rehydration solution
Figure 3
Figure 3
Sampling results.
See this image and copyright information in PMC

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