Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program

Marianne El-Khoury; Kathryn Banke; Phoebe Sloane

doi:10.9745/GHSP-D-16-00021

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An over‐the‐counter medicine seller in Ghana sells oral rehydration salts (ORS) and Zintab, a zinc product manufactured locally by M&G Pharmaceuticals.
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A poster advertising oral rehydration salts (ORS) and zinc, part of the SHOPS mass media campaign in Ghana, was distributed widely to pharmacies and over‐the‐counter medicine sellers to improve caregivers’ and providers’ awareness of the new diarrhea treatment protocols for children under 5.

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TABLE 1 Characteristics of Study Samples in Ghana at Baseline (2012) and Follow-Up (2014)

Characteristics	Baseline (N = 754)	Follow-Up (N = 751)	P Value
Caregiver
Female, %	97.9	97.8	.98^a
Age, mean (SD), years	31.1 (9.1)	31.5 (9.1)	.64^a
Married, %	77.0	84.0	.07^*^a
Education, % distribution			.16^b
None	15.4	15.3
Primary	26.2	20.7
Completed primary or some middle	43.9	43.5
Completed middle or some secondary	13.9	18.5
Completed secondary or above	0.6	2.1
Child
Child age, mean (SD), months	29.3 (15.4)	28.0 (13.9)	.31^a
Diarrhea duration, mean (SD), days	4.5 (3.0)	4.3 (3.3)	.64^a
Diarrhea with fever, %	43.8	43.5	.95^a
Diarrhea with blood, %	11.4	5.6	.095^*^a
Household
Wealth index score,^c mean (SD)	0.58 (0.2)	0.59 (0.1)	.70^a
Wealth quintile, % distribution			.008^***^b
First (poorest)	23.4	14.3
Second	19.9	32.6
Third	42.1	46.2
Fourth	14.1	10.3
Fifth (wealthiest)	0.6	0.3

Abbreviation: SD, standard deviation.
↵*** P< .01,
** P< .05
↵* P< .10.
↵a P value from t test.
↵b P value from chi-square test.
↵c Wealth index score ranges from 0 to 1.

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TABLE 2 Changes in Caregiver Diarrhea Management Practices in Ghana Between Baseline (2012) and Follow-Up (2014) (N = 1,505)

	(A) Bivariate Regression Results				(B) Multivariate Regression Results^a
Treatment	Baseline (β₀)	Follow-Up (β₀ + δ₀)	Difference Over Time (δ₀)	P Value	Follow-Up (β₀ + δ₀)	Difference Over Time (δ₀)	P Value
(1) Zinc (with or without ORS)	0.013	0.313	0.300^***	<.001	0.321	0.308^***	<.001
(2) ORS (with or without zinc)	0.377	0.599	0.222^***	<.001	0.611	0.234^***	<.001
(3) ORS with zinc	0.008	0.292	0.284^***	<.001	0.301	0.293^***	<.001
(4) Antibiotics	0.662	0.382	-0.280^***	<.001	0.350	-0.312^***	<.001
(5) Antidiarrheals	0.102	0.051	-0.051^**	.02	0.074	-0.028	.13

Abbreviation: ORS, oral rehydration salts.
↵*** P< .01,
↵** P< .05,
* P< .10.
↵a Covariates included in multivariate regressions are caregiver characteristics (sex, age, education, marital status), child age, diarrhea characteristics (duration in days, presence of fever, presence of blood), household characteristics (wealth index score, wealth quintile), and district fixed effects.

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TABLE 3 Characteristics of Diarrhea Episode Among Caregivers in Ghana Who Gave ORS With Zinc in Combination With Antibiotics at Follow-Up (2014) (N = 52)

Characteristics of Diarrhea Episode	Value
Diarrhea with no blood in stool or fever, %	43.2
Diarrhea with fever only, %	49.0
Diarrhea with blood in stool only, %	3.0
Diarrhea with blood in stool and fever, %	4.7
Diarrhea duration, mean (SD), days	4.3 (2.5)

Abbreviations: ORS, oral rehydration salts; SD, standard deviation.

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GHSP-D-16-00021 Supplementary Material

Sloane et al. doi: 10.9745/GHSP-D-16-00021

Supplementary Material - Sloane et al. doi: 10.9745/GHSP-D-16-00021