To evaluate whether co-packing of zinc with ORS using a plastic pouch can enhance the joint adherence to diarrhea treatment or not.
This cluster-randomised trial was conducted in 2015 in eight districts of Ethiopia. Thirty two HCs were randomly assigned to one of the following intervention arms: (i) âCentral bundling’ (zinc and ORS bundled using a pouch that has instructional message distributed to HCs); (ii) âHC level bundling’ (zinc, ORS and a similar pouch distributed to the HCs and bundled by health workers); (iii) âBundling without message’ (zinc, ORS and plain pouch distributed and bundled by the health workers); and, (iv) âStatus quo’ (zinc and ORS co-administered without bundling). In each arm, 176 children 6-59 months of age with acute diarrhea were enrolled. Twelve days after enrollment, level of adherence was assessed. A composite scale of adherence was developed and modeled using linear regression analysis. The unit costs associated with the arms were estimated using secondary data sources and compared across the arms using Incremental CE analysis.
The follow-up rate was 95.6%. As compared with the âstatus quo’ arm, the joint adherences in the âcentral’ and âHC level’ bundling arms raised substantially by 15.1 and 15.7 Percentage Points (PP), respectively (P<0.05). No significant difference observed between âbundling without message' and the âstatus quo' arms. The unit cost incurred by the âcentral bundling' is relatively higher (USD 0.658/episode) as compared with the âHC level bundling' approach (USD 0.608/episode). The incremental CE ratio in the âcentral bundling' modality was two times higher than in the âHC based bundling' approach.
Bundling zinc with ORS using a pouch with instructional messages increases adherence to the diarrhea treatment.