Knowledge of prescription of zinc and low-osmolarity ORS for under-five children with diarrhoea by Primary Healthcare Workers in Ibadan, Nigeria
PDF (engleski)

Ključne reči

Low Osmolarity Oral Rehydration Solution
Zinc
Under-five Children
Diarrhoea
prescription

Apstrakt

Background: Zinc supplement plus Low Oral

Rehydration Salt (Zn+Lo-ORS) solution has been

recommended for the management of acute

diarrhoea. Studies have shown that it has the potential

to reduce diarrhoea-related mortality by up to 88%.

Nigeria has adopted the recommended diarrhoeal

management policies and although, it is not known

how many children with diarrhoea access Lo-ORS,

the proportion of children who received zinc

supplementation increased from less than 1% in 2008

to over 2% in 2013. Majority of diarrhoea patients in

Nigeria are treated with antibiotics by Primary

Healthcare Workers (PHCWs) who are the first line

of contact for many of these children. However, little

is known about the level of knowledge of Zn+LoORS

by the PHCWs and their knowledge of prescription

of Zn+Lo-ORS, in Ibadan.

Objectives: The objective was to assess the level

of knowledge of Zn+Lo-ORS and of its prescription,

for under-five children with diarrhoea amongst

PHCWs in Ibadan. Factors associated with the level

of knowledge of Zn+Lo-ORS and of prescription of

Zn+Lo-ORS were also determined.

Subjects and methods: This was a descriptive

cross-sectional study among PHCWs in five local

government areas of Ibadan. Information from 200

PHCWs, selected via a three-stage sampling

technique, was obtained using a self-administered

questionnaire. Descriptive statistics, Chi-square and

logistic regression tests were utilized in analysing

quantitative data with the level of significance set at

P < 0.05.

Results: The PHCWs were from seven cadres, mean

age 40.6 ±9.90 years, 191 (95.5%) females, and 85

(42.5%) had been on the job for 16-20 years. Only

69.5% had good knowledge of Zn+Lo-ORS and

51.3% had knowledge of correct prescription of

Zn+Lo-ORS for the treatment of childhood diarrhoea.

Chi-square tests revealed significant association

between respondents’ cadre and knowledge of

Zn+Lo-ORS (X 2= 19.33, P< 0.001); and knowledge

of prescription of Zn+Lo-ORS (X 2=18.63, P< 0.001).

PHCWs with 1-5 years of working experience were

more likely to have good knowledge (OR= 1.65; 95%

CI = 0.46-5.84) and those with 6-10 years of working

experience were more likely to prescribe (OR= 1.95;

95% CI = 0.78-4.84) Zn+Lo-ORS compared to 16-

20 years. Midwives were more likely to have good

knowledge (OR= 10.20; 95% CI = 1.75-59.36) and

more likely to prescribe (OR= 22.14; 95% CI = 2.35-

208.15) Zn+Lo-ORS compared to other cadres of

PHCW.

Conclusion/Recommendation: The primary health

care workers’ level of knowledge and prescription

of zinc and Lo-ORS for childhood diarrhoea was sub

optimal. Primary health care workers should be trained

periodically on current management guidelines.

PDF (engleski)

Reference

Wardlaw T, Salama P, Brocklehurst C, Chopra

M and Mason E. Diarrhoea: why children are

still dying and what can be done. Lancet.

;375(9718):870–872.

Lamberti LM, Fischer-Walker CL, Noiman A,

Victora C and Black RE. Breastfeeding and the

risk for diarrhea morbidity and mortality. BMC

Public Health. 2011;11(SUPPL. 3).

Nikhil, T. and Ian RS. Diarrhoea in children: an

interface between developing and developed

countries. Lancet. 2004;363:641–653.

Goh Nancy and Katherine Pollak. Progress over

a Decade of Zinc and ORS Scale-up/ : 2016;56.

ORAL REHYDRATION SALTS Production of

the new ORS. 2006.

UNICEF Supply Division. Oral Rehydration Salts

and Zinc/ : UNICEF Suppliers and Product.

;(February):1–6.

Fischer Walker CL, Fontaine O, Young MW and

Black RE. Zinc and low osmolarity ORS for

SO Bamidele and KL Adediran

diarrhoea: a renewed call to action. Bull World

Health Organ [Internet]. 2009 Oct 1 [cited 2018

Sep 24];87(10):780–6. Available from: http://

www.who.int/bulletin/volumes/87/10/08-

pdf

Baqui AH, Black RE, El Arifeen S, et al. Zinc

therapy for diarrhoea increased the use of oral

rehydration therapy and reduced the use of

antibiotics in Bangladeshi children. J Health Popul

Nutr [Internet]. 2004 Dec [cited 2018 Sep

;22(4):440–2. Available from: http://

www.ncbi.nlm.nih.gov/pubmed/15663177

Shah M.S., Ahmad A., Khalique N., et al. Homebased management of acute diarrhoeal disease

in an urban slum of Aligarh, India. Journal

infection developing countries. J Infect Dev

Ctries 2012; 6(2) 137-142. 2012;6(2):137–142.

Lamberti LM, Walker CLF, Taneja S, Mazumder

S am Black RE. The association between

provider practice and knowledge of ORS and

zinc supplementation for the treatment of

childhood diarrhea in Bihar, Gujarat and Uttar

Pradesh, India: A multi-site cross-sectional study.

PLoS One. 2015;10(6):1–16.

Baqui AH, Black RE, El Arifeen S, et al. Effect

of zinc supplementation started during diarrhoea

on morbidity and mortality in Bangladeshi

children: community randomised trial. BMJ

[Internet]. 2002 Nov 9 [cited 2018 Sep

;325(7372):1059. Available from: http://

www.ncbi.nlm.nih.gov/pubmed/12424162

Scrimgeour AG and Lukaski HC. Zinc and

diarrheal disease: Current status and future

perspectives. Curr Opin Clin Nutr Metab Care.

;11(6):711–717.

Baqui AH. Effect of zinc supplementation started

during diarrhoea on morbidity and mortality in

Bangladeshi children: community randomised

trial. BMJ [Internet]. 2002 Nov 9 [cited 2018

Sep 24];325(7372):1059–1059. Available from:

htt p:// www.b mj.com/ cgi/ doi/1 0. 11 36 /

bmj.325.7372.1059

NDHS. Nigeria Demographic and Health Survey

Niger Demogr Heal Surv 2013 Natl Popul

Comm Fed Repub Niger [Internet]. 2014;1–400.

Available from: https://dhsprogram.com/pubs/pdf/

FR293/FR293.pdf

Sankar MJ, Sinha B, Chowdhury R, et al. Optimal

breastfeeding practices and infant and child

mortality: a systematic review and meta-analysis.

Acta Paediatr [Internet]. 2015;104:3–13.

Available from: http://doi.wiley.com/10.1111/

apa.13147

Omuemu VO, Ofuani IJ and Kubeyinje IC.

Knowledge and use of zinc supplementation in

the management of childhood diarrhoea among

health care workers in public primary health

facilities in Benin-City, Nigeria. Glob J Health

Sci [Internet]. 2012 Mar 1;4(2):68–76. Available

from: https://www.ncbi.nlm.nih.gov/pubmed/

Victora CG, Bryce J, Fontaine O and Monasch

R. Reducing deaths from diarrhoea through oral

rehydration therapy. Bull World Health Organ.

;78(10):1246–1255.

Macdonald V, K Banke and n R. A Public-Private

Partnership for the Introduction of Zinc for

Diarrhea Treatment in Benin Results and Lessons

Learned. 2010;

Bryce J, Boschi-Pinto C, Shibuya K and Black

RE, WHO Child Health Epidemiology Reference

Group. WHO estimates of the causes of death

in children. Lancet (London, England) [Internet].

Mar [cited 2018 Sep 24];365(9465):1147–

Available from: http://linkinghub.elsevier.com/

retrieve/pii/S0140673605718778

Meremikwu M, Udoh E, Esu E, et al. FacilityBased treatment of underfive diarrhoea in Cross

River State A clinical audit. Niger J Paediatr

[Internet]. 2015;42(4):314–8. Available from:

http://www.njpaediatrics.com/2015/v42n4/

Facility-Based treatment of underfive diarrhoea

in Cross River State A clinical audit.html

Abdu H, Olosunde Z, Awogbenja M and Zango

A. Assessing the Capacity of Community Health

Workers on the Current Management of

childhood Diarrhea in Jigawa state, Nigeria. Jos

J Med. 2013;5(1):27–31.

Omuemu VO, Ofuani IJ and Kubeyinje IC.

Knowledge and use of zinc supplementation in

the management of childhood diarrhoea among

health care workers in public primary health

facilities in Benin-City, Nigeria. Glob J Health

Sci. 2012;4(2):68–76.

WHO | Diarrhoea treatment guidelines including

new recommendations for the use of ORS and

zinc supplementation for clinic-based healthcare

workers. WHO. 2005;47.

NPC. Report of Nigeria’s National Population

Commission on the 2006 census. Popul Dev Rev

[Internet]. 2007 [cited 2020 Jan 29];33(1):206–

Available from: http://www.jstor.org/stable/

%0Ahttp://www.jstor.org/stable/

Detailed Information of the 33 Local Governments

In Brief – Oyo State Government [Internet]. [cited

Zn+Lo-ORS prescription by Hea;th Workers 603

Oct 8]. Available from: https://oyostate.gov.ng/

ministry-of-local-government-and-chieftaincymatters/detailed-information-of-the-33-localgovernments-in-brief/

Primary N, Care H, Agency D. MINIMUM

STANDARDS FOR.

State L of HF in O. List of Health Facilities in

Oyo State. 2015;

Mulaudzi MC. Adherence to case management

guidelines of Integrated Management of

Childhood Illness (IMCI) by healthcare workers

in Tshwane, South Africa. SAJCH South African

J Child Heal. 2015;9(3):89–92.

Jones W. Diarrhoea ( Acute ) and Breastfeeding

Mothers. 2014;(330639):1–2.

Santos FS, Hunaldo L, Saldan PC and Stabnow

FC. Breastfeeding and Acute Diarrhea Among

Children. 2016;25(1):1–8.

UNICEF’s GOBI - FFF Program - Rehydration

Project [Internet]. [cited 2020 Feb 17]. Available

from: https://rehydrate.org/facts/gobi-fff.htm

Löfgren J, Tao W, Larsson E, Kyakulaga F and

Forsberg BC. Treatment patterns of childhood

diarrhoea in rural Uganda: A cross-sectional

survey. BMC Int Health Hum Rights.

;12(1):2–7.

Priyadarshini K, Raj V and Balakrishnan S. Audit

of use of antibiotics and zinc supplement in

childhood diarrhea. J Pharmacol Pharmacother

[Internet]. 2013 Jul;4(3):204–5. Available from:

https://pubmed.ncbi.nlm.nih.gov/23960426.