Zinc Treatment in Complex Emergency and Post-Conflict Settings

Abstract

Presenter:MD Emmanuel D’ Harcourt; Senior Child Survival Technical Advisor; International Rescue Committee, USA

Authors: Emmanuel d’Harcourt, MD, MPH, Joseph Ndakala, MD, MPH, Maureen Phelan, MPH, All with the International Rescue Committee

Background:WHO and UNICEF policy sanctions zinc treatment of children with diarrhea in areas where malnutrition is prevalent, and convenient, affordable zinc tablets are available, but implementation of zinc treatment has been very limited worldwide.  This is especially true in complex emergency and post-conflict settings; even though both malnutrition and diarrhea are usually prevalent in those settings.  This lack of implementation is in part due to a paucity of information about the practical aspects of implementing zinc treatment programs in these difficult settings.  We report here on the early experience of the International Rescue Committee (IRC) with zinc treatment.

Program description:The IRC initially tested zinc treatment of children with diarrhea in July 2004 in Eastern DR Congo, a region with high rates of malnutrition and diarrhea; implementation of its first pilot program began in November 2004 in the same area.  Zinc treatment is provided at no charge by community health workers supervised by health center staff.  Zinc was purchased from Nutriset.  The IRC is also beginning zinc treatment in Eastern Chad and in Darfur, Sudan, and will begin shortly in Rwanda and Sierra Leone.  In all sites, IRC staff and partners conduct a baseline survey for coverage of zinc and ORS, as well as inappropriate use of antibiotics.  IRC staff also visited households of patients treated in the first month of implementation.

Results:Baseline results in DR Congo and Chad showed low rates of ORS use, 26% and 39% respectively, and in both places no zinc treatment was available.  In the first month of the pilot program in DR Congo, 134 children were treated for diarrhea with zinc and ORS, as compared to an average of five children treated for diarrhea each month at Cibingu Health Center in the three months from September to November 2004.  Mothers of treated children reported high rates of satisfaction with the program, citing the convenience of having treatment available nearby, the perceived efficacy of the program, and the follow-up provided by community distributors.

We intend to report similar data from programs that will have started by April 2005.

Conclusions:Zinc treatment in complex emergencies is feasible, is popular with beneficiaries, and has the potential to dramatically increase coverage of ORS treatment as well.  There is evidence that zinc treatment is relatively inexpensive to implement and serves to strengthen other components of community health programs, such as community-based treatment of children with malaria.

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