Survey of caregivers in Kenya to assess perceptions of zinc as a treatment for diarrhea in young children and adherence to recommended treatment behaviors

BACKGROUND In 2004, the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) revised their recommendations for management of acute diarrhea in children to include zinc treatment as well as oral rehydration solution (ORS). Little is known about how caregivers in low-resource settings perceive and use zinc treatment. METHODS Using a semi-structured quantitative survey, we interviewed Kenyan caregivers who had used zinc to treat children aged 6-60 months with an episode of diarrhea during the previous 6 months. The survey asked about experience using zinc, compliance with course and dosing regimens, and the attributes of zinc compared with other treatments. We surveyed a quota sample of 100 women from several communities where zinc treatment was available, primarily through public sector providers. RESULTS The mean duration of the reference diarrhea episode was 5.3 days (95% confidence interval (CI) 4.7-5.9). Eighty-two respondents had used zinc tablets, and 18 had given zinc syrup. Among those who used tablets, 62% reported giving zinc for fewer than the recommended 10 days, with a mean of 6.8 days (95% CI 6.1-7.4 days), and 50% said they had been instructed to give zinc for 5 days or less. Also, only 55% gave the correct daily dose. When asked about other treatments, 64% of the respondents reported using antibiotics, 59% ORS, and 56% a homemade remedy. Among the zinc tablet users, 55% provided zinc as the 3(rd) or 4(th) treatment for the reference episode. Also, 75% of respondents reported receiving the zinc treatment free of charge. Caregivers reported a very high level of satisfaction with zinc treatment, with 88% indicating that zinc (either in tablet or syrup form) was their most preferred treatment. CONCLUSIONS Despite the potential benefits of zinc for children with acute diarrhea in low-resource settings, treatment regimens remain unwieldy and unrealistic, perhaps unnecessarily. Furthermore, the availability of zinc is limited primarily to public-sector providers. Increasing access to this treatment beyond the public clinic or hospital may accelerate uptake and sustained use.