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Arlington, Virginia, Camp Dresser and McKee International, Environmental Health Project, 2004 Mar. vi, 80 p. (Activity Report No. 128; USAID Contract No. HRN-I-00-99-00011-00)The tools presented in this report relate to technical support provided by USAID through the Environmental Health Project (EHP) to the Public Private Partnership (PPP) for Handwashing with Soap Initiative, which was started by UNICEF and implemented with financial assistance from USAID and the World Bank. As part of USAID/EHP’s technical support, EHP worked with Howard Delafield International (HDI) and prepared a series of program/planning tools used in the preparation of the first-phase of the Nepal Handwashing with Soap Initiative. These tools were based on a literature review of “lessons learned” from the Central American Handwashing Inititiative, as well as a review of other background material prepared for other handwashing with soap activities, and were developed in partnership with UNICEF /Nepal during 2003. The planning tools can be used and/or adapted by other organizations, public or private sector, interested in initiating a PPP in their country. For more information on PPP initiatives, please refer to www.globalhandwashing.org. (excerpt)
Social Science and Medicine. 1993 Jul; 37(1):97-103.Dehydration from diarrheal disease is the leading cause of infant and child mortality in many developing countries. World Health Organization (WHO) policy recommends oral rehydration solution (ORS) for its treatment and prevention. In concordance with this recommendation, many community-based oral rehydration therapy programs have been implemented since the late 1960s, making ORS widely available and affordable. The solution, however, has not been incorporated universally where needed into people's health-seeking practices. A study was conducted on the household management of childhood diarrhea in a poor, urban neighborhood of Managua, Nicaragua, over the period February 1987 - April, 1988. Results are based upon data collected from interviews with 8 key informants and 109 mothers, and 44 reported cases of diarrhea. Despite the provision of ORS by state health facilities, pharmacies, and informal drug vendors, and health education efforts to change mothers' beliefs and practices, the appropriate use of ORS was not common in the household management of diarrhea. Mothers knew about dehydration and diarrhea, but their explanatory models and actual practice reflected heavy reliance upon self-prescribed pharmaceuticals and home remedies; ORS use was associated with clinic attendance. These findings underscore the existing obstacles to changing people's explanatory models for illness and illness management. To best effect positive, healthy change, the context in which treatment options are assessed and used must be understood.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991 Jun.  p. (Occasional Operations Papers; USAID Contract No. DPE-5969-Z-00-7064-00)The paper presents results from diarrheal disease control (CDD) activities in Kenya. A World Health Organization Diarrheal Diseases Household Case Management Survey of 23,884 children under 5 years of age indicates a high use of recommended fluids before and during episodes of diarrheal illness. ORT use was high, while ORS use and volume were low, with better diarrheal management practiced in Western Kenya. Children with diarrhea in districts with CDD communication program are more likely to receive proper care. For home treatment of diarrhea, the Kenyan Food and Fluids Panel recommends mothers to use uji, a locally available porridge, liberal quantities of plain water, fresh fruit juices, fermented milk, and coconut water; exclusive breastfeeding for the 1st 4 months of life; continued feeding of at least 5 times/day during diarrhea; and improved, targeted communication for behavior change especially among mothers of at-risk children. Additional research on food, feeding, communications, and marketing ORS was also recommended. Principal research findings of the survey are discussed in detail. Messages most effective in improving the management of diarrhea include emphasizing feeding during diarrhea, stressing the use of nutritional fluids, continued hesitation of ORS promotion until 1.2- liter packets become generally available through the health system, and emphasizing the rare need for drug therapy of diarrhea. Recognizing signs suggesting the need for health facility treatment should be reinforced.
CURRENT SCIENCE. 1990 Jul 25; 59(13-14):710-3.The Government of India (GOI) founded the National Diarrhoea Management Programme in 1985 to address a leading public health problem which kills >1.5 million children every year. GOI and UNICEF based the program on 3 assumptions: rural Indian mothers do not perceive diarrhea as a serious problem; they do not give food and fluids to their child during diarrhea; and they do not refer their ill child to a medical practitioner. It has since conducted various studies to look at current knowledge, attitudes, and practices of mothers towards diarrhea. Research revealed that indeed mothers did not consider diarrhea a problem until after 4-5 loose stools. Further they did not believe diarrhea could cause death. They only took action when the child with diarrhea did not improve. On the other hand, research showed that 98% of the mothers continued to breast feed or give their child fluids during a diarrhea episode. Nevertheless 70% only gave their child <100 ml or fluid at a time, <3 times/day. Most also fed their child, but usually in smaller quantities. 1 study indicated that most mothers (65%) consulted a medical practitioner, usually a private practitioner, during the most recent diarrhea episode. The medical practitioner was not necessarily a qualified physician and usually prescribed antidiarrheals, even though he knew of ORS. GOI and market research agencies have considered the results of these studies to design advertising and education campaigns that would persuade and convince caretakers and medical practitioners to treat diarrhea in children with oral rehydration solution (ORS) or a sugar salt solution. Moreover the program has restructured its plan to include reinforcing the use of well known home available fluids and foods and promoting the ORS packet as the 1st response to the 1st response to the 1st loose stool.