Assessing critical gaps in implementation of WHO and UNICEF’S 7-point diarrhea control and prevention strategy in Uttar Pradesh, India

Context: Diarrhea is one of the leading causes of under-five mortality globally and also in India. In the state of Uttar Pradesh, the prevalence of childhood diarrhea is 12.43% and only around half of the children with diarrhea have access to health-care services. Aims: The aim of this study is to understand the critical gaps at the public health system and community levels for the effective implementation of comprehensive diarrhea control. Settings and Design: This study was conducted in the rural settings and data collection was done at health facility and community levels. Subjects and Methods: A mixed methodology was used to conduct this study. Quantitative data were collected through a household survey with 1350 households in four districts and qualitative data were collected through focused group discussions and in-depth interviews at health facility and community levels. Statistical Analysis Used: SPSS was used for quantitative data analysis. Thematic analysis was performed for qualitative data. Results: Mothers are largely aware of use of oral rehydration solution (ORS) but only a third of the children with diarrhea were treated with ORS. Only a fifth of the mothers knew about the use of zinc and just 7% of children with diarrhea were treated with zinc. Majority of the mothers do not wash their hands with soap at critical times. The use of toilet and safe drinking water were also found minimal. There were challenges related to procurement, supply chain of ORS and zinc and also with respect to health human resource capacity at facility and community level. Conclusions: For comprehensive diarrhea control and prevention, health systems and community-level barriers largely related to supplies, training of staff, and community behavior and practices should be addressed.
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