PT  - JOURNAL ARTICLE
AU  - Rohit Ramchandani
AU  - Simon Berry
AU  - Jane Berry
AU  - Stephen Tembo
AU  - Robert E Black
TI  - Emulating value-chains of fast-moving consumer goods to improve uptake of co-packaged ORS and zinc for childhood diarrhoea: evaluation of the ColaLife trial
AID  - 10.1136/bmjinnov-2021-000914
DP  - 2022 Jul 01
TA  - BMJ Innovations
PG  - 169--182
VI  - 8
IP  - 3
4099  - http://innovations.bmj.com/content/8/3/169.short
4100  - http://innovations.bmj.com/content/8/3/169.full
SO  - BMJ Innov2022 Jul 01; 8
AB  - Introduction Oral rehydration salts (ORS) and zinc comprise the globally recommended treatment for diarrhoea in children aged <5 years. However, limited access contributes to low uptake of this treatment and subsequently high rates of morbidity and mortality among this age group in low-income and middle-income countries. We adopted approaches used for private-sector value-chains of fast-moving consumer-goods, involving the simultaneous stimulation of supply and demand. These approaches were applied to the introduction of an innovative co-packaged diarrhoea-treatment kit (ORSZ co-pack) to increase ORS and zinc coverage at the community level in Zambia.Methods We tested our approach using an observational pre–post test study design in two intervention districts in rural Zambia (Kalomo and Katete), each with a matched comparator (Monze and Petauke, respectively). We assessed the effect on coverage, of ORS and zinc as well as ORS alone, by conducting household surveys of a total of 2458 and 2477 caregivers of children aged <5 years at baseline and endline, respectively, across the four districts. We also assessed whether the source of ORS (public or private sector) changed following the intervention.Results Both intervention districts experienced significant increases in coverage of ORS and zinc from <1% at baseline to 46.9% and 46.3% in Kalomo and Katete, respectively. Uptake in the comparator districts remained low at 1.7% and 0.6% in Monze and Petauke, respectively. For the secondary outcome examining ORS coverage (with or without zinc), the intervention was associated with a significant increase in Kalomo versus Monze, but not in Katete versus Petauke. There was a clear shift from the public to the private sector, and specifically to the use of the ORSZ co-pack.Conclusion Implementation of a value-chain creation approach for an innovative, over-the-counter, co-packaged diarrhoea-treatment kit can significantly improve the coverage of ORS and zinc.Data are available on reasonable request. Deidentified household survey data from the ColaLife Operational Trial Zambia (COTZ) are available upon request from ColaLife, UK charity number 1142516.