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J Glob Health. 2019 Jun;9(1):010501. doi: 10.7189/jogh.09.010501.

Effect of enhanced detailing and mass media on community use of oral rehydration salts and zinc during a scale-up program in Gujarat and Uttar Pradesh.

Author information

Clinton Health Access Initiative, Boston, Massachusetts, USA.
Northern Arizona University, Center for Health Equity, Flagstaff, Arizona, USA.
Teach for America, New York, New York, USA.
Alive & Thrive / FHI Solutions LLC, New Delhi, India.
Clinton Health Access Initiative, New Delhi, India.
RTI International India, New Delhi, India.
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.



The Clinton Health Access Initiative implemented a program from 2012-2016 to increase use of oral rehydration salts (ORS) and zinc to treat diarrhea in children under five in three states in India: Gujarat, Madhya Pradesh, and Uttar Pradesh. The program interventions included detailing and development of a rural supply chain to reach private rural health care providers, training of Accredited Social Health Activists (ASHAs), technical support to the state governments, and a mass media campaign targeted at caregivers. In Gujarat and Uttar Pradesh, some of the program activities, such as detailing and ASHA trainings, were targeted to high-burden focal districts, thus providing an opportunity to study their effect compared to statewide activities that covered all districts, such as the mass media campaign. Our study aimed to estimate the effect of activities on ORS and zinc use.


Household surveys were conducted at two points during the program and in both focal and non-focal districts. We used a difference-in-difference quasi-experimental approach to estimate the effect of the enhanced activities in focal districts and mass media campaign on the odds of a child being treated with ORS and zinc.


Focal district interventions were associated with a significant increase in the odds of a diarrhea episode receiving ORS in Gujarat and Uttar Pradesh. Living in focal districts increased the odds of receiving ORS in Gujarat and Uttar Pradesh by factors of 3.42 (95% CI = 1.39-8.33) and 2.29 (95% CI = 1.19-4.39), respectively. Focal district interventions were also associated with 15.02 (95% CI = 2.97-75.19) greater odds of receiving both ORS and zinc in Gujarat. In Uttar Pradesh, where the mass media campaign was focused, exposure to the campaign further modified the odds of receiving ORS and combined ORS and zinc by 1.38 (95% CI = 1.04-1.84) and 1.57 (95% CI = 1.01-2.46), respectively.


Comprehensive public and private provider interventions combined with mass media are effective strategies for increasing ORS and zinc use.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: SA, NB, FL, MRP, KS, MS, VS, AT, AM, HS, NT, and LW were employed by the Clinton Health Access Initiative and received funding to design, implement, and evaluate the program addressed in this manuscript to scale up the use of ORS and zinc. GP received fees from the Clinton Health Access Initiative to support data analysis. The authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare no other conflicts of interest.

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