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J Glob Health. 2019 Jun;9(1):010502. doi: 10.7189/jogh.09.010502.

Program evaluation of an ORS and zinc scale-up program in 8 Nigerian states.

Author information

Clinton Health Access Initiative, Boston, Massachusetts, USA.
Clinton Health Access Initiative, Abuja, Nigeria.
National Primary Health Care Development Agency, Abuja, Nigeria.
This paper is dedicated to Dr Nnenna Ihebuzor who passed away on March 24, 2018. The study and the program described would not have been possible without her tireless efforts.



In Nigeria, diarrhea is the second leading killer of children under five. Between 2012-2017, the Clinton Health Access Initiative, Inc. (CHAI) and the Government of Nigeria implemented a comprehensive program in eight states aimed at increasing the percentage of children under five with diarrhea who were treated with zinc and oral rehydration solution (ORS). The program addressed demand, supply, and policy barriers to ORS and zinc uptake through interventions in both public and private sectors. The interventions included: (1) policy revision and partner coordination; (2) market shaping to improve availability of affordable, high-quality ORS and zinc; (3) provider training and mentoring; and (4) caregiver demand generation.


We conducted cross-sectional household surveys in program states at baseline, midline, and endline and constructed logistic regression models with generalized estimating equations to assess changes in ORS and zinc treatment during the program period.


In descriptive analysis, we found 38% (95% CI = 34%-42%) received ORS at baseline and 4% (95% CI = 3%-5%) received both ORS and zinc. At endline, we found 55% (95% CI = 51%-58%) received ORS and 30% (95% CI = 27%-33%) received both ORS and zinc. Adjusting for other covariates, the odds of diarrhea being treated with ORS were 1.88 (95% CI = 1.46, 2.43) times greater at endline. The odds of diarrhea being treated with ORS and zinc combined were 15.14 (95% CI = 9.82, 23.34) times greater at endline. When we include the interaction term to investigate whether the odds ratios between the endline and baseline survey were modified by source of care, we found statistically significant results among diarrhea episodes that sought care in the public and private sector. Among cases that sought care in the public sector, the predictive probability of treatment with ORS increased from 57% (95% CI = 50%-65%) to 83% (95% CI = 79%-87%). Among cases that sought care in the private sector, the predictive probability increased from 41% (95% CI = 34%-48%) to 58% (95% CI = 54%-63%).


Use of ORS and combined ORS and zinc for treatment of diarrhea significantly increased in program states during the program period.

[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: FL, A Abdulwahab, JH, O Adekeye, MA, A Akinjeji, TB, O Ajeroh, MS, NG, KS, OW, and MRP were employed by the Clinton Health Access Initiative and received funding to design, implement, and evaluate the program described. 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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