Control of Diarrhoeal Diseases (CDD) Programme

This campaign was holistic and sustained, involving synergy among all partners rather than being bound to a particular non-government organisation (NGO), activity, or time.

Because the awareness of ORT in Bangladesh at the project's inception was fairly high, the campaign aimed to increase ORT usage by addressing ground-level "influencers", or credible spokespeople who would create an environment of acceptance and support for caretakers - with the aim of increasing their use of ORT. These influencers include schoolteachers, development and health workers, maulvis or Islamic religious leaders, urban medical professionals, and rural health functionaries/village doctors. The idea was that all possible conduits to the primary caretaker - the parents, especially the mothers - should support the same idea and messages.

Each of these influencers had specially designed packages of material to encourage and facilitate their participation in the campaign. The schoolteachers, religious leaders and health workers participated in orientation and training programmes to support use of the packages designed for them. The schoolteachers' package described activities such as skits, quizzes, and games that could be used as part of the curriculum to provide children with information on ORT; the religious leaders were provided with information that highlighted their status in society and the influence they wielded. Drawing inferences from the Al-Kuran, they were asked them to talk about the importance of ORT in saving children's lives. Posters using Koranic metaphor to stress the importance of rehydration were put up at mosques and other places of worship.

The package for health workers was designed on the enter-educate principle. It consisted of a self-learning guide on diarrhoea management with local terms and references, as well as a flip book in story format with narrative structured to increase reader participation. A key feature of the package was the demonstration kit consisting of an inflatable plastic doll with an inlet at the top from which water could be filled and an outlet for the water to drain out. When the doll is filled with water, it depicts a healthy child; when drained, it becomes shriveled to depict a dehydrated child. However, merely replacing the stopper in the outlet doesn't restore the doll; it has to be refilled with water to look healthy, thus demonstrating the key point that it is more crucial to replenish the body with fluids than to merely stop the diarrhoea itself.

An Action Guide for Scouts and Guides on ORT was prepared based on the Meena initiative (click here for a summary). Scouts and guides were mobilised to teach 10 new families about ORT and follow up with 10 other families to ensure correct ORT use; for their efforts they were awarded with badges of merit. The key message was: "Give a child suffering from diarrhoea plenty to drink.

Easy-to-use reference booklets were prepared for caretakers based on visual literacy using folk motifs to emphasise core messages on rehydration, oral rehydration sals (ORS), and symptoms for referral.

Direct mailers were sent to urban medical professionals positioning ORS as the most advanced, WHO-approved, internationally prescribed remedy for diarrhoea. It consisted of direct mail, posters, and ads in medical journals that had a simple call to action - "prescribe ORS; it is the world's remedy for diarrhoea." Also included was a diarrhoea management chart. Rural medical practitioners, who often prescribed needless antibiotics without prescribing ORT, were provided with posters and information on diarrhoea management, stressing the three golden rules - increase fluids, continue feeding, and get further help if necessary. Relevant sections of "Facts for Life" were mass-mailed to 8000 village doctors.

In all of the above-mentioned packages and materials, an ORT logo showed the fluid rising in a child as the caretaker's hand feeds the child fluid from a glass. Red and yellow colours were used in the logo to ensure optimum visibility and impact. These colors were carried through all the communication material to create a unified, easily recognisable look. A specially designed border in an easily identifiable folk style was also used with traditional motifs to illustrate the importance of various home fluids in the management of diarrhoea at home.

In addition, divisional advocacy meetings were held with civil surgeons, district primary education officers along with local media and representatives from the department of health engineering and local NGOs. Advocacy efforts consisted of press campaigns addressing teachers, maulvis (religious leaders) and mail carriers to build a climate of acceptance and heighten their roles in diarrhoea management. They were provided with orientation and training sessions on ORT, emphasising their status as role models and praising their efforts as prime movers.

Children, Health.

Thanks to door-to-door contact made in the 1980s with over 13 million rural households, today there is a 90% knowledge of ORT in Bangladesh. ORT usage rose from 24 percent in 1990 to 60% in 1994. However, diarrhoea claims one child every two minutes in the country. Forty percent of caretakers never seek help outside the home, and only 7% of them take their children to the public health care system. Only 45% of caretakers take the crucial step of giving increased fluids children with diarrhoea. Therefore, there is a critical need to increase the usage of ORT.

A process evaluation indicated that the schoolteachers' packages in particular have been extremely popular with the children, all of whom are now fully familiar with ORT.

Phase 2 of the campaign, which primarily addressed urban and semi urban populations and made use of radio and television spots, emphasised the message "provide fluids, immediately."