Point-of-Use Water Disinfection and Zinc Treatment (POUZN) Project
Point-of-Use Water Treatment:Lack of access to safe drinking water is a reality for more than a billion people in the developing world, and contaminated water is one of the leading causes of diarrhoea among children. According to organisers, POU water disinfection with the Safe Water System (SWS) that includes chlorine solution or tablets, safe storage, and behaviour change communication (BCC) is a proven strategy for reducing diarrhoeal disease. SWS was developed by the Centers for Disease Control and Prevention (CDC) and the Pan-American Health Organization (PAHO); field trials have shown a 44-85% reduction in diarrhoeal episodes. POU water treatment has been found to be affordable, practical, and an immediate solution to lack of clean drinking water. When used correctly, the water treatment products disinfect water at POU by inactivating microbial pathogens that cause diarrhea. A bottle of SWS or a chlorine tablet typically provides safe drinking water to a family of 6 for as little as US$0.01 to US$0.03 per day.
The POUZN project supports POU water disinfection programmes in 7 countries: Angola, Benin, Democratic Republic of the Congo, Haiti, Kenya, Malawi, and Rwanda. These programmes promote the use of three products that can be safely used at the household level: a liquid dilute chlorine bleach usually manufactured in country by local manufacturers; Medentech's Aquatabs, a chlorine-based tablet, sold in strips of 10 tablets; and Procter and Gamble's PUR, Purifier of Water, a disinfectant/deflocculant which treats and purifies turbid, or cloudy, water.
Zinc Therapy:According to organisers, Zinc is a cost-effective approach for the prevention and treatment of childhood diarrhoea. Studies have shown that zinc supplements, taken daily for 10-14 days during a bout of diarrhoea, reduce its severity and duration. In addition, zinc supplements have been shown to have a preventive and long-lasting impact, reducing the number of episodes of diarrhoea for an additional 2-3 months. For this reason, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend that children be given zinc supplements, together with a new formulation of oral rehydration salts or oral rehydration therapy (ORS/ORT), for the treatment of acute diarrhoea.
The POUZN project supports zinc treatment programmes in 3 countries: Nepal, Benin, and Madagascar. The Nepal programme, highlighted below, completed its first year of national promotion (as of April 2009) and has been integrated into the United States Department for International Development (USAID)'s Nepal Social Marketing Program. In Benin and Madagascar, 10 tablets of dispersible zinc are being packaged together with two sachets of the new low-osmolarity ORS and marketed as a Diarrhea Treatment Kit.
This diarrhoea prevention and treatment project draws centrally upon social marketing and BCC implemented through mass media and interpersonal communication (IPC) in an effort to encourage healthy behaviours - POU water disinfection and zinc treatment. Amongst the communication tools developed by each of the country programmes to increase knowledge of the correct treatment of diarrhoea and to create demand for all of the products are the following: television and radio commercials, mobile video shows, song contests, community theater performances, and point of sales materials. Improved health practices are also promoted through home visits and edutainment sessions. Programme communications also underscore the importance of hand washing, continued feeding practices, and other elements of proper diarrhoea management and hygiene practices.
Partnership has been a key strategy in developing these messages. POUZN field offices have mobilised private-sector distribution networks in an effort to make high-quality water treatment, ORS, and zinc products available to low-income people at affordable prices. In addition, POUZN country teams have worked with local partner non-governmental organisations (NGOs) to develop information, education, and communication (IEC) materials such as banners and pamphlets with graphic demonstrations on the use of the product. According to organisers, shop owners, health centre volunteers, and community-based care groups are using these materials in their promotions, demonstrations, health days, and health education sessions. POUZN country teams also developed training curriculum for a series of personnel. Training of trainers programmes were launched with NGO partners and Ministry of Health counterparts. Participants then trained public sector health centre staff, pharmacists, community health workers, and community volunteers; private sector providers, pharmacists/chemists; and partner NGO community mobilisers and staff. All programmes have worked closely and collaboratively with Ministry of Health counterparts to develop strong public/private partnerships for health.
Children, Health, Diarrhoea Prevention and Treatment.
Highlight on the Nepal Diarrhea Treatment Program:
Beginning in 2005, Nepal's Ministry of Health and Population embraced the WHO/UNICEF recommendation to integrate zinc into its diarrhoea management programme, encouraging the launch of zinc treatment programmes through both public health facilities and private sector channels. The Ministry requested support from USAID through the POUZN Project to introduce zinc through the private sector. Multiple communications channels were designed to ensure that caregivers and providers understood that zinc together with ORT/ORS is the appropriate treatment for uncomplicated diarrhoea and that inappropriate diarrhoea treatments may be harmful, and that they knew where to obtain zinc. Initially, no appropriate zinc products were available in Nepal, but collaboration with local pharmaceutical manufactures resulted in 3 companies producing and introducing quality, affordable zinc tablets.
Key results: After 6 months of nationwide activity, the POUZN programme in Nepal contributed to an increase in zinc use from 0.4% in 2005 to 15.4% in 2008. Of users, 78% correctly took zinc and ORS together, 64% correctly took zinc for the full 10 days, and 53% correctly used zinc for the full 10 days along with ORS. Mass media was essential in increasing knowledge and use, with organisers identifying television and radio as the most effective means of transmitting key messages to the population. Fifty-three percent of respondents had heard about a zinc product - 50% on the radio and 85% via the television commercial. POUZN messages have reinforced this correct behaviour by instructing caregivers to "use ORS and Zinc tablets - the most effective diarrhea treatment for children under 5." Research also found that caregivers exposed to specific media messages were more than twice as likely to have treated their children with zinc and to have used it correctly for 10 days along with ORS or ORT. They were also much more likely to know where to purchase zinc (77% of those exposed vs. 2% of those not exposed). Organisers stress that zinc promotion through mass media has been essential not only in creating demand but also in providing consumers with information about zinc, its correct use, and access points. Those who had heard POUZN's radio or television messages were 4 times more likely to use zinc during the diarrhoea episode, provide the child with ORS along with the zinc, and provide the zinc for the full 10 days. Several chemists reported having also seen and heard the media spots, motivating them to obtain stocks of the products.
Abt Associates, Population Services International, Procter and Gamble, Medentech, Nutriset. Ministries of Health.
Emails from Angela Milton and Ashleigh Hodge to The Communication Initiative on December 17 2007 and April 28 2009, respectively; Private-Sector Partnerships (PSP) for Better Health-One [PSP-One] website; and "Social Marketing Zinc to Improve Diarrhea Treatment Practices - Findings and Lessons Learned from Cambodia", by POUZN, October 2007.
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