Qualitative Research for a Zinc Treatment Program in Nepal: Findings and Recommendations

This 33-page study provides the results of formative research conducted in the Kathmandu valley of Nepal as part of an international initiative to introduce zinc as the treatment for childhood diarrhoea in the public and private sectors. The United States Agency for International Development (USAID)'s Social Marketing Plus for Diarrheal Disease Control programme (POUZN - implemented by Abt Associates and Population Services International) and the Nepalese Ministry of Health and Population (MOHP) are working together to pilot zinc introduction programmes in several districts with the intention of using the results to launch a national zinc treatment programme.

As a basis for the development of communication campaigns to support the launch of zinc in both sectors, POUZN contracted with the Central Department of Population Studies, Centre for Population Research and Training of Tribhuvan University, to conduct a qualitative study of diarrhoea treatment practices in Nepal. Focus group sessions with caregivers from varying socio-economic subgroups and in-depth interviews with 30 pharmacists revealed that diarrhoea symptoms and danger signs are well understood. Oral rehydration therapy (ORT) and/or oral rehydration salts (ORS) are both commonly requested and used by caregivers and "prescribed" by pharmacists. Caregivers were found to be amenable to using zinc as a diarrhoea treatment if it proves effective. Both caregivers and pharmacists have long associated zinc with vitamin supplements rather than as a pharmaceutical treatment for illness.

The formative research also identified a number of issues that will need to be addressed in both educational and promotional campaigns that will accompany the launch of the programme. Both caregivers and pharmacists have long associated zinc with vitamin supplements rather than as a pharmaceutical treatment for illness. The challenge will be to convey the concept of zinc as a high quality essential diarrhoea treatment rather than as an "extra" or adjunct treatment or supplement. It is clear from the research that the behaviour change messages must address the following: the quality of the product; how zinc works to decrease the duration and severity of diarrhoea and to prevent future bouts of diarrhoea; the need to continue to use ORT to prevent dehydration; the need to take the full 10-day regimen to get the maximum protective benefit; cost and treatment effectiveness of zinc in comparison to antibiotics and anti-protozoals; and the nature of side effects.

The results of this study will be used to inform the development of communication and marketing strategies and the design of a range of communication and educational materials and training curricula for both public and private sector health care providers and pharmacists.