Formative Research to Develop and Test Messages to Educate Mothers on Zinc Supplementation in

Childhood Diarrhea

Cecilia S. Acuin1,2, Alberta S. Vargas3 and Cynthia P. Cordero1,2

Background. Zinc is now recommended as part of childhood diarrhea case management but there are concerns
regarding treatment duration and perceptions of its use when given with ORT.

Objectives. This study developed and tested messages on zinc supplementation for childhood diarrhea.

Methods. Messages were based on 1) a review of literature and product advertisements, 2) drugstore seller
interviews, and 3) focus group discussions (FGDs) among 10 mothers with children six to 59 months old.
Subsequent FGDs with 15 mothers consulting at a government hospital helped determine message
clarity, comprehension and appeal. A behavioral trial, involving nine mothers whose children had diarrhea,
tested recall of and adherence to the messages.

Results: The trial tested three messages—Zinc: 1) strengthens resistance; 2) is a vitamin for the gut; 3) increases
the appetite of a child with diarrhea. Seven of nine mothers were able to follow instructions on zinc
administration, and demonstrated recall and understanding of these messages. Mothers understood that
zinc helps the child with diarrhea, improves appetite, reduces
symptoms and hastens recovery, but had concerns regarding the side effects (vomiting), co-morbidities
(fever, cough) and consequences of overdose. Standardized counseling cards addressed these concerns.
Respondents preferred a simple logo labeled “zinc” with zinc administration instructions on the packaging.
Zinc supplementation did not affect ORT use.

Conclusion and Recommendations. Messages sufficiently addressed mothers’ concerns on zinc use during
childhood diarrhea, with those on zinc improving “resistance” and as a “vitamin for the gut” having the best
recall. Results can contribute to zinc’s introduction and promotion in the public sector.

 a. b. Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines

Manila
 2. a. b. Department of Clinical Epidemiology, College of Medicine, University of the Philippines
Manila
 3. The Medical City, Ortigas Avenue, Pasig City

ISSN 0001-6071
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Food and Waterborne Diseases Prevention and Control Program

Profile:

Food and Waterborne Diseases (FWBDs) are among the most common causes of diarrhea. In the Philippines,
diarrheal diseases for the past 20 years is the number one cause of morbidity and mortality incidence rate
is as high as 1,997 per 100,000 population while mortality rate is 6.7 per 100,000 population. From 1993
to 2002, FWBDs such as cholera, typhoid fever, hepatitis A and other food poisoning/foodborne diseases
were the most common outbreaks investigated by the Department of Health. Also, outbreaks from FWBDs
can be very passive and catastrophic. Since most of these diseases have no specific treatment modalities,
the best approach to limit economic losses due to FWBDs is prevention through health education and
strict food and water sanitation.
The Food and Waterborne Disease Prevention and Control Program (FWBDPCP) established in 1997 but
became fully operational in year 2000 with the provision of a budget amounting to PHP551,000.00. The
program focuses on cholera, typhoid fever, hepatitis A and other foodborne emerging diseases (e.g.
Paragonimiasis). Other diseases acquired through contaminated food and water not addressesd by other
services fall under the program.

Diarrhea kills 10,000 Pinoy kids every year - WHO

MANILA, Philippines - Over 70,000 Filipino children have died of diarrhea in span of seven years, the World
Health Organization (WHO) said in a study released Friday.

In its study which it co-conducted with the Department of Health and United Nations Children Emergency
Fund (UNICEF), WHO said this figure makes diarrhea the fourth leading cause of deaths among children
less than five years old and the third leading cause of illness among the children.

The study showed that if the trend continues, it is expected to cause 10,000 deaths every year.

Dr. Maria Ricardo, health specialists revealed that the Philippines ranks second among 13 countries
included in the census in terms of the number of diarrhea cases.

Ricardo said the number of diarrhea cases in the Philippines is almost double the figure for other Asian
countries like Vietnam, Mongolia, Malaysia, Hong Kong, Japan, Laos, Papua New Guinea, Cambodia and
Korea.

Statistics likewise showed that the country is the second largest contributor to diarrhea morbidity in the
world, next to China with 593,372 deaths based on the 2000 census conducted by the group.

The same survey also revealed that between 10 to 20 percent or 1.5 million children under the age of five
suffer from diarrhea at one time, and attributed the prevalence of the illness to poor hygiene. Experts note
that the incidence of diarrhea may easily be lowered by 40 percent by having kids wash their hands with
water and soap.

“Unfortunately, many children do not wash their hands due to lack of access to water and basic sanitation
facilities, poor hygienic practices, and handed down practice from parents," Ricardo said.

Meanwhile, Dr. Yolanda Oliveros, director of the National Center for Disease Prevention and Control
(NCDPC) said that the national government has also launched its own analysis for the year 2000 on
handwashing practice among adults and children.

She said that among adults, 90 percent have said that they wash their hands before eating but less than
50 percent of children below 12 years old adhere to the practice.

The study also indicated that only 20 percent of children below five years old, 37 percent among
adolescents, 44 percent of adults, and 50 percent of older people wash their hands after they use the
toilet.

The study was released ahead of the commemoration of the 1st Global Handwashing Day next month. -
GMANews.TV
Environmental Health

Environmental Health is concerned with preventing illness through managing the environment and by changing
people's behavior to reduce exposure to biological and non-biological agents of disease and injury.  It is
concerned primarily with effects of the environment to the health of the people.

Program strategies and activities are focused on environmental sanitation, environmental health impact
assessment and occupational health through inter-agency collaboration.  An Inter-Agency COmmittee on
Environmental Health was created by virute of E.O. 489 to facilitate and improve coordination among
concerned agencies.  It provides the venue for technical collaboration, effective monitoring and
communication, resource mobilization, policy review and development.  The Committee has five sectoral
task forces on water, solid waste, air, toxic and chemical substances and occupational health.

Vision:

Health Settings for All Filipinos

Mission:

Provide leadership in ensuring health settings

Goals:

Reduction of environmental and occupational related diseases, disabilities and deaths through health promotion
and mitigation of hazards and risks in the environment and worksplaces.

Strategic Objectives:

1.  Development of evidence-based policies, guidelines, standards, programs and parameters for specific healthy
settings.

2.  Provision of technical assistance to implementers and other relevant partners

3.  Strengthening inter-sectoral collaboration and broad based mass participation for the promotion and
attainment of healthy settings

Key Result Areas:

 Appropriate development and regular evaluation of relevant programs, projects, policies and plans
on environmental and occupational health
 Timely provision of technical assistance to Centers for Health Development (CHDs) and other
partners
 Development of responsive/relevant legislative and research agenda on DPC
 Timely provision of technical inputs to curriculum development and conduct of human resource
development
 Timely provision of technically sound advice to the Secretary and other stakeholders
 Timely and adequate provision of strategic logistics

Components:

 Inter- agency Committee on Environmental Health

 IACEH Task Force on Water
 IACEH Task Force on Solid Waste
  IACEH Task Force on Toxic Chemicals
 IACEH Task Force on Occupational Health
 Environmental Sanitation
 Environmental Health Impact Assessment
 Occupational Health

Pollution, sanitation, hygiene RP’s biggest concerns--report

By Alexander Villafania
INQUIRER.net
First Posted 11:20:00 09/06/2007

Filed Under: Health, Environmental pollution, Environmental Issues

MANILA, Philippines -- Air pollution, lack of good sanitation and hygiene practices are the most significant
environment-related health risks in the country, according to a joint report by the World Bank and two
government agencies.

The Philippine Environment Monitor 2006 of the World Bank, the Department of Environment and Natural
Resources and the Department of Health, which was launched Tuesday, show that these concerns
account for 22 percent of reported disease cases and six percent of deaths and cost P14.3 billion per year
in lost income and medical expenses.

The report states that water-borne diseases, poor sanitation conditions and poor hygiene practices account for
one-sixth of all deaths in the Philippines and about 6,000 premature deaths per year. Diarrhea is the most
common water-borne disease, followed by intestinal worms, typhoid, and cholera.

Over 25 million Filipinos do not have access to basic sanitation and another 13 million do not have proper water
resources contributing to the problem, the report said. Due to water pollution, cost of treatment and lost
income amounted to P6.7 billion in 2006, it says.

Air pollution is another problem and among the diseases attributed to this are chronic bronchitis, pneumonia and
cardiovascular diseases. City dwellers, amounting to 18 million Filipinos, are the biggest victims of air
pollution due to their proximity to smoke belching vehicles, and even tobacco smoke, the report says.

It states that losses from cost of treatment and lost income due to air pollution amounts to P7.6 billion per year, it
says.

The PEM also reports however that there have been improvements in alleviating diseases from pollution and lack
of hygiene, which include government’s more pro-active attempt in raising the profile of environmental role
in health.

Agencies concerned with health and environment should also provide useful and easy-to-access information on
different methods, the report says.

The PEM also suggests that there should be more improvements in health infrastructure, such as more basic
sanitation facilities and expand water resource development to prevent health risks from water pollution.

The government is also urged to act on regulations discouraging the use of vehicles with high smoke emissions, it
says.

The full PEM 2006 report can be accessed from the World Bank website (www.worldbank.org.ph)