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Can the Management of Uncomplicated Diarrhea at the ADDOs in Tanzania be Further Improved?

Can the Management of Uncomplicated Diarrhea at the ADDOs in Tanzania be Further Improved?. ICIUM 2011 Dr.Suleiman Kimatta. Tanzania: Child Health Indicators. General indicators Infant mortality rate 51/1000 live births <5 mortality rate is 81/1000 live births

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Can the Management of Uncomplicated Diarrhea at the ADDOs in Tanzania be Further Improved?

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  1. Can the Management of Uncomplicated Diarrhea at the ADDOs in Tanzania be Further Improved? ICIUM 2011 Dr.SuleimanKimatta

  2. Tanzania: Child Health Indicators General indicators • Infant mortality rate 51/1000 live births • <5 mortality rate is 81/1000 live births • Neonatal mortality rate is 26/1000 (reduced 25–30% since 1999 Diarrhea management • During the 2 weeks before survey, 13% of children <5 had diarrhea • 96% awareness of oral rehydration solution (ORS) • 54% ORS and 70% ORT use rate • 45% taken to health facility for treatment • 2005–2009, 53% of <5s with diarrhea received oral rehydration and continued feeding Sources: Tanzania DHS -2005, UNICEF State of the World Children 2011, MOHSW 2011

  3. Interventions to Improve Diarrhea Management in ADDOs

  4. Study Methodology Objective: To determine how ADDO dispensers manage uncomplicated diarrheal in children under 5 Design and setting • Quantitative data collection using a mystery shopper scenario in— • Ruvuma region (7 years of ADDO operation) • Singida region (1 year of ADDO operation) • Mara region (no ADDOs/control) • 60 randomly selected ADDOs from each region Outcome measure • Percentage of uncomplicated diarrheal encounters in which antibiotics or appropriate treatment using ORS were dispensed

  5. Average Availability of Recommended Products to Manage Uncomplicated Diarrhea 20 mg

  6. Diarrhea Case Management: Singida and Mara

  7. Diarrhea Case Management: Ruvuma

  8. Key Lesson Learned • Managing uncomplicated diarrhea with ORS increased and antibiotic dispensing decreased after the ADDO intervention in Ruvuma and Singida • However, practices still fall well short of the recommended national treatment guidelines • Changing health provider prescribing behavior takes time, which has policy and program implications • Caregivers trust public sector health providers; interventions need to target them to change medicine use

  9. Challenges & Future Research Questions Is profit indeed the motive in the ADDOs? Apply what is already known about perceptions of antibiotic use for diarrhea management Quantify current prescriber contribution to inappropriate diarrhea management in ADDOs and propose solution

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