RotaFlash, April 2016
Zinc deficiency places children at greater risk of illness and death due to diarrhea and pneumonia, particularly children under five years old in low-resource settings. Evidence shows that zinc is beneficial in managing acute or persistent diarrhea in children ages 6–59 months, showing clinically important reductions in illness duration and severity. Preventive zinc supplementation has been shown to reduce the incidence of diarrhea, and research has also demonstrated that zinc supplementation reduces the incidence of acute lower respiratory infection among children under 5. Several studies show that preventive zinc supplementation reduces by 18 per cent deaths among children ages 12–48 months. However, use of zinc in countries with the highest under five mortality rates due to diarrhea is limited.
Kenya is ranked 14th among countries with highest number of under-five deaths due to diarrheal disease with 32,000 children dying annually from diarrhea. According to the Kenya Service Provision Assessment 2010, only 49% of children with diarrhea received treatment from a skilled health care provider. In addition, zinc sulphate is used in fewer than 1% of diarrhea cases, despite its proven effectiveness as a high-impact, low-cost intervention for children under five years old.
Considering that majority of children with diarrhea are treated at home, it is imperative for Kenya to increase access to Zinc Sulphate and oral rehydration salts (ORS) at the community level using the existing Community Strategy through the Community Health Workers (CHWs). The Kenyan Division of Child and Adolescent Health, together with civil society partners, including PATH, has been advocating to the Pharmacy and Poisons Board (PPB)— the national drug regulatory authority—to revise the legal categorization of zinc from a prescription-only drug to an over-the-counter drug. In August 2012, the PPB granted this application, creating an opportunity in scaling up management of diarrhea at community level through access to zinc sulphate, a commodity that has been prioritized at a global level for saving lives of children. Scaling up access to zinc sulphate is already a priority in the policy guidelines, whose development, printing and launch was supported by PATH on control and management of diarrheal diseases for children under five years in Kenya. Besides accessing zinc sulphate through the healthcare facilities, parents and other caregivers can now access it through nearby pharmacies, local chemists, shops, and kiosks. More importantly, zinc sulphate will now be much more available through the community health workers (CHWs) who are especially effective at reaching the marginalized and poorer children even at household levels, who have limited access to healthcare.