Emulating commercial, private-sector value-chains to improve access to ORS and Zinc in rural Zambia: evaluation of the colalife trial

Type Thesis or Dissertation - Doctor of Public Health
Title Emulating commercial, private-sector value-chains to improve access to ORS and Zinc in rural Zambia: evaluation of the colalife trial
Publication (Day/Month/Year) 2016
URL https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39229/RAMCHANDANI-DISSERTATION-2016.pdf
Globally, diarrhea remains a leading cause of avoidable morbidity and
mortality in children under 5. The most pressing challenges and recommendations for
the reduction of childhood diarrhea today are consistent with those described over the
past decade, pointing to a need for innovation. Key challenges include insufficient
access, production, distribution and promotion of essential commodities like ORS
and zinc, the globally recommended treatments. Market-based solutions that engage
the private sector and simultaneously stimulate both supply and demand of these
commodities have been recommended as a way of increasing coverage, and
ultimately reducing mortality.
The ColaLife project aimed to emulate the commercial, private-sector value
chains of fast moving consumer goods (FMCGs), like Coca-Cola, and apply similar
principles to the development and introduction of an innovative diarrhea treatment
kit called the Kit Yamoyo®. This dissertation explores key elements related to the
establishment of an end-to-end value-chain for this new product in Zambia. It
includes 1) analysis of the overall impact of the approach on uptake of ORS and zinc,
2) determining the effect of applying human-centered design to global health product
innovation, and 3) a detailed description of commercial general stores to inform their
potential as informal, community-level providers of public health commodities.
The main data sources include cross-sectional, rural household surveys
conducted in August of 2012 (baseline) and August of 2013 (endline), as well as
retailer surveys conducted in March of 2013 (midline) and August of 2013
(endline). Questionnaires were administered to 2458 and 2477 caregivers of
children under 5, across 4 rural districts of Zambia, at baseline and endline,
respectively. Two districts (Kalomo and Katete) served as intervention districts,
while the other two (Monze and Petauke) served as matched comparators. Paper #1
uses a generalized linear model (GLM) with Poisson distribution to calculate the
adjusted relative risk of combination therapy use in intervention districts vs.
comparator districts at endline. Secondary analysis uses difference-in-differences
estimation to compare ORS use (with or without zinc) in the intervention and
comparison districts, before and after market-shaping activities. Paper #2 compares
ORS use in children under 5 with diarrhea who either used Kit Yamoyo or standard
one-liter sachets of ORS from rural health centers. Data drawn from the endline
survey is analyzed using logistic regression and calculates the odds of correct
preparation of ORS (i.e. concentration) in kit-users vs. non-users. Secondary analysis
examines to what extent preparation of ORS in the correct concentration, or other
factors, are associated with a change in the odds of perceiving ORS as effective.
Paper #3 is predominantly descriptive in nature. It uses retailer survey data from
180 interviews of general, community-level retailers across the 4 study districts,
who commonly sell FMCGs, to explore the potential of using them as outlets for
provision of basic public health products like ORS and zinc. Findings are grouped
under key themes including: infrastructure, staffing, ownership and operations,
purchasing patterns, product preferences, and level of engagement with an intervention to
expand coverage of a newly introduced diarrhea treatment kit.

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