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Diarrhea, InfantileNCT04335877

Effect of Prompting the Supply of Zinc/LO-ORS Co-packs in the Private Sector Plus BCI on Childhood Diarrhea Treatment

A study testing Private sector component + modified BCC in people with Diarrhea, Infantile, run by Nutrition International at 1 site in Kenya.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study assesses whether prompting the supply of zinc and LO-ORS co-packs in the private sector coupled with behavior change communication (BCC) has an effect on the treatment of uncomplicated childhood diarrhea. Read more about this study

Who is it for?
Ages 2 to 60 months
Conditions the study is for
Diarrhea, Infantile
What is being tested?
Private sector component + modified BCC
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,245 participants
Where
1 siteKenya
Study dates
1 Mar 2021to 2 Apr 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 2 to 60 months
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • All children under 5 years of age who live in the selected areas to be included in the study are eligible to participate. All children in area selected for the intervention will be exposed to the private sector component and the modified BCC.
  • In addition, all private sites (shops, kiosks, chemists) in the intervention area will be eligible to participate in the study.

Who cannot join

  • None

Trial locations and contacts

1 site in 1 country.

Kenya1 site
  • Nutrition International - Kenya

    Nairobi

Other trials in Kenya

About this study

Official title: Effectiveness-Implementation Research to Assess the Effect of Prompting the Supply of Zinc/LO-ORS Co-packs Through the Private Sector Coupled With Behavior Change Intervention on the Treatment of Uncomplicated Childhood Diarrhoea in Kenya

This study assesses whether prompting the supply of zinc and LO-ORS co-packs in the private sector coupled with behavior change communication (BCC) has an effect on the treatment of uncomplicated childhood diarrhea. In addition the study will evaluate the acceptability, adoption, feasibility and coverage of the intervention model. One group of children and caregivers will receive the current standard of care and will be exposed to standard BCC and the second group will be exposed to the private sector component and to a modified BCC.

Read the detailed description

Diarrhoea accounts for 7% of all under-five deaths in Kenya. Recent experiences in other countries show that the private health sector can be successfully harnessed to improve diarrhoea treatment coverage.

This study assesses the effect of prompting the supply of zinc and low-osmolarity oral rehydration salts (LO-ORS) co-packs in the private sector coupled with increasing the demand for co-packs among caregivers on: 1) the treatment of uncomplicated childhood diarrhoea, 2) care-seeking in the private sector, and 3) availability of co-packs in the private sector.

The target population will be children under five years of age and their caregivers in Vihiga County. The study will use a effectiveness-implementation hybrid design with two arms: 1) children and caregivers from areas that receive the current standard of care and will be exposed to standard BCC and 2) children and caregivers from areas where the private sector component will be implemented and that will be exposed to a modified BCC. Two of the five existing sub-counties in Vihiga will be selected by convenience to be assigned to one of the two study arms. The selection will take into account geographical distance between the two sub-counties (i.e. maximizing the distance between the two counties to minimize cross-pollination between the two study groups), rural vs urban population, and number of operational community units and CHV in each sub-county. All private sector retailers within each sub-county will be identified with assistance from wholesalers. Retailers will be invited to participate in the study via sensitization meetings.

Baseline and endline assessments will be conducted at the household level to collect information on care-seeking practices, availability of the co-pack in the household, treatment of diarrhoea, and whether caregivers received information from shopkeepers on using the co-pack. Monitoring of process indicators will be conducted throughout the intervention period. The monitoring process will also be used to evaluate the adoption and feasibility of the implementation model. In addition, the endline survey will be used to evaluate the acceptability, adoption, and coverage of the implementation model.

Being tested
Private sector component + modified BCC
Medical subject headings
Diarrhea, Infantile

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Private sector component + modified BCCOther

    Intervention group will be exposed to the private sector component + modified BCC and will receive current standard care

Study groups in NCT04335877
Study groupRoleWhat they receive
Private sector component + modified BCCExperimentalPrivate sector component + modified BCC + current standard of care
Receives: Other: Private sector component + modified BCC
ControlNo interventionCurrent standard of care + standard BCC

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Treatment of uncomplicated diarrhea

    change in % of caregivers who use zinc and LO-ORS co-pack to treat uncomplicated childhood diarrhea at 12 months

    Measured: 12 months

  2. Care-seeking in the private sector

    Change in % of caregivers seek care for uncomplicated childhood diarrhea in the private sector at 12 months

    Measured: 12 months

  3. Availability of zinc and LO-ORS co-pack in the private sector

    Change in % of private retailers who have stock of zinc and LO-ORS co-pack at time of visit at 12 months

    Measured: 12 months

  4. Acceptability of private sector

    % private retailers who express intention to stock co-packs after sensitization and training.

    Measured: 1 month

  5. Acceptability of caregivers

    % caregivers who indicate preferred treatment for uncomplicated childhood diarrhea is co-pack.at 12 months

    Measured: 12 months

  6. Adoption by private sector at month 1

    % private retailers who stock co-pack after 1 month

    Measured: 1 month

  7. Adoption by private sector at month 2

    % private retailers who stock co-pack after 2 months

    Measured: 2 months

  8. Adoption by private sector at month 3

    % private retailers who stock co-pack after 3 months

    Measured: 3 months

  9. Adoption by private sector at month 4

    % private retailers who stock co-pack after 4 months

    Measured: 4 months

  10. Adoption by private sector at month 5

    % private retailers who stock co-pack after 5 months

    Measured: 5 months

  11. Adoption by private sector at month 6

    % private retailers who stock co-pack after 6 months

    Measured: 6 months

  12. Adoption by private sector at month 7

    % private retailers who stock co-pack after 7 months

    Measured: 7 months

  13. Adoption by private sector at month 8

    % private retailers who stock co-pack after 8 months

    Measured: 8 months

  14. Adoption by private sector at month 9

    % private retailers who stock co-pack after 9 months

    Measured: 9 months

  15. Adoption by private sector at month 10

    % private retailers who stock co-pack after 10 months

    Measured: 10 months

  16. Adoption by private sector at month 11

    % private retailers who stock co-pack after 11 months

    Measured: 11 months

  17. Adoption by private sector at month 12

    % private retailers who stock co-pack after 12 months

    Measured: 12 months

  18. Adoption by caregivers

    % caregivers who indicate having co-pack in house

    Measured: 12 months

  19. Feasibility of intervention at month 1

    % private retailers who indicate that they can purchase/procure co-packs with ease after 1 month

    Measured: 1 month

  20. Feasibility of intervention at month 2

    % private retailers who indicate that they can purchase/procure co-packs with ease after 2 months

    Measured: 2 months

  21. Feasibility of intervention at month 3

    % private retailers who indicate that they can purchase/procure co-packs with ease after 3 months

    Measured: 3 months

  22. Feasibility of intervention at month 4

    % private retailers who indicate that they can purchase/procure co-packs with ease after 4 months

    Measured: 4 months

  23. Feasibility of intervention at month 5

    % private retailers who indicate that they can purchase/procure co-packs with ease after 5 months

    Measured: 5 months

  24. Feasibility of intervention at month 6

    % private retailers who indicate that they can purchase/procure co-packs with ease after 6 months

    Measured: 6 months

  25. Feasibility of intervention at month 7

    % private retailers who indicate that they can purchase/procure co-packs with ease after 7 months

    Measured: 7 months

  26. Feasibility of intervention at month 8

    % private retailers who indicate that they can purchase/procure co-packs with ease after 8 months

    Measured: 8 months

  27. Feasibility of intervention at month 9

    % private retailers who indicate that they can purchase/procure co-packs with ease after 9 months

    Measured: 9 months

  28. Feasibility of intervention at month 10

    % private retailers who indicate that they can purchase/procure co-packs with ease after 10 months

    Measured: 10 months

  29. Feasibility of intervention at month 11

    % private retailers who indicate that they can purchase/procure co-packs with ease after 11 months

    Measured: 11 months

  30. Feasibility of intervention at month 12

    % private retailers who indicate that they can purchase/procure co-packs with ease after 12 months

    Measured: 12 months

Secondary outcomes (3)
  1. Care-seeking to all sources

    Change in % of caregivers who seek care for childhood diarrhea outside the home at month 12

    Measured: 12 months

  2. Prompt treatment of uncomplicated childhood diarrhoea with zinc and LO-ORS co-pack

    Change in % of caregivers who use zinc and LO-ORS co-pack to treat uncomplicated childhood diarrhea within 24-h of the onset of the episode of diarrhea at 12 months

    Measured: 12 months

  3. Caregivers receive information from private retailers

    Change in % caregivers who indicate received information from private retailers about zinc and LO-ORS to treat uncomplicated childhood diarrhea at 12 months

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Apr 2020
  2. Study start1 Mar 2021
  3. Primary completion2 Apr 2022
  4. Study completion2 Apr 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
1,245 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04335877
Sponsor's protocol ID
NI-01-2006-ZNIR
Status last verified
Apr 2023
First submitted
30 Mar 2020
Last updated
6 Apr 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), 'Levels & Trends in Child Mortality: Report 2019, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation', United Nations Children's Fund, New York, 2019

  • GBD 2016 Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018 Nov;18(11):1211-1228. doi: 10.1016/S1473-3099(18)30362-1. Epub 2018 Sep 19.

    PubMed 30243583
  • UNICEF. Diarrhoeal disease - UNICEF DATA. 2018. Available from: https://data.unicef.org/topic/child-health/diarrhoeal-disease. (Accessed 24 Sept 2019)

  • KDHS, Kenya Demographic and Health Survey. Kenya National Bureau of Statistics, the National AIDS Control Council (NACC), the National Council for Population and Development (NCPD), and the Kenya Medical Research Institute (KEMRI), ICF International. 2014.

  • Walker CL, Black RE. Zinc for the treatment of diarrhoea: effect on diarrhoea morbidity, mortality and incidence of future episodes. Int J Epidemiol. 2010 Apr;39 Suppl 1(Suppl 1):i63-9. doi: 10.1093/ije/dyq023.

    PubMed 20348128
  • Munos MK, Walker CL, Black RE. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. Int J Epidemiol. 2010 Apr;39 Suppl 1(Suppl 1):i75-87. doi: 10.1093/ije/dyq025.

    PubMed 20348131
  • International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health. Pneumonia and Diarrhoea Progress Report 2015: Sustainable Progress in the Post-2015 Era. 2015.

  • World Health Organization. Clinical Management of acute diarrhoea: WHO/UNICEF joint statement. 2004. Available: http://www.who.int/iris/handle/10665/68627. Accessed: 24 September 2019

  • International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health. Pneumonia and Diarrhea Progress Report 2017: Pushing Progress through Investment & Action; 2017. Available from: https://www.jhsph.edu/research/centers-and-institutes/ivac/resources/IVAC-2017-Pneumonia-Diarrhea-Progress-Report.pdf. Accessed: 23 Sept 2019.

  • Bradley, Sarah E. K., Lauren Rosapep, and Tess Shiras. 2018. Sources for Sick Child Care in Kenya. Brief. Rockville, MD: Sustaining Health Outcomes through the Private Sector Plus Project, Abt Associates

  • ACTwatch Group. (2015). ACTwatch Outlet Surveys 2013-2014 - ORS and Zinc Availability Findings from 9 Countries. Washington DC: PSI.

  • Kim Y, Hahn S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database Syst Rev. 2001;2002(2):CD002847. doi: 10.1002/14651858.CD002847.

    PubMed 11406049
  • Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016 Dec 20;12(12):CD005436. doi: 10.1002/14651858.CD005436.pub5.

    PubMed 27996088
  • Lamberti LM, Fischer Walker CL, Taneja S, Mazumder S, Black RE. The Association between Provider Practice and Knowledge of ORS and Zinc Supplementation for the Treatment of Childhood Diarrhea in Bihar, Gujarat and Uttar Pradesh, India: A Multi-Site Cross-Sectional Study. PLoS One. 2015 Jun 22;10(6):e0130845. doi: 10.1371/journal.pone.0130845. eCollection 2015.

    PubMed 26098305
  • Carter E, Bryce J, Perin J, Newby H. Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review. BMC Public Health. 2015 Aug 18;15:788. doi: 10.1186/s12889-015-2127-1.

    PubMed 26282400

Questions about this trial

What is this clinical trial studying?

A study testing Private sector component + modified BCC in people with Diarrhea, Infantile, run by Nutrition International at 1 site in Kenya.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Kenya. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Treatment of uncomplicated diarrhea (time frame: 12 months). The study lists 30 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04335877, which also lists 32 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Apr 2023.

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