Dispensing practices of life-saving diarrhoea treatment in Zambian children: understanding the role of co-packaging

 
ColaLife was a UK charity established to catalyse an increase in access to the recommended diarrhoea treatment - Oral Rehydration Salts (ORS) and Zinc - which most children do not get. Around 450,000 under 5 children die from diarrhoea each year. In Zambia, the charity employed a systems change approach which increased ORS/Zinc coverage from <1% (2012) to 35% (2019). ColaLife went on to instigate and lead a successful global effort to add co-packaged ORS and Zinc to the WHO Essential Medicines List and to co-found the ORS/Zinc Co-pack Alliance, an informal global network of actors seeking to accelerate the uptake of co-packaging.

ColaLife closed down on 31-Mar-2024 having done what it set out to achieve and more.
 
The request
In Zambia, the charity (in collaboration with the Zambian government) introduced a co-pack containing ORS and Zinc, and collected data on diarrhoea-treatment dispensing practices in local health facilities, both before and after the co-pack introduction.The request to the Statistician for Society volunteer was to determine whether the dispensing of the WHO/UNICEF recommended treatment (ORS+zinc) had become significantly more common following the introduction of the co-pack.
 
The approach
The charity shared the data and their needs with Dario, the S4S volunteer statistician. Dario produced summary statistics and graphics to compare dispensing practices before and after the co-pack introduction. Statistical mixed-effect models were also considered to assess the impact of co-packaging on dispensing practices and the variability of the effect across health facilities.
 
The result
The analyses highlighted that dispensing practices had undergone a significant improvement after the co-pack introduction, particularly in less well-resourced rural health facilities. The significance of the results led the charity and the volunteer to draft a scientific article with details of the analyses and the associated findings. This has been submitted to an international peer-reviewed journal of global public health and is currently under review.
 
Impact and benefits
In the literature there is a dearth of evidence around the use of co-packaged ORS and zinc for the treatment of diarrhoea in children, even though the treatment has been listed in the WHO's model essential medicines list since 2019. Before this project, the charity had unique evidence on the effect of co-packaging on dispensing behaviour, but this was stuck in grey literature. Thanks to Statisticians for Society, it is now being considered for scientific publication and, if published, will influence treatment strategies, increase ORS and zinc coverage and ultimately save children's lives.
 
 
Volunteer: Dario Domingo
Charity contacts: Simon Berry & Jane Berry