Evaluation of the awareness and utilization of oral rehydration salt and zinc in managing diarrhoea among under-five children in Oyo State, Nigeria

Adeniyi Francis Fagbamigbe, Juma Joseph, Alfred Owino Odongo, Dominic Mogere, John Kariuki


Background: Nigeria ranks as one of the countries with the highest negative consequences of diarrhoea in sub-Saharan Africa. The aim of the study was to evaluate the awareness and utilization of ORS and zinc in managing diarrhoea among under-five children (U5C) in Oyo state, Nigeria.

Methods: Data was obtained from a cross-sectional survey (n=1154) as well as focus group discussions among mothers/caregivers of U5C and key informant interviews in Oyo state. Descriptive, bivariate and multivariate logistic regression analyses were performed.

Results: Nine of every ten caregivers were aware of the use of ORS/zinc for managing diarrhoea cases. Prevalence of ever-use of ORS/zinc for managing diarrhoea cases was 5.4% while the prevalence of having diarrhoea recently was 6.2% (71/1154). Of the 71 mothers whose U5C recently had diarrhoea, 41 (57.7%) used ORS/zinc to manage a recent episode of diarrhoea. Adjusted odds of using ORS/zinc to manage diarrhoea was 2.64 (aOR=2.64; 95%CI: 1.18-10.27 times higher among children who are the first births than those with fourth or higher birth order. The adjusted odds of using ORS/zinc to manage diarrhoea was 9 times (aOR= 9.15; 95%CI: 1.99-34.47) higher among mothers aged 20 to 24 years than those aged 30 to 39 years.

Conclusions: Despite the high level of awareness of use of ORS and zinc in managing diarrhoea, ever-utilization is low but recent use by three-fifths of caregivers is fair. There is a need for Oyo state ministry of health and other stakeholders to promote the use of ORS and zinc in managing diarrhoea.


Barriers to utilization, Diarrhoea, Nigeria, Unavailability, Unaffordability

Full Text:



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;18:1211-28.

Gill CJ, Thea DM, Hibberd P. Diarrhoeal disease trends in the GBD 2015 study: optimism tempered by scepticism. Lancet Infect Dis. 2017;17:884-5.

Wilson ME. Global burden from diarrhea: decreasing but still a leading cause of death. NEJM Journal Watch. 2017;2017:1.

Benue State Government of Nigeria. Push Diarrhea Away. Shop Plus Project. Available at: https://www. Accessed on 5 March 2019.

Clinical Management of acute diarrhoea: WHO/UNICEF joint statement. Available at: http://www. Accessed on 5 March 2019.

Black RE. Progress in the use of ORS and zinc for the treatment of childhood diarrhea. J Glob Heal. 2019;9: 10-2.

Schroder K, Battu A, Wentworth L, Houdek J, Fashanu C, Wiwa O. Increasing coverage of pediatric diarrhea treatment in high-burden countries. J Glob Heal. 2019; 9:1-5.

Clinton Health Access Initiative. Zinc/ORS Scale-up in Nigeria. Available at: https://www.clintonhealth Accessed on 5 March 2019.

Lenters LM, Das JK, Bhutta ZA. Systematic review of strategies to increase use of oral rehydration solution at the household level. BMC Public Health. 2013; 13(3): s28:1-8.

Lazzerini M, Wanzira H. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2016;12:CD005436.

Walker FCL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013;381:1405-16.

Diarrhoeal Disease. Available at: en/. Accessed on 5 March 2019.

Onwukwe S, van Deventer C, Omole O. Evaluation of the use of oral rehydration therapy in the management of diarrhoea among children under 5: knowledge attitudes and practices of mothers/caregivers. South African Fam Pract. 2016;58:42-7.

Wagner Z, Shah M, Sood N. Barriers to use of oral rehydration salts for child diarrhea in the private sector: Evidence from India. J Trop Pediatr. 2015;61: 37-43.

Carvajal-vélez L, Amouzou A, Perin J, Maïga A, Tarekegn H, Akinyemi IA, et al. Diarrhea management in children under five in sub-Saharan Africa : does the source of care matter ? A Countdown analysis. BMC Public Health. 2016;16:1-14.

Andersen RM. A behavioral model of families’ use of health services. Research Series No. 25. Chicago, IL: Center for Health Service Publisher;1968.

Andersen RM. Revisiting the behavioral model and access to medical care: Does it matter?. J Health Social Behav. 1995;36:1-10.

Wolinsky F. Seeking and Using Health Services. In: The Sociology of Health. 2nd ed. Belmont, Canada: Wadsworth; 1988.

Aday L, Andersen RM. A framework for the study of access to medical care. Health Serv Res. 1974;9:208-20.

Babitsch B, Gohl D, von Lengerke T. Das Verhaltensmodell der Inanspruchnahme gesundheitsbezogener Versorgung von Andersen re-revisited: Ein systematischer Review von Studien zwischen 1998-2011. GMS Psycho-Social-Med. 2012; 9:34-9.

Cummings GG, Reid RC, Estabrooks CA, Norton PG, Cummings GE, Rowe BH, et al. Older persons’ transitions in care (OPTIC): A study protocol. BMC Geriatr. 2012;12:42-7.

Ghimire PR, Agho KE, Renzaho AMN, Dibley M, Raynes-Greenow C. Association between health service use and diarrhoea management approach among caregivers of under-five children in Nepal. PLoS One. 2018;13:e0191988.

National Population Commission(NPC), ICF International. Nigeria Demographic and Health Survey 2018. Available at: Accessed on 5 March 2019.

Riaz N, Tul Muntaha S, Qibtia M, Sohail S. Use of Zinc and Oral Rehydration Solution in Home Management of Diarrhea: Knowledge of Mothers attending a Tertiary Care Hospital. J Islam Med Dent. 2019;8:135-40.

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; 10:e0130845.

Omuemu VO, Ofuani IJ, Kubeyinje IC. Knowledge and use of zinc supplementation in the management of childhood diarrhoea among health care workers in public primary health facilities in Benin-City, Nigeria. Glob J Health Sci. 2012;4:68-76.

Akinyemi IA, Fagbamigbe AF, Omoluabi E, Agunbiade OM, Adebayo SO. Diarrhoea Management Practices and Child Health Outcomes in Nigeria: Sub-National Analysis. Adv Integr Med. 2018;5:15-22.