The Nonlinear Library EA - Nigeria pilot report: Reducing child mortality from diarrhoea with ORS & zinc, Clear Solutions by Martyn J
Mar 21, 2024
39:44
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Nigeria pilot report: Reducing child mortality from diarrhoea with ORS & zinc, Clear Solutions, published by Martyn J on March 21, 2024 on The Effective Altruism Forum.
Summary
We introduce Clear Solutions, a Charity Entrepreneurship (now AIM) incubated charity founded in September 2023. Our focus is the prevention of deaths of young children from diarrhoea, an illness that kills approximately 444,000 children under-5 every year.
From December 2023 to February 2024, we ran a pilot distribution of low-cost, highly effective treatments for diarrhoea, oral rehydration solution and zinc (ORSZ) in Kano, Nigeria, with implementation partner iDevPro Africa. We estimate having reached ~6900 children under-5. The intervention, based upon a randomised controlled trial in Uganda (Wagner et al, 2019), provides free co-packaged ORS and zinc ("co-packs") door-to-door to all households with children under 5 years old.
The distribution is performed by local Community Health Workers (CHWs), who provide guidance and printed instructions on ORSZ usage during the visit.
We surveyed communities pre- and post-intervention, allowing 6 weeks between ORSZ distribution and follow-up surveys for diarrhoea cases to accumulate. At these survey rounds, we recorded the timing of the child's last diarrhoea episode (if applicable) and how they were treated (if at all). Our primary outcome measure is the change in ORSZ usage rates pre-to-post intervention, though also we collected extensive contextual data to monitor operations and guide program improvements.
This post summarises our preliminary analysis and conclusions. A more detailed report is available on our website here. We were kindly supported by knowledgeable advisors, but did not have an academic partnership, nor has this analysis been peer-reviewed. Nonetheless, we believe there is value in sharing our results and learnings with this community.
Results in brief: Across 4 wards (geographic areas) of differing rurality, baseline usage rates for under-5s' last diarrhoea episode in the preceding 4 weeks were reported at a range across wards of 44.7% - 50.9% for ORS and 11.1% - 26.7% for ORS+zinc when asked directly. At follow-up post-intervention, the usage rate for the preceding 4-weeks was reported at a range across wards of 90.0 - 97.7% for ORS and 88.2% - 94.1% for ORSZ.
(95% margins of error up to 10pp and are not shown here for readability; see Results for details.)
Superficially, this indicates a change of 42.0 - 52.8 percentage points (pp) in ORS use and 61.5 - 83.0pp for ORSZ. However, we treat this result with caution, with specific concerns such as social desirability bias in survey responses inflating true values. We discuss more in Limitations below.
Conclusions in brief: We consider this to be a solid result in favour of the intervention having a strong potential to prevent deaths in a cost-effective manner in the Nigerian context. (We do not estimate cost-effectiveness in this report, but will be working on a follow-up with that). There are, however, clear limitations in the pilot that warrant considerable down-weighting of our results, though we do not expect this to change the conclusions qualitatively.
Introducing Clear Solutions
Clear Solutions was founded in September 2023 with the support of Charity Entrepreneurship (now AIM). Our mission is to prevent deaths of young children from diarrhoea, a leading cause of death for under-5s globally, in a cost-effective and evidence-based manner.
The 1970s medical breakthrough, Oral Rehydration Solution (ORS), a dosed mixture of sugar, salts and water, unlocked the possibility of preventing >90% of diarrhoeal deaths at full coverage. The addition of zinc can reduce diarrhoea duration and recurrence, and the World Health Organisation recognised this in 2019 by adding co-packaged ORS a...
Summary
We introduce Clear Solutions, a Charity Entrepreneurship (now AIM) incubated charity founded in September 2023. Our focus is the prevention of deaths of young children from diarrhoea, an illness that kills approximately 444,000 children under-5 every year.
From December 2023 to February 2024, we ran a pilot distribution of low-cost, highly effective treatments for diarrhoea, oral rehydration solution and zinc (ORSZ) in Kano, Nigeria, with implementation partner iDevPro Africa. We estimate having reached ~6900 children under-5. The intervention, based upon a randomised controlled trial in Uganda (Wagner et al, 2019), provides free co-packaged ORS and zinc ("co-packs") door-to-door to all households with children under 5 years old.
The distribution is performed by local Community Health Workers (CHWs), who provide guidance and printed instructions on ORSZ usage during the visit.
We surveyed communities pre- and post-intervention, allowing 6 weeks between ORSZ distribution and follow-up surveys for diarrhoea cases to accumulate. At these survey rounds, we recorded the timing of the child's last diarrhoea episode (if applicable) and how they were treated (if at all). Our primary outcome measure is the change in ORSZ usage rates pre-to-post intervention, though also we collected extensive contextual data to monitor operations and guide program improvements.
This post summarises our preliminary analysis and conclusions. A more detailed report is available on our website here. We were kindly supported by knowledgeable advisors, but did not have an academic partnership, nor has this analysis been peer-reviewed. Nonetheless, we believe there is value in sharing our results and learnings with this community.
Results in brief: Across 4 wards (geographic areas) of differing rurality, baseline usage rates for under-5s' last diarrhoea episode in the preceding 4 weeks were reported at a range across wards of 44.7% - 50.9% for ORS and 11.1% - 26.7% for ORS+zinc when asked directly. At follow-up post-intervention, the usage rate for the preceding 4-weeks was reported at a range across wards of 90.0 - 97.7% for ORS and 88.2% - 94.1% for ORSZ.
(95% margins of error up to 10pp and are not shown here for readability; see Results for details.)
Superficially, this indicates a change of 42.0 - 52.8 percentage points (pp) in ORS use and 61.5 - 83.0pp for ORSZ. However, we treat this result with caution, with specific concerns such as social desirability bias in survey responses inflating true values. We discuss more in Limitations below.
Conclusions in brief: We consider this to be a solid result in favour of the intervention having a strong potential to prevent deaths in a cost-effective manner in the Nigerian context. (We do not estimate cost-effectiveness in this report, but will be working on a follow-up with that). There are, however, clear limitations in the pilot that warrant considerable down-weighting of our results, though we do not expect this to change the conclusions qualitatively.
Introducing Clear Solutions
Clear Solutions was founded in September 2023 with the support of Charity Entrepreneurship (now AIM). Our mission is to prevent deaths of young children from diarrhoea, a leading cause of death for under-5s globally, in a cost-effective and evidence-based manner.
The 1970s medical breakthrough, Oral Rehydration Solution (ORS), a dosed mixture of sugar, salts and water, unlocked the possibility of preventing >90% of diarrhoeal deaths at full coverage. The addition of zinc can reduce diarrhoea duration and recurrence, and the World Health Organisation recognised this in 2019 by adding co-packaged ORS a...