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Behavior Profile Sample: Management of Diarrhea

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating Behavior Profiles.

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Health Goal	Improve maternal and child survival
Accelerator Behavior	Behavior: Caregivers appropriately manage diarrhea in children Indicator: Percentage of children born in the five years preceding the survey with diarrhea in the two weeks preceding the survey who received oral rehydration solution (ORS), that is either fluid from an ORS packet or a pre-packaged ORS fluid

Behavior Analysis	Strategy
STEPS What steps are needed to practice this behavior? Recognize signs and symptoms of diarrhea If the child is breastfeeding or drinking poorly or has signs of dehydration or blood in the stool, provide ORS and seek immediate care from a trained provider. If these signs are not present, follow the steps listed below. Obtain quality, low osmolarity ORS and full course of zinc Give child ORS throughout the diarrheal episode Give child a daily zinc supplement (usually for 10 to 14 days) Continue or increase breastfeeding appropriate for age Continue other fluids and feeding as possible during illness Provide extra food according to age for at least 2 weeks following illness Click on any box to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior. of the behavior.	FACTORS What factors may prevent or support practice of this behavior? These should be analyzed for each country context. Structural Accessibility: ORS and zinc are either out of stock or not always readily available beyond the health system Accessibility: Zinc is expensive, even when co-packaged with ORS Service Provider Competencies: Providers tend to over-prescribe antibiotics and not emphasize the importance of ORS with zinc Service Experience: Caregivers do not go to sanctioned providers because they prefer informal sector sources that are nearby for treatment of diarrhea Social Norms: Caregivers do not seek immediate care for diarrhea because it is considered common and expected for young children Internal Attitudes and Beliefs: Caregivers do not use ORS and zinc because they are skeptical about their effectiveness and prefer antibiotics Attitudes and Beliefs: Caregivers will not complete the full course of zinc believing that once the diarrhea has stopped it is not necessary Knowledge: Some caregivers are unaware of the benefits of ORS and many do not know about the use of zinc, and the need for special recuperative feeding after illness Skills: Most caregivers do not follow the full 10-14 day zinc regime because they do not understand the instructions	SUPPORTING ACTORS AND ACTIONS Who must support the practice of this behavior? Institutional Policymakers: Begin dialogue to ensure private sector is engaged and sanctioned Policymakers: Seek policies to promote equitable access to ORS and zinc Providers: Prescribe ORS/Zinc instead of antibiotics for diarrhea and explain benefit to caregivers Logistics Personnel: Actively monitor stock levels and forecast needed medical supplies and drugs Community Community Health Workers and Peer Educators: Follow-up with families whose children have diarrhea to ensure that ORS is properly mixed and that a full course of zinc is taken Community and Religious Leaders: Promote immediate care-seeking for all sick children and importance of ORS and zinc	POSSIBLE PROGRAM STRATEGIES How might we focus our efforts based on this analysis? Enabling Environment Financing: Expand free or low-cost access to ORS and zinc Partnerships and Networks: Engage the private sector in recommending and distribution of ORS and zinc at local pharmacies Systems, Products and Services Products and Technology: Combine ORS and zinc packets in grocery stores, pharmacies, kiosks, etc Supply Chain: Set up effective supply chain and quality control systems for public and private sectors Quality Improvement: Ensure health care personnel (public and private) practice appropriate antibiotic prescription vs use of ORS and zinc and train them on how to communicate that to caregivers Demand and Use Communication: Provide pictorial instructions for mixing and administering ORS and daily reminders for zinc supplements Collective Engagement: Conduct ongoing community activities about the dangers of dehydration resulting from diarrhea, the need for immediate careseeking, effectiveness of ORS and zinc, and the need for recuperative feeding after illness

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?

Recognize signs and symptoms of diarrhea
If the child is breastfeeding or drinking poorly or has signs of dehydration or blood in the stool, provide ORS and seek immediate care from a trained provider. If these signs are not present, follow the steps listed below.
Obtain quality, low osmolarity ORS and full course of zinc
Give child ORS throughout the diarrheal episode
Give child a daily zinc supplement (usually for 10 to 14 days)
Continue or increase breastfeeding appropriate for age
Continue other fluids and feeding as possible during illness
Provide extra food according to age for at least 2 weeks following illness

Click on any box
to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.
of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.

Structural

Accessibility: ORS and zinc are either out of stock or not always readily available beyond the health system

Accessibility: Zinc is expensive, even when co-packaged with ORS

Service Provider Competencies: Providers tend to over-prescribe antibiotics and not emphasize the importance of ORS with zinc

Service Experience: Caregivers do not go to sanctioned providers because they prefer informal sector sources that are nearby for treatment of diarrhea

Social

Norms: Caregivers do not seek immediate care for diarrhea because it is considered common and expected for young children

Internal

Attitudes and Beliefs: Caregivers do not use ORS and zinc because they are skeptical about their effectiveness and prefer antibiotics

Attitudes and Beliefs: Caregivers will not complete the full course of zinc believing that once the diarrhea has stopped it is not necessary

Knowledge: Some caregivers are unaware of the benefits of ORS and many do not know about the use of zinc, and the need for special recuperative feeding after illness

Skills: Most caregivers do not follow the full 10-14 day zinc regime because they do not understand the instructions

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?

Institutional

Policymakers: Begin dialogue to ensure private sector is engaged and sanctioned

Policymakers: Seek policies to promote equitable access to ORS and zinc

Providers: Prescribe ORS/Zinc instead of antibiotics for diarrhea and explain benefit to caregivers

Logistics Personnel: Actively monitor stock levels and forecast needed medical supplies and drugs

Community

Community Health Workers and Peer Educators: Follow-up with families whose children have diarrhea to ensure that ORS is properly mixed and that a full course of zinc is taken

Community and Religious Leaders: Promote immediate care-seeking for all sick children and importance of ORS and zinc

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?

Enabling Environment

Financing: Expand free or low-cost access to ORS and zinc

Partnerships and Networks: Engage the private sector in recommending and distribution of ORS and zinc at local pharmacies

Systems, Products and Services

Products and Technology: Combine ORS and zinc packets in grocery stores, pharmacies, kiosks, etc

Supply Chain: Set up effective supply chain and quality control systems for public and private sectors

Quality Improvement: Ensure health care personnel (public and private) practice appropriate antibiotic prescription vs use of ORS and zinc and train them on how to communicate that to caregivers

Demand and Use

Communication: Provide pictorial instructions for mixing and administering ORS and daily reminders for zinc supplements

Collective Engagement: Conduct ongoing community activities about the dangers of dehydration resulting from diarrhea, the need for immediate careseeking, effectiveness of ORS and zinc, and the need for recuperative feeding after illness

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Management of Diarrhea

Key Points from Global Research