Child Health and Immunization

Management of Diarrhea

Behavior: Caregivers appropriately manage diarrhea in children

Timely and appropriate treatment for diarrhea can prevent 93% of deaths due to diarrhea among children. 1The effect of oral rehydration solution and recommended home fluids on diarrhea mortality
Munos M, Fischer-Walker C.L., Black R.E.
This is an occasional behavior that needs to be practiced without hesitation at the onset of diarrhea.

Key Points from Global Research

  • Expanding the number of well-trained, stocked and sanctioned private-sector providers selling diarrhea treatments can encourage caregivers to properly treat diarrhea.
  • Packaging or selling oral rehydration salts (ORS) and zinc together can ensure caregivers obtain what they need and provide the proper, continual treatment for diarrhea.
  • Assuring fixed, proper pricing of both ORS and zinc can encourage caregivers to use it properly and when needed.

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. 

Create Behavior Profiles

Improve maternal and child survival
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



What steps are needed to practice this behavior?
  1. Recognize signs and symptoms of diarrhea
  2. 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.
  3. Obtain quality, low osmolarity ORS and full course of zinc
  4. Give child ORS throughout the diarrheal episode
  5. Give child a daily zinc supplement (usually for 10 to 14 days)
  6. Continue or increase breastfeeding appropriate for age
  7. Continue other fluids and feeding as possible during illness
  8. 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.


What factors may prevent or support practice of this behavior? These should be analyzed for each country context.
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
Norms: Caregivers do not seek immediate care for diarrhea because it is considered common and expected for young children
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


Who must support the practice of this behavior?
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 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


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

Global Status of Accelerator Behavior

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

The DHS Program Indicator Data API, The Demographic and Health Surveys (DHS) Program

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