The effect of improved information and training on the adherence to Zinc medication to treat diarrhea and respiratory infections in children was examined.


Investigation of various factors optimizing the adherence to the treatment of infectious disease with Zinc

Project Team

R García, ML Roche, M Vossenaar, NW Solomons


Province San Marcos, Guatemala


Data collection completed


Diarrhea remains the second greatest cause of child morbidity and mortality in Guatemala, yet adherence to the WHO recommended treatment of Zinc (Zn) & oral rehydration salts (ORS) is low. The Micronutrient Initiative of Ottawa, Canada, at the behest of the Ministry of Health of Guatemala has requested assistance in the development of a communication strategy to enhance the adherence to the prescription to take oral zinc medication. The recommendation was that young children take Zinc for a full 10 days following consultation at health centers in the San Marcos Province to treat  for acute diarrhea or acute respiratory infection. The research seeks to understand the diseases, the prescriptions and attitudes at all levels of stakeholders from facility-directors, to medical, nursing and auxiliary staff and to the families of patients.

This project applies a randomized community design to test the effectiveness of health center level co-packaging and counseling messages. The goal was to improve provider and caregiver behavior regarding the treatment of diarrhea with zinc & oral rehydration salts (ORS) and of pneumonia with zinc & antibiotics in children aged 2-59 months old. We evaluate the adherence of caregivers in 10 health posts in 5 municipalities. They were randomly assigned to receive co-packaging and counseling messages in addition to current standard care. The results were compared with the caregivers in 10 health posts in 5 municipalities receiving only the current standard of care.

The main objective was to establish the effectiveness of a facility level co-packaging and counseling messages for increasing caregivers’ adherence  to the prescribed 10 day treatment with zinc to complement ORS for the treatment of diarrhea. In parallel, we investigated zinc to complement the antibiotics for the treatment of pneumonia diagnosed and treated in public health posts.

Specific Quantitative Objectives:

To determine if visible co-packaging accompanied by pre-tested counseling messages will improve adherence of caregivers towards the prescribed zinc treatment. Can this approach improve knowledge, awareness or attitudes of caregivers and health providers towards the prescribed zinc treatment? Will it increase health care-seeking for the treatment of diarrhea and pneumonia at public health care centers?

Specific Qualitative Objectives:

To establish the perception, attitudes and experiences of caregivers, of Health providers at public health care centers and of children 4 to 5 years of age towards the visible co-packaging with pre-tested counseling messages to promote the prescribed zinc treatment.


The intervention improved both the prescription practices and adherence to zinc medication. Consequent application of this innovation could improve diarrhea treatment in Guatemala.

Corresponding publications

Click for complete reference

Abstracts EB 2015: ID 1657

Abstracts EB 2015: ID 3242