ABSTRACT
Objectives: To determine the prevalence and risk factors of zinc deficiency among young children in rural south-western Burkina Faso. Methods: We collected socio-economic, demographic, feeding practice and morbidity information from a sample of 473 children 6-18 mo of age residing in southern Orodara health district; and measured plasma zinc concentration (PZC) by ICP-AES and C-reactive protein and alpha-1 acid glycoprotein by ELISA to adjust PZC for inflammation. Zinc deficiency was defined as PZC ˂ 65μg/L. Associations between selected risk factors and low PZC were screened in bivariate analyses and assessed by generalized multivariable logistic regression. Results: Mean adjusted PZC was 68.4±13.1 ug/L, and the prevalence of zinc deficiency was 43.5% [95%CI: 38.4-48.7]. The odds of zinc deficiency was significantly higher in households with no livestock ownership as compared to the two highest quintiles of livestock ownership (OR= 2.4- 2.5, p<0.05) and when more households shared the family compound (OR= 1.8, p<0.026 for 3-4 households as compared to 1 household per compound). Religion was also associated with zinc deficiency, but recent child morbidity history and feeding practices were not. Conclusions: There is a high prevalence of zinc deficiency among young children in rural southwestern Burkina Faso, especially among children living in large family compounds. Homestead livestock rearing and possibly some religious/cultural habits may reduce the risk of zinc deficiency.
ABSTRACT
Objectives: Zinc supplements may decrease incidence of diarrhea among young children at risk of zinc deficiency. We estimated the cost-effectiveness of three approaches for delivery of preventive and therapeutic zinc supplements in rural Burkina Faso. Methods: Cost estimates were derived from data collected during a community-based randomized zinc trial, information on ongoing child-health days to distribute public health services, and an indepth study of the current health care system. Diarrhea incidence reduction is based on intent-totreat analysis of zinc trial data. Activity-based costing using an ingredients approach accounts for the costs of mutually exclusive inputs related to defined program activities for each approach. Cost-effectiveness is analyzed and compared across an intermittent preventive zinc (IPZ) approach (quarterly delivery of 10-days of 10 mg/d supplements to childrens’ homes), and a therapeutic approach (10-days of 20 mg/d supplements delivered during an ill-child consultation at a local clinic (TZ-CSPS) or via community-based health worker (TZ-CHW)). We assume 81.6% of children are reached with IPZ and .06% and 52% of diarrhea cases treated with TZ-CSPS and TZCHW, respectively. Results: Estimated annual program cost per additional child reached is $3.52 (IPZ), $3.49 (TZCSPS) and $17.59 (TZ-CHW). Cost per death averted in the first program-year is estimated to be $3164 (IPZ), $7363 (TZ-CSPS), and $14068 (TZ-CHW), assuming a diarrhea case fatality rate of 0.3% and 2.64 episodes of diarrhea/child/year. Estimated cases of diarrhea averted per year are 11.5% (IPZ), 0.9% (TZ-CSPS), and 8.2%(TZ-CHW). Conclusions: IPZ is the most cost-effective approach for a zinc program among our study population.