RESUMO
Objectives: Childhood diarrhea is a major cause of morbidity and mortality in Haiti; a situation exacerbated by the cholera outbreak in 2010. Oral rehydration salts (ORS), when combined with zinc (ORS-zinc), is effective in preventing death and reduces severity of illness—yet their combined use remains low. An intervention to expand delivery of ORS-zinc is underway. To guide the scale up of the intervention, we conducted a qualitative study to identify caregivers’, influencers’ and healthcare providers’ knowledge, attitudes and practices related to diarrhea and its treatment. Methods: Study conducted in two departments in Haiti: North West, where ORS-zinc distribution has already begun, and North, where ORS-zinc will be implemented in 2014. Using rapid ethnographic methods, we conducted 1) semi-structured interviews with both health workers of traditional and modern medicine (n=16), 2) facility observations where child diarrhea is treated (n=4), 3) six focus group discussions (FGD) with caregivers (n= 62) and influencers (n=39). Results: All modern and most traditional health workers recommended ORS in their practice, however, only those already receiving the intervention prescribed zinc while a few modern practitioners in the non-intervention group had heard of it. Facility observations demonstrated a gap in how the use of ORS-zinc is explained to patients. FGD showed that care seeking behaviour is strongly influenced by perceptions of the type of diarrhea and availability of healthcare provider. Conclusions: Knowledge and attitudes affect the prescription and use of ORS-zinc. These findings will affect the design of targeted behavior change interventions for scaling up ORS-zinc in northern Haiti.
RESUMO
Objectives: In Haiti, limited coverage of Vitamin A supplementation (VAS) in children under 5 years of age is associated with a weak and fragmented health system. To address this, the government and partners implemented a process to identify and remedy problems and bottlenecks. Methods: Evaluative activities that were conducted include: 1) participative and de-centralized stakeholder workshop to assess the Child Health Week (CHW) platform for distributing VAS; 2) NGO-mapping conducted in all 10 Haitian departments; and 3) interview-based and observational supply chain assessment. Results: Each assessment highlighted enabling factors and barriers for improving coverage of VAS in Haiti. 1) The CHW workshop identified weak national program coordination and ownership, and bottlenecks in data collection and reporting. The existence of trained departmental data managers was identified as an opportunity to improve VAS Program reporting. 2) The NGO mapping identified 43 organizations currently involved or interested in getting involved in the VAS program, which can serve to extend program reach. Inadequate knowledge of VAS protocols by NGO personnel was limiting their potential involvement. 3) The supply chain assessment identified inadequate forecasting, a fragmented stock management system, and under-utilized supply warehouses. New stock management tools and opportunities for shared transportation represent potential areas to improve the supply chain. Conclusions: Strengthening the health system in Haiti remains a long term goal. These three assessments identified short term strategies - including synergies with existing health resources and utilizing the capacity of NGOs - that could help improve coverage of the national VAS program.