Maternal, neonatal, and child health in southeast Asia: towards greater regional collaboration.

Although maternal and child mortality are on the decline in southeast Asia, there are still major disparities, and greater equity is key to achieve the Millennium Development Goals. We used comparable cross-national data sources to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child deaths. We present inequalities in intervention coverage by two common measures of wealth quintiles and rural or urban status. Case studies of reduction in mortality in Thailand and Indonesia indicate the varying extents of success and point to some factors that accelerate progress. We developed a Lives Saved Tool analysis for the region and for country subgroups to estimate deaths averted by cause and intervention. We identified three major patterns of maternal and child mortality reduction: early, rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with a downward trend (Laos, Cambodia, and Myanmar). Economic development seems to provide an important context that should be coupled with broader health-system interventions. Increasing coverage and consideration of the health-system context is needed, and regional support from the Association of Southeast Asian Nations can provide increased policy support to achieve maternal, neonatal, and child health goals.

Formative research to develop and test messages to educate mothers on zinc supplementation in childhood diarrhea

BACKGROUND: Zinc is now recommended as part of childhood diarrhea case management but there are concerns regarding treatment duration and perceptions of its use when given with ORT. OBJECTIVES: This study developed and tested messages on zinc supplementation for childhood diarrhea. METHODS: Messages were based on 1) a review of literature and product advertisements, 2) drugstore seller interviews, and 3) focus group discussions (FGDs) among 10 mothers with children six to 59 months old. Subsequent FGDs with 15 mothers consulting at a government hospital helped determine message clarity, comprehension and appeal. A behavioral trial, involving nine mothers whose children had diarrhea, tested recall of and adherence to the messages. RESULTS: The trial tested three messages - zinc: 1) strengthens resistance; 2) is a vitamin for the gut; 3) increases the appetite of a child with diarrhea. Seven of nine mothers were able to follow instructions on zinc administration, and demonstrated recall and understanding of these messages. Mothers understood that zinc helps the child with diarrhea, improves appetite, reduces symptoms and hastens recovery, but had concerns regarding the side effects (vomiting), co-morbidities (fever, cough) and consequences of overdose. Standardized counseling cards addressed these concerns. Respondents preferred a simple logo labeled with zinc administration instructions on the packaging. Zinc supplementation did not affect ORT use. CONCLUSION AND RECOMMENDATIONS: Messages sufficiently addressed mothers concerns on zinc use during childhood diarrhea, with those on zinc improving and as a vitamin for the gu having the best recall. Results can contribute to introduction and promotion in the public sector.