Grant is closed

Sep 2010 – Dec 2015

Oral Rehydration Salts & Zinc Treatments



India – South Asia

To reduce childhood diarrhoea through public-sector provision of oral rehydration salts (ORS) and zinc in Bihar.

$6,250,000 Grant Value

Diarrhoea is a leading cause of morbidity among children under five years of age around the world. 

In India, each child under two experiences an average of 3.1 diarrhoea episodes per year and nearly 150,000 children died from diarrhoea in 2010.

Despite ORS being available and recommended in India since the 1980s, the most recent national survey reports that only 26% of children with diarrhoea in the previous two weeks were given ORS. State-level adoption of zinc for treatment of diarrhoea has been slow throughout many states in India, including Bihar.

The grant aimed to ensure that 60% of public sector heath workers were treating diarrhoea with ORS and zinc. Projections showed that this could help avert over 4,000 childhood deaths.

In Bihar, India, Micronutrient Initiative rolled out a new initiative to enhance diarrhoea treatment with zinc and ORS in the public sector. The programme included training, supportive supervision for health workers and the distribution of diarrhoea treatment kits.

The Johns Hopkins University Bloomberg School of Public Health and collaborators at the Society of Applied Studies conducted an external evaluation to measure changes in diarrhoea care-seeking and treatment in intervention districts.


In 2013, after the first two years of the programme, public health centres were mentioned as appropriate sources of care for childhood diarrhoea more often than they were at baseline (71.3% to 38.4%).

By 2013, the odds of receiving zinc, with or without ORS, increased by more than 2.7 times compared to 2011. Children who were taken to the public sector for care were more likely to receive zinc and/or zinc in addition to ORS compared to children who were not taken to the public sector.

The programme showed that coverage of zinc and ORS can improve with public sector programmes targeted at training and increasing product availability, but it is essential to ensure a reliable stock of zinc and ORS . Also, demand creation may be needed to increase public sector care-seeking in areas where the private sector has historically provided much of the care.