Impact Evaluation of a Diarrhea Treatment Uptake Scale-up Program in Nigeria - a Difference-in-Difference Analysis

Abstract

Diarrheal disease is the second leading cause of death in children under 5 years in Nigeria with an estimated 151,700 annual child deaths. Clinton Health Access Initiative (CHAI) worked with the Nigerian government to reduce child mortality by increasing treatment and coverage of ORS and zinc treatment for diarrheal disease. It is important to evaluate the reported increase in zinc and ORS coverage after the intervention was applied to assess whether the increased availability of diarrhea treatment led to an increase in treatment-seeking behavior among children under 5 years with diarrheal disease. Through a difference-in-difference analysis (DiD) in STATA/SE 18.0, the paper will evaluate whether there was a causal impact of the zinc and oral-rehydration salt (ORS) scale-up program on increasing diarrheal treatment-seeking. A logistic regression with robust standard errors was conducted on four treatment seeking outcomes (zinc, ORS, zinc and ORS, and zinc or ORS) while controlling for individual, household, and community level variables. After controlling for individual, household, and community variables, there were no statistically significant changes in zinc or ORS treatment uptake for children under 5 years that could be attributed to the intervention (Odds of OR: 0.87 95% CI=0.48, 1.59), zinc and ORS treatment (Odds of OR: 0.73 95% CI=0.12, 4.30), zinc treatment (Odds of OR: 0.85 95% CI=0.16, 4.57), or ORS treatment (Odds of OR: 0.90 95% CI=0.48, 1.67). We therefore did not find evidence that the program had an impact on uptake of zinc and ORS treatment. There is a need for more research that adopts rigorous causal methods to demonstrate the impact of policies targeted at reducing the burden of diarrheal diseases.