Sinaps evaluation: results of community distribution of oral rehydration salts in Guatemala.

3 factors are crucial to ensure success in the community distribution of ORS: 1) adequate information training and supervision of mothers with continuing positive reinforcement of their motivation; 2) continued support from health professional personnel especially adequate treatment and follow-up referrals; and 3) appropriate supply of ORS to cover all households on a regular basis. A community distribution intervention having these goals is described. ORS was distributed at the household level by 377 community voluntary health workers (called health promoters) to a population of 68465 inhabitants as part of the routine operations of SINAPS a primary health care system in the eastern part of Guatemala. In this population dehydration due to diarrhea is a main cause of infant and child mortality. Due to an inadequate supply of ORS a simplified formula was developed for local production household distribution and education to mothers on how to use ORS. Information to motivate parents to use ORS was provided in the community. Each family received a package of 6 250 ml bags/child under 5 years of age. Simple printed material on how to prepare ORS was also delivered and carefully explained to the mother. The advice of the health promoters was readily available at all times. Findings indicate that before the intervention the availability and knowledge of ORS were about 0. 1 year later 83.7% of families with children under 5 had ORS available at home. The use of ORS at home increased notably from less than 1% to over 1/3 of the cases of diarrhea in the 1st year after the intervention. Self-sufficiency at the health center level to provide ORS to all families and community participation in prevention and treatment of a major health problem were the main benefits resulting from the intervention. The increase in production created a major complication for standard quality control procedures. The capital cost of setting up local production was US$550/production unit.