The role of price and convenience in use of oral rehydration salts to treat child diarrhea: A cluster randomized trial in Uganda

Abstract

Over half a million children die each year of diarrheal illness, although nearly all deaths could be prevented with Oral Rehydration Salts (ORS). The literature on ORS documents both impressive health benefits and persistent underuse. At the same time, little is known about why ORS is underused and what can be done to increase use. We hypothesized that price and inconvenience are important barriers to ORS use and tested whether eliminating financial and access constraints increases ORS coverage. The findings show that most caretakers of children with diarrhoea in low-income countries seek care in the private sector where they are required to pay for ORS. However, our results suggest that price is an important barrier to ORS use and that switching to free distribution by CHWs substantially increases ORS coverage. Switching to free distribution is low-cost, easily scalable, and could substantially reduce child mortality. Convenience was not important in this context.