Impact of a social franchising program on uptake of oral rehydration solution plus zinc for childhood diarrhea in myanmar: a community-level randomized controlled trial

J Trop Pediatr. 2014 Jun;60(3):189-97. doi: 10.1093/tropej/fmt108. Epub 2014 Jan 8.


Background: Diarrhea's impact on childhood morbidity can be reduced by administering oral rehydration solution (ORS) with zinc; challenges to wider use are changing health-seeking behavior and ensuring access.

Methods: We conducted a randomized controlled trial to increase ORS plus zinc uptake in rural Myanmar. Village tracts, matched in 52 pairs, were randomized to standard ORS access vs. a social franchising program training community educators and supplying ORS plus zinc.

Results: Intervention and control communities were comparable on demographics, prevalence of diarrhea and previous use of ORS. One year after randomization, ORS plus zinc use was 13.7% in the most recent case of diarrhea in intervention households compared with 1.8% in control households (p < 0.001) (N = 3605). A significant increase in ORS plus zinc use was noted in the intervention (p = 0.044) but not in the control (p = 0.315) group.

Conclusions: Social franchising increased optimal treatment of childhood diarrhea in rural Myanmar. Scale-up stands to reduce morbidity among children in similar settings.

Trial registration: Current Controlled Trials ISRCTN73606238.

Keywords: Myanmar; cluster randomized trial; diarrhea; oral rehydration solution; zinc.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Bicarbonates / administration & dosage
  • Child
  • Community Health Services / organization & administration
  • Diarrhea / therapy*
  • Female
  • Glucose / administration & dosage
  • Health Impact Assessment*
  • Health Services / statistics & numerical data
  • Health Services Accessibility
  • Humans
  • Myanmar / epidemiology
  • Potassium Chloride / administration & dosage
  • Prevalence
  • Private Sector
  • Program Evaluation
  • Rehydration Solutions / administration & dosage*
  • Rural Health
  • Rural Population
  • Social Marketing*
  • Sodium Chloride / administration & dosage
  • Zinc / administration & dosage*


  • Bicarbonates
  • Rehydration Solutions
  • World Health Organization oral rehydration solution
  • Sodium Chloride
  • Potassium Chloride
  • Glucose
  • Zinc

Associated data

  • ISRCTN/ISRCTN73606238