This section of the website summarises data submitted by ORSZCA members on the ORS and Zinc status in their country, or a country they are familiar with. This dataset seeks to answer the most frequently asked question, that no one can answer, which is “What is the current status of ORS and Zinc across LMICs?”:
-
- Which countries are using ORS/Zinc co-packs?
- Where does Zinc have “over the counter” status?
- Which countries have co-packaged ORS/Zinc on their Essential Medicines List?
- Co-pack brands, pricing and so on
Please add to this dataset using this questionnaire or by leaving a comment at the bottom of the individual country page. You do not have to know the answer to every question; our aim is to quickly gather insights from the information you have at your fingertips. We hope to receive multiple questionnaires from each country. It takes less than 10 minutes to submit the questionnaire and helps us provide a unique resource for would-be donors and strategists.
| Country | Questionnaires | Comments | Co-packaged ORS/Zinc on National EML? |
EN/FR |
| Bangladesh | 1 | 0 | No | EN |
| Burkina Faso | 1 | 1 | No | FR |
| Cameroon (8th) | 1 | 0 | Unknown | FR |
| Chad (5th) | 0 | 0 | Unknown | FR |
| DRC (7th) | 1 | 0 | No | FR |
| Ethiopia (4th) | 3 | 0 | Yes (since 2020) | EN |
| Ghana | 1 | 0 | No | EN |
| India (2nd) | 4 | 3 | No | EN |
| Indonesia | 1 | 1 | No | EN |
| Iraq | 1 | 0 | No | EN |
| Kenya | 3 | 1 | Yes (since <2018) | EN |
| Madagascar (9th) | 2 | 2 | Yes (since 2019) | FR |
| Malawi | 2 | 0 | No | EN |
| Mali | 1 | 0 | No | FR |
| Myanmar | 1 | 0 | No | EN |
| Nepal | 4 | 3 | No | EN |
| Niger (6th) | 0 | 0 | Unknown | FR |
| Nigeria (1st) | 7 | 4 | Yes (since 2016) | EN |
| Pakistan (3rd) | 1 | 1 | Yes (since 2020 at national level) but health issues are devolved to provinces and co-packaging does not feature in provincial lists |
EN |
| Rwanda | 1 | 0 | No | EN |
| Senegal | 4 | 0 | Yes (since <2018) | FR |
| Somalia (10th) | 1 | 0 | No | EN |
| South Africa | 1 | 0 | No | EN |
| South Sudan | 1 | 0 | No | EN |
| Uganda | 2 | 2 | Yes (since 2018) | EN |
| Zambia | 1 | 2 | Yes (not actually on NEML but gov’ment policy is to distribute co-packs) |
EN |
Top 10 countries for diarrhoea deaths with ranking in red >>more
While we build the above dataset, the table below is the best information we have. It shows the status of ORS and Zinc on selected national essential medicines lists. It is based on internet research and includes 55 countries. The top 10 countries for diarrhoea mortality are covered except for Niger and these all have both ORS and Zinc on their respective national essential medicines lists. However, only two list co-packaged ORS and Zinc (Nigeria and Ethiopia).
Source: The successful application to WHO to add co-packaged ORS and Zinc to the Essential Medicines List updated with information from the dataset above.
Status of ORS and Zinc on national Essential Medicines lists (internet research – 55 countries).
| ORS/zinc co-pack (7 countries) | Ethiopia (f), Kenya, Nigeria, Pakistan,(e) Senegal, Vietnam, Zambia(a). |
| Both ORS and zinc separately, NOT co-pack (24 countries) | Afghanistan, Angola, Argentina, Bangladesh, Bolivia, Botswana, Burkina Faso,(b) Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Eritrea(c), Ghana, Guinea, India, Madagascar, Nepal,(d) Rwanda, Somalia, Sri Lanka, Sudan, Tanzania, Uganda. |
| ORS only, not Zinc (14 countries) | Algeria, Armenia, Bahrain, Barbados, Belize, Cambodia, China, Cook Islands, Indonesia, Malaysia, Mauritania, Myanmar, Timor-Leste, Togo. |
| Zinc only, not ORS (5 countries) | Brazil, Chile, El Salvador, Mali, Republic of Congo. |
| Neither ORS nor zinc (5 countries) | Cape Verde, Colombia, Côte d’Ivoire, Croatia, Lesotho. |
| Countries in the top 10 high burden countries whose status we do not know | Niger. |
Top 10 countries for diarrhoea mortality are highlighted in red.
(a) Co-packaged ORS and Zinc is not yet listed in the latest published national EML as publishing lags behind decisions.
(b) Does not specifically list co-pack, but does make a note: “En case de diarrhée aiguë, le sulfate de zinc doit être utilisé comme adjuvant de la réhydratation orale chez l’enfant.”
(c) Does not specifically note that medicines should be taken together, but they are listed together under “Medicines used in Diarrhoea.” There is no indication they are listed as a co-pack.
(d) A note is made: “In acute diarrhoea, zinc sulfate should be used as an adjunct to oral rehydration salts .”
(e) National level only – not get featured in provincial EMLs.
(f) Since 2020. Although ORS and Zinc are listed separately, a note under the Zinc entry states that: “zinc sulfate should be used as an adjunct to oral rehydration salts (co-packaged ORS/zinc)”.
It is beginning to appear on some packets of ORS in Nigeria where the tablets of zinc are also enclosed in the pack of ORS. However, it is a widely practiced phenomenon across most ORS sachets sold in the country. A lot still needs to be done. The parents and physicians actually knows the importance of zinc tablets and ORS for acute diarrhea.