Wednesday, August 03, 2016
Assessing knowledge of health care providers in management of childhood diarrhoea
Diarrhoea is a common cause of death in children below 5 years of age in developing countries. The World Health Organization (WHO) recommends zinc and oral rehydration salts (ORS) for treating diarrhoea. A study published in the Journal of Global Health assessed the knowledge and practice of formal and informal private sector providers regarding the use of zinc and ORS, a year after implementing the Diarrhoea Alleviation through Zinc and ORS Therapy (DAZT) programme in Uttar Pradesh, India.
Formal providers were those who had medical degrees, and informal providers were those who did not have medical degrees or certification in traditional Ayush medicine. Staff trained in childhood diarrhoea treatment visited private sector providers to promote ORS and zinc, using informative videos and materials. Surveys, interviews, and direct observation of healthcare providers were carried out in 12 districts of UP.
Out of 232 providers, 155 reported that they were trained or informed about diarrhoea treatment in the past 6 months. For treating simple acute diarrhoea, which is characterized by 5 episodes of loose stools for 3 days, 68.1% of providers prescribed ORS, and 65.9% of them prescribed antibiotics. When providers were interviewed about prescribing ORS and zinc, 14% of them reportedly prescribed zinc to all children suffering from diarrhoea, while 36% prescribed zinc to 50% of the children with diarrhoea. Direct observation of 97 providers treating children with diarrhoea revealed that 77.3% of them prescribed ORS and 29.9% prescribed zinc. Treatments other than ORS and zinc were also prescribed. Healthcare providers that prescribed antibiotics were about 61.9% while 17.5% of them prescribed anti-diarrhoeals for treating diarrhoea. Twenty-six providers followed the WHO/Indian Academy of Pediatrics guidelines and prescribed both ORS and zinc.
This study had some limitations. All providers were not covered in this study, and the sample studied may not represent providers who were not included in the study. Direct observation of the providers was carried out in the dry season, with only few diarrhoea cases being reported. Sometimes the providers were interviewed when there were no diarrhoeal cases for observation. There was no standard method of observing providers in practice, and providers might be biased while treating the children when being observed.
There were many challenges in implementing DAZT programme among formal and informal private providers in rural UP. Healthcare providers need to be trained properly to prevent unnecessary prescription of antibiotics and anti-diarrhoeals. There is a need to create awareness and knowledge about recommending ORS and zinc for the treatment of diarrhoea. A collaboration between policymakers and programme implementers in connecting with informal providers is necessary, as they play a major role in treating children with diarrhoea, in inaccessible areas.