Management of acute diarrhea in children: is the treatment guidelines is really implemented?
DOI:
https://doi.org/10.18203/2320-6012.ijrms20180294Keywords:
Acute diarrhea, ORS, Prescribing trend, ZincAbstract
Background: Acute diarrhea is a common problem in children especially in poor and developing nations. It is one of the leading cause of under-five years’ mortality globally. The children used to die each year of dehydration and electrolyte imbalance caused by acute diarrhea. Despite of WHO recommendations on the use of ORS and zinc in the management of acute diarrhea as a simple and effective treatment, the prescribing trend of ORS and zinc in acute diarrhoea is not up to the mark, which further increases the burden of the problems. Objectives: we aimed to assess; (1) prescribing trend of ORS and zinc in acute diarrhoea in children aged 6months to 5years by health care providers, (2) to asses’ proportion of patient education in acute diarrhea by health care providers.
Methods: This was a qualitative, cross-sectional, hospital based study carried among children aged 6months to 5yrs.
Results: This study was conducted among 313 children of acute diarrhoea who had been treated outside. Mean age (months) was 27.53±15.87. Out of all children who were treated from outside, 180 (57.50%) took treatment from general physician, 113 (36.10%) children took the treatment from pediatrician, and 20 (6.85%) took the treatment from the physician and 25 (7.9%) took treatment as over the counter antidiarrheal by the pharmacists. Out of them dehydration was documented only in 97 (30.99%), while ORS was given in 229 (73.16%) and zinc was given in 121 (38.65%) children. Patients education was done in 39 (12.46%).
Conclusions: There was gross under implementation of treatment guidelines in the management of acute diarrhea by health care providers especially by general physicians.
Metrics
References
Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO child health epidemiology reference group. who estimates of the causes of death in children. Lancet. 2005;365(9465):1147-52.
Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, et al. Childhood malnutrition and infection network. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol. 2008;37(4):816-30.
Burton MJ, Mabey DC. The global burden of trachoma: a review. PLoS Negl Trop Dis. 2009;3(10):e460.
Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglected tropical diseases: the global burden of disease framework. PLoS Negl Trop Dis. 2007;1(2):e114.
WHO. Prüss-Ustün A, Bos R, Gore F, Bartram J. Safer water, better health. Geneva, World Health Organization; 2008. Available at http://www.who.int/quantifying_ehimpacts/publications/saferwater/en/. Accessed 23 November 2009.
WHO. UNICEF joint monitoring programme for water supply and sanitation. Progress on sanitation and drinking-water 2010 update. Geneva, World Health Organization, 2010 Available at http://www.who.int/water_sanitation_health/publications/9789241563956/en/. Accessed 31 March 2011.
Curtis VA, Danquah LO, Aunger RV. Planned, motivated and habitual hygiene behaviour: an eleven-country review. Health Educ Res. 2009;24(4):655-73.
Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, Shet A, et al. Million death study collaborators. causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet. 2010;376(9755):1853-60.
Cash RA, Nalin DR, Rochat R, Reller LB, Haque ZA, Rahman AS. A clinical trial of oral therapy in a rural cholera-treatment center. Am J Trop Med Hyg. 1970;19(4):653-6.
Mahalanabis D, Choudhuri AB, Bagchi NG, Bhattacharya AK, Simpson TW. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med J. 1973;132(4):197-205.
Mahalanabis D, Wallace CK, Kallen RJ, Mondal A, Pierce NF. Water and electrolyte losses due to cholera in infants and small children: a recovery balance study. Pediatrics. 1970;45(3):374-85.
Nalin DR, Cash RA. Oral or nasogastric maintenance therapy in pediatric cholera patients. J Pediatr. 1971;78(2):355-8.
Nalin DR, Cash RA, Islam R, Molla M, Phillips RA. Oral maintenance therapy for cholera in adults. Lancet. 1968;2(7564):370-3.
Pierce NF, Banwell JG, Rupak DM, Mitra RC, Caranasos GJ, Keimowitz RI, et al. Effect of intragastric glucose-electrolyte infusion upon water and electrolyte balance in Asiatic cholera. Gastroenterology. 1968;55(3):333-43.
Pierce NF, Sack RB, Mitra RC, Banwell JG, Brigham KL, Fedson DS, et al. Replacement of water and electrolyte losses in cholera by an oral glucose-electrolyte solution. Ann Intern Med. 1969;70(6):1173-81.
Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM, Hidayat A, et al. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr. 2000;72(6):1516-22.
WHO. Reduced osmolarity oral rehydration salts (ORS) formulation. Geneva: World Health Organization; 2001. Available at http://apps.who.int/iris/handle/10665/67322.
Baqui AH, Black RE, El Arifeen S, Yunus M, Chakraborty J, Ahmed S, et al. Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomised trial. BMJ. 2002;325(7372):1059.
Water with sugar and salt. Lancet. 1978;2(8084):300-1.
WHO. Implementing the new recommendations of the clinical management of diarrhoea. Geneva: World Health Organization; 2006. Available at http://www.who.int/maternal_child_adolescent/documents/9241594217/en/.
Inclen Childnet zinc effectiveness for diarrhea (IC-ZED) group. Zinc supplementation in acute diarrhea is acceptable, does not interfere with oral rehydration, and reduces the use of other medications: a randomized trial in five countries. J Pediatric Gastroenterol Nutrition. 2006;42(3):300-5.
Duggan C, Lasche J, McCarty M, Mitchell K, Dershewitz R, Lerman SJ, et al. Oral rehydration solution for acute diarrhea prevents subsequent unscheduled follow-up visits. Pediatrics. 1999;104(3):e29.
Fischer Walker CL, Fontaine O, Young MW, Black RE. Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. Bull World Health Organ. 2009;87(10):780-6.
United Nations. Department of Economic, United Nations. Department of Public Information. Millennium Development Goals Report 2009 (Includes the 2009 Progress Chart). United Nations Publications; 2009. Available at http://www.un.org/millenniumgoals/. Accessed March 2011.
Davis DA, Taylor-Vaisey A. Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ. 1997;157(4):408-16.
MoH, South Sudan, Basic Package of health and nutrition service for South Sudan, January 2009. Available at https://www.unicef.org/southsudan /South_Sudan_Basic_package_of_health_services.pdf.
WHO. Clinical Management of acute diarrhoea (WHO/FCH/CAH/04.07) Geneva and New York; World Health Organization and United Nations Children’s Fund, 2004. Available at http://www.who.int/maternal_child_adolescent/documents/who_fch_cah_04_7/en/.
Donabedian A. Evaluating the quality of medical care. The Milbank Quarterly. 2005;83(4):691-729.