Cheap and effective treatments for potentially fatal diarrheal diseases are widely available, yet too few children receive treatment. According to the analysis This suggests that provider misunderstandings may be causing the crisis.
Health
Many children do not have access to cheap and effective diarrhea treatment
Oral rehydration salts (ORS), a solution of glucose and electrolytes that prevent dehydration, are a first-line treatment for diarrhea in children. WHO List of Essential Medicines.but studyA paper published in the journal Science suggests that misunderstandings among health care providers can lead doctors to underprescribe cheaper treatments.
The problem is particularly acute in South Asia and sub-Saharan Africa, where children in wealthy urban areas are more likely to receive treatment than those in poor rural areas.
Researchers surveyed ORS prescribing among 2,282 healthcare providers in two regions of India. Karnataka has above-average per capita income and above-average use of oral rehydration salts. Bihar has high poverty rates and below average ORS usage. They said they had recruited and trained actors to visit health care providers and seek care for a 2-year-old with rotovirus-related diarrhea for two days.
The usual standard of care in these cases is oral rehydration salts rather than antibiotics or other drugs. Some actors expressed a preference for oral rehydration salts, others expressed a preference for antibiotics, and others said they had no preference. To reduce the likelihood that financial incentives would encourage health care providers to prescribe expensive medications, the attackers told health care providers to purchase drugs from other pharmacies.
Overall, patients who expressed a preference for oral rehydration salts increased ORS prescription rates by 27%. Many healthcare providers who did not prescribe ORS assumed that patients did not want it, and that misperception accounted for 42% of underprescriptions, the study said.
Removing financial incentives increased the likelihood of ORS being prescribed in pharmacies, but not in clinics. Efforts to ensure that clinics had ORS in stock on-site resulted in only a small increase in dispensing volumes, the study found.
The researchers suggested pursuing interventions that target health care providers and encourage patients and caregivers to request ORS for diarrhea. Improving prescribing rates could save children's lives, but the researchers pointed to another potential benefit. It aims to reduce the overprescription of antibiotics, which is leading to antibiotic resistance for diarrhea around the world.
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