Adherence of Doctors to Standard Diarrhoeal Management Guideline During Treatment of Under-Five Diarrhoeal Episodes: A Study From Eastern India

Behera, Priyamadhaba; Bhatia, Vikas; Sahu, Dinesh Prasad; Kamble, Raviraj; Panda, Priyambada; Singh, Arvind Kumar

doi:10.7759/cureus.13433

Cited by 5 publications

(8 citation statements)

References 15 publications

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“…In this study, several themes demonstrated that drugstore personnel made their clinical judgment not based on clinical evidence. For example, failure to provide ORS was found in this study and the others [ 11 15 16 ], even though ORS is the absolute main goal for the treatment of diarrhea [ 17 ], We found that the perception about the severity of diarrhea was used as a criterion for giving the ORS. Next, in this study, zero drugstore personnel have dispensed zinc because it was not known as a treatment option.…”

Section: Discussionmentioning

confidence: 49%

“…WHO has issued guidelines for the treatment of diarrhea in 2005 to encourage the use of ORS and zinc as the first-line treatment and to encourage the nutritional recommendation during and after diarrhea. However, non-compliance to the guidelines is common, both in hospitals [ 10 11 ], and pharmacies [ 14 ]. This study was one of a few studies that investigated the rationale for the non-compliance to the guideline.…”

Section: Discussionmentioning

confidence: 99%

“…Even though WHO has released the manual for the treatment of diarrhea for decades, inappropriate drug treatment and inadequate patient counseling on food and fluid intake still exist [ 9 ]. A few quantitative studies have investigated the prevalence and characteristics of non-compliance to the diarrhea treatment guidelines issued by WHO [ 10 11 ]. However, qualitative research that investigates the causes of non-compliance to the guidelines is scarce.…”

Section: Introductionmentioning

confidence: 99%

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Medication selection for the treatment of acute infective diarrhea in Thai pharmacies: a qualitative study

Leelakanok

Petchsomrit

Methaneethorn

et al. 2021

Transl Clin Pharmacol

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World Health Organization (WHO) released the treatment manual of diarrhea in 2005. We aimed to investigate the rationale for selecting medications for acute infective diarrhea in Thai community pharmacies and to see if the selection complied with the WHO manual. A theoretical 18-year-old patient with acute infective diarrhea was used for interviews. The protocol and materials for the research were approved by Institutional Review Board. A total of 30 drugstore personnel were selected by convenience sampling and included. The first author manually coded, extracted for themes, and translated the transcript. Participants did not dispense oral rehydration salt because of the feeling that diarrhea was not severe. Absorbents were dispensed because they were perceived as the first-line medication for noninfective or mild diarrhea. Antibiotics were dispensed because of the concerns for the prognosis and the expected patient pressure. None provided zinc to the patient because of the lack of knowledge of the indication of zinc. We found that dispensing for acute infective diarrhea in Thai drugstores deviated from the WHO treatment guideline. The reasons were that the pharmacy personnel were not practicing evidence-based medicine, the lack of knowledge, the patient pressure, the unavailability of products, and the perceived availability of information in local guidelines.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Medication selection for the treatment of acute infective diarrhea in Thai pharmacies: a qualitative study

Leelakanok

Petchsomrit

Methaneethorn

et al. 2021

Transl Clin Pharmacol

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“…This is due to the high prevalence of comorbid infections among the patients that necessitate antibiotic therapy (Jordan et al 2020). However, the fact that some respondents would still prescribe antibiotics indicated a lack of confidence in oral rehydration therapy and proper training in diarrhea management (Behera et al 2021). This study's results showed that cotrimoxazole was the most commonly prescribed antibiotic medication.…”

Section: Resultsmentioning

confidence: 99%

“…In eastern India, doctors' compliance with diarrhea treatment guidelines for infants under the age of 5 was also low. These deviations occurred frequently, although the WHO recommends the administration of oral rehydration solution and zinc (De et al 2016, Behera et al 2021.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Acute Diarrhea in Children Aged 1–5 Years Provided by Doctors in Surabaya

Alpha Fardah Athiyyah,

Insyira Rayhana Irsan,

Nurmawati Fatimah

2023

FMI

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Highlights: 1. The focus of this study was on the treatment methods for acute diarrhea, which have not been extensively investigated in the region studied.2. This study can provide an overview of doctors' adherence to the available guidelines for the treatment of acute diarrhea in children aged 1–5 years in Surabaya, Indonesia. Abstract: Diarrhea is the second leading cause of death among children under five, following pneumonia. Insufficient knowledge of diarrhea and dehydration management may contribute to this high mortality rate. Implementing prompt and effective management and prevention strategies has the potential to decrease morbidity and mortality associated with diarrhea. Therefore, this cross-sectional study aimed to investigate the treatment methods used by doctors for children aged 1–5 suffering from acute diarrhea in Surabaya, Indonesia. Data were collected from doctors in Surabaya using an online form containing case-based questions. Microsoft Excel for Mac version 16.17 (Microsoft Inc., Redmont, WA, USA) was used to process the binary data by calculating frequencies and percentages with a point estimate of 95% confidence interval (CI). A descriptive method was used in the data analysis, and the findings were presented in tables. From a total of 51 respondents who participated in this study, 18 (35.29%) only administered oral rehydration therapy. In addition, 49 respondents (96.08%) prescribed zinc supplementation for ten days, while 10 respondents (19.61%) opted for antibiotics. Interestingly, 49 respondents (96.08%) recommended both breast milk and food for the patients, and nearly all respondents provided guidance to the mother or caregiver of the patient. The findings of this study suggested that the respondents primarily used rehydration therapy to treat children suffering from acute diarrhea with moderate dehydration. However, some respondents still relied on antibiotics despite the available recommendations to use oral rehydration therapy. Nearly all respondents agreed on zinc supplementation, breast milk and food provision, and advice for the mother or caregiver of the patient. While certain aspects of the disease management for diarrhea align with the recommended guidelines, there is room for improvement in promoting the exclusive use of oral rehydration therapy and reducing unnecessary antibiotic prescriptions.

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Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador

Sánchez,

Calderón,

Solis

et al. 2023

J Prim Care Community Health

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Background: Diarrheal disease remains a significant cause of child mortality, particularly in regions with limited access to healthcare and sanitation. Inappropriate practices, including unjustified medication prescriptions, pose challenges in the management of acute diarrhea (AD), especially in low- and middle-income countries. Objective: This study analyzed antibiotic prescription patterns and assessed compliance with Integrated Management of Childhood Illness (IMCI) guidelines in children under 5 with AD in the Ministry of Public Health (MOPH) Ambulatory Care Centers of Quito city, Ecuador. Methods: A cross-sectional design was used, collecting electronic health records (EHR) of patients diagnosed with AD from 21 health facilities in District 17D03. A probabilistic and stratified sampling approach was applied. Patient characteristics, prescriber characteristics, treatments, and compliance of IMCI guideline recommendations were evaluated. A stepwise logistic regression analysis examined the association between antibiotic prescription and patient and physician characteristics. Results: A total of 359 children under 5 years of age were included, with 58.77% being girls. 85.24% of the cases of AD were attributed to gastroenteritis and colitis of infectious and unspecified origin. Amebiasis and other protozoal intestinal diseases accounted for 13.37% and 1.11% of the cases, respectively. The completion rates of recording various IMCI parameters varied; parameters such as duration of diarrhea, presence of blood in stool, and evidence of sunken eyes had high completion rates (100%, 100%, and 87.47%, respectively), while parameters like state of consciousness, presence of thirst, and type of diarrhea had low completion rates (0.28%, 0.28%, and 0.84%, respectively). None of the cases had all parameters fully recorded. Antimicrobials were prescribed in 38.72% of the cases. Children aged 3 to 5 years had higher odds of receiving antimicrobial prescription for AD (aOR: 4.42, 95% CI 2.13-9.18, P < .0001) compared to those under 1 year, after adjusting for the number of loose stools per day, gender, and age of the health professional. Conclusion: Variations in IMCI guideline compliance were observed, with no cases fully adhering to the guidelines. Antimicrobial prescription rates were notably high, especially among older children. Further research and specialized interventions are necessary to gain comprehensive insight into the factors underlying non-compliance with the IMCI guidelines.

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Adherence of Doctors to Standard Diarrhoeal Management Guideline During Treatment of Under-Five Diarrhoeal Episodes: A Study From Eastern India

Cited by 5 publications

References 15 publications

Medication selection for the treatment of acute infective diarrhea in Thai pharmacies: a qualitative study

Medication selection for the treatment of acute infective diarrhea in Thai pharmacies: a qualitative study

Treatment of Acute Diarrhea in Children Aged 1–5 Years Provided by Doctors in Surabaya

Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador

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