Research report. The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico

Bojalil, Rossana; Guiscafré, H; Espinosa, Patricia; Martı́nez, Homero; Palafox, Miguel; Romero, Giovanni E.; Gutiérrez, Gonzalo

doi:10.1093/heapol/13.3.323

Cited by 31 publications

(23 citation statements)

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“…The study concluded that there is a need for intervention to curb the irrational use of antibiotics and injections in private clinics. A study from Mexico evaluated the quality of case management by private and public GPs to children under 5 years of age with diarrhoea and ARI (Bojalil et al, 1998). In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drugs, respectively, compared with 30% and 20% of public GPs, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…This de®nition gives a more medical therapeutic view of rational drug use and may substantially differ from the consumers' perspective. Unlimited access to and irrational use of drugs is common in many developing countries (Van der Geest, 1987;Some, 1994;Hossain et al, 1982;Alubo, 1994;Alam et al, 1998;Greenhalgh,there are two studies, one from Tanzania (Massele and Nsimba, 1997) and the other from Mexico (Bojalil et al, 1998), that have compared the differences among prescription practices of primary health care (PHC) providers working in the public and private sector.…”

Section: Introductionmentioning

confidence: 99%

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Prescription practices of public and private health care providers in Attock District of Pakistan

Siddiqi¹,

Hamid

Rafique

et al. 2002

Health Planning & Management

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The irrational use of drugs is a major problem of present day medical practice and its consequences include the development of resistance to antibiotics, ineffective treatment, adverse effects and an economic burden on the patient and society. A study from Attock District of Pakistan assessed this problem in the formal allopathic health sector and compared prescribing practices of health care providers in the public and private sector. WHO recommended drug use indicators were used to study prescription practices. Prescriptions were collected from 60 public and 48 private health facilities. The mean (+/- SE) number of drugs per prescription was 4.1 +/- 0.06 for private and 2.7 +/- 0.04 for public providers (p < 0.0001). General practitioners (GPs) who represent the private sector prescribed at least one antibiotic in 62% of prescriptions compared with 54% for public sector providers. Over 48% of GP prescriptions had at least one injectable drug compared with 22.0% by public providers (p < 0.0001). Thirteen percent of GP prescriptions had two or more injections. More than 11% of GP prescriptions had an intravenous infusion compared with 1% for public providers (p < 0.001). GPs prescribed three or more oral drugs in 70% of prescriptions compared with 44% for public providers (p < 0.0001). Prescription practices were analysed for four health problems, acute respiratory infection (ARI), childhood diarrhoea (CD), fever in children and fever in adults. For these disorders, both groups prescribed antibiotics generously, however, GPs prescribed them more frequently in ARI, CD and fever in children (p < 0.01). GPs prescribed steroids more frequently, however, it was significantly higher in ARI cases (p < 0.001). For all the four health problems studied, GPs prescribed injections more frequently than public providers (p < 0.001). In CD cases GPs prescribed oral rehydration salt (ORS) less frequently (33.3%) than public providers (57.7%). GPs prescribed intravenous infusion in 12.3% cases of fever in adults compared with none by public providers (p < 0.001). A combination of non-regulatory and regulatory interventions, directed at providers as well as consumers, would need to be implemented to improve prescription practices of health care providers. Regulation alone would be ineffective unless it is supported by a well-established institutional mechanism which ensures effective implementation. The Federal Ministry of Health and the Provincial Departments of Health have to play a critical role in this respect, while the role of the Pakistan Medical Association in self-regulation of prescription practices can not be overemphasized. Improper prescription practices will not improve without consumer targeted interventions that educate and empower communities regarding the hazards of inappropriate drug use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prescription practices of public and private health care providers in Attock District of Pakistan

Siddiqi¹,

Hamid

Rafique

et al. 2002

Health Planning & Management

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“…Studies from the region have shown that more than half of the providers treating child diarrhoea cases and ARI are in the private sector (Berman and Rose, 1994); that private physicians account for 38% of the child treatment in rural areas of Guatemala (Van der Stuyft et al, 1996); and that in Mexico private practitioners perform significantly worse than public ones in terms of advice, therapy, and drugs prescribed for both diarrhoea and ARI (Bojalil et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

The role of private providers in treating child diarrhoea in Latin America

2007

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Diarrhoeal disease, a leading cause of child mortality, disproportionately affects children in low-income countries - where private and non-governmental providers are often an important source of health care. We use 10 Living Standards Measurement Surveys from Latin America to model the choice of care for child diarrhoea in the private sector compared to the public sector. A total of 36.8% of children in the combined data set saw a private provider rather than a public one when taken for treatment. Each additional quintile of household economic status is associated with an increase of 6.5 percentage points in the probability that a child with diarrhoea is taken to a private provider (p<0.001). However, treatments provided in the private sector are manifestly of worse quality than in the public sector. A total of 33.0% of children visiting a public provider received Oral Rehydration Solution, compared to 13.7% of those visiting a private provider. Conversely, children treated by a private provider are more likely to receive drugs, most commonly unnecessary antibiotics. Ironically, when it comes to treatment for child diarrhoea, wealthier and better educated households in Latin America are paying for treatment in the private sector that is ineffective in comparison with treatments that are commonly and inexpensively available.

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“…Many of the services provided in the Basic Health Services Package are designed to reduce the major causes of post-neonatal mortality such as child respiratory and intestinal infections, and malnutrition. Research, though limited, suggests that the quality of treatment for diarrheal diseases and respiratory infections was adequate in the public sector in Mexico prior to Progresa (Bojalil et al, 1998), so the interventions should be effective.…”

Section: Program Mechanisms To Reduce Infant and Neonatal Mortalitymentioning

confidence: 99%

A healthier start: The effect of conditional cash transfers on neonatal and infant mortality in rural Mexico

Barham

2011

Journal of Development Economics

109

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Research report. The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico

Cited by 31 publications

References 0 publications

Prescription practices of public and private health care providers in Attock District of Pakistan

Prescription practices of public and private health care providers in Attock District of Pakistan

The role of private providers in treating child diarrhoea in Latin America

A healthier start: The effect of conditional cash transfers on neonatal and infant mortality in rural Mexico

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