Treatment of diarrhea in young children: results from surveys on the perception and use of oral rehydration solutions, antibiotics, and other therapies in India and Kenya

Abstract

BackgroundDiarrheal disease is a leading cause of morbidity and mortality among children under five. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries. This study surveyed caregivers and health care providers in India and Kenya to gather information about perceptions and use of various diarrhea treatments, assess reasons for low ORS use, and identify opportunities for expanding ORS use.MethodsThe project team conducted two rounds of semi–structured, quantitative surveys with more than 2000 caregivers in India and Kenya in 2012. A complementary survey covered more than 500 pharmacy staff and health care workers in both countries. In Kenya, the team also surveyed rural pharmacies to gather pricing and sales data.ResultsAlthough caregivers generally had very positive perceptions of ORS, they typically ranked antibiotics ahead of ORS as the strongest medicine for diarrhea (in India 62% ranked antibiotics first and 23% ranked ORS first, n = 404; in Kenya results were 55% and 29%, n = 401). Many caregivers had misconceptions about the purpose and effectiveness of various treatments. For example, most caregivers who gave ORS at last episode expected it to stop their child’s diarrhea (65% in India, n = 190; 73% in Kenya, n = 154). There were noteworthy differences between India and Kenya in the selection and sourcing of treatments. Much of the money spent by families during the last episode of diarrhea was for inappropriate treatments. This was especially true in India, where rural households typically spent US$ 2.29 (median for the 79% of rural households that paid for health care services or treatments, n = 199) with most of this going to pay fees of private health workers and/or for antibiotics.ConclusionsCaregivers’ primary treatment goal is to stop diarrhea, and many believe that antibiotics or ORS will accomplish this goal. Inappropriate treatment – and especially overuse of antibiotics – is common. Satisfaction with ORS is high, but dosing is a challenge for caregivers. The results provide valuable insight into treatment behaviors and suggest significant opportunities to enhance use of ORS in developing countries.

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

“…Probiotics are expensive to purchase, and there is limited evidence of their effectiveness in treating childhood diarrhea [24]. A recent study in Kenya and India reported that healthcare workers and pharmacy staff prescribe antibiotics (which they perceive to be stronger medicines) due to parents' expectations that these drugs will reduce the duration of diarrhea [25]. A similar rationale could explain the high proportion of antibiotics and antimotility agents dispensed in the study setting.…”

A study of misconceptions about childhood diarrhoea among adults in urban Pondicherry, India

“…In a study done by Zwisler G et al, it was found that most of the caregivers who gave ORS, believed that the ORS would arrest their child's diarrheal episodes. 3,4,7 Less number of illiterate people believed that antibiotics are necessary compared those who were educated till high school or above, it may be due to the lack of awareness about the treatment among illiterates and incorrect knowledge among educated.…”

“…It is estimated that 60-70 per cent of diarrhoea related deaths are caused by dehydration. 3 Lack of knowledge of mothers/ caregivers about diarrheal diseases is a common problem in many developing countries. Although oral rehydration solution (ORS) has tremendous therapeutic benefits, coverage of and demand for this product have remained low in many developing countries.…”

“…4 It largely depends, on the level of mother's/caregiver's knowledge and their attitude towards its use. 3 Hence the present study was conducted in urban Pondicherry to gather information about common misconceptions regarding the management of diarrhoea and their perceptions and role of breast feeding, various diarrhoea treatments, ORS use and also to find out the association between socio-demographic factors with the misconceptions of diarrheal management. Objectives of the study are to study the misconceptions of caregivers regarding diarrheal management among under five children in an urban area of puducherry and to study the association of false beliefs with socio-demographic factors.…”

Kajian Penggunaan Antibiotik Pada Pasien Diare Akut Di Bangsal Rawat Inap Anak

“…Ironisnya, pemakaian antibiotik secara tidak rasional pada diare akut anak masih banyak terjadi di berbagai daerah di dunia 5,12,2,11 . Salah satu pertimbangan yang mendasari pemberian antibiotik adalah hasil pemeriksaan leukosit dan suhu tubuh pasien.…”