28 September 2010
By Umesh Isalkar
50% medical staff dump ORS
UNICEF Study Also Reveals Irrational Use of Antibiotics
Only 43 per cent children suffering from diarrhoea (loose motion) in India receive ORS (oral rehyadration solution) – a simple treatment to regain lost water.
Surprisingly, it was found that awareness about ORS was considerably high among service providers (trained medical staff) and mothers, but very few service providers prescribe it. As a result, the actual utilisation of ORS for childhood diarrhoea remains low.
Diarrhoea continues to be an important contributor to childhood deaths in India with almost 10 per cent of infants and 14 per cent in the 0–4–year age category dying due to the infection in India every year.
The study was cross–sectional and included both quantitative and qualitative methods. In each of the 10 districts, 1,230 households with children in the age group of 2–59 months who had diarrhoea in the two weeks preceding the survey, were selected using a multi–stage sampling. The districts surveyed were Medak in Andhra Pradesh; Dibrugarh in Assam; Vaishali in Bihar; East Singhbhum in Jharkhand; Guna in Madhya Pradesh; Latur in Maharashtra; Koraput in Orissa; Krishnagiri in Tamil Nadu; Lalitpur in Uttar Pradesh and Purulia in West Bengal.
"Knowledge among medical staff about specific aspects of current diarrhoea management guidelines is lacking, especially on how much ORS to give and how often; indications for use of antibiotics; need to increase/continue feeding during the infection; and on use of zinc as an adjunct therapy," states the study.
The Government of India has recently revised the guidelines for diarrhoea management including revised therapeutic advances such as use of low–osmolarity ORS and zinc. However, the study found that prescription of zinc was low. Government and private practitioners of modern medicine have begun to prescribe zinc (range 30 –36.3 %) than other service providers, the study found.
On awareness about zinc, it was found that hardly one per cent of the mothers whose children had diarrhoea in the last two weeks prior to the survey, reported to have heard of zinc.
Practice of giving additional advice among health care providers was found to be low. Advises such as increased fluids continued feeding, breastfeeding, hand washing, and recognition of danger signs which together should become an integral part of diarrhoea management, the study states.
"A good number of service providers, ranging from 33 per cent of private practitioners of modern medicine and government AYUSH practitioners to 55 per cent of unqualified health practitioners, advised giving food to the child less frequently during the infection. These instructions are contrary to the present diarrhoea management guidelines," underlines the report.
Persistence of some inappropriate advice from service providers continues to be disturbing such as bottle feeding and withholding fluids and food during diarrhoea. As a result, caregivers carry on with these harmful practices. These erroneous behaviours need urgent correction, the study Steps have also been initiated to improve supplies of low–osmolarity ORS and zinc through the public health system under the National Rural Health Mission (NRHM) of the Government of India.
However the study underlines that increasing compliance with diarrhoea management guidelines remains a challenge for district/block health officials and community health workers.
K Sujatha Rao, secretary (Health), Department of Health and Family Welfare, New Delhi, could not be contacted despite repeated attempts.