Fig: GIS map of Ujjain city showing the participating pharmacies and hospitals Adherence to...
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Transcript of Fig: GIS map of Ujjain city showing the participating pharmacies and hospitals Adherence to...
Fig: GIS map of Ujjain city showing the participating pharmacies and hospitals
Adherence to Treatment Guidelines for Acute Diarrhoea in Children up to 12 Years in Ujjain, India*
Ashish Pathak(1,2) , Deepali Pathak (1,3), Gaetano Marrone(1), Vishal Diwan(1,4), and Cecilia Stålsby Lundborg(1)
1. IHCAR, Division of Global Health, Karolinska Institutet, Sweden, India;
2. Department of Paediatrics, R.D. Gardi Medical College, Ujjain, India;
3. Grasim Trust‘s G.D. Birla Memorial Hospital, Ujjain, India;
4. Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India
E-mail: [email protected]
Policy implications and conclusions:
Low adherence to treatment guidelines, low use of zinc and the high use of antibiotics
To improve case management of acute diarrhoea, continuing professional development targeting practitioners of all systems of medicine is
necessary.
IntroductionIn India, diarrhoea accounts for 20% of all
paediatric deaths
WHO recommendations, the Indian Academy of
Paediatrics, and the Government of India treatment
guidelines are in place, but adherence to these
guidelines is not analyzed
Objective: To analyze prescriptions for adherence to
treatment guidelines
Results: Information was collected from 843 diarrhoea
prescriptions.
Only 6 prescriptions adhered with the recommended treatment
(ORS along with zinc) with no additional probiotics, antibiotics,
racecadotril, or antiemetics (except Domperidone for vomiting)
ORS alone was prescribed to 58% and ORS with zinc to 22%
Antibiotics were prescribed in 71% of prescriptions. Broad-
spectrum antibiotics were prescribed in illogical fixed-dose
combinations, such as ofloxacin with ornidazole (22% of antibiotics
prescribed).
Practitioners from alternate systems of medicine and IHPs were
significantly less likely (OR 0.13, 95% CI 0.04-0.46, P = 0.003) to
prescribe ORS and zinc than pediatricians
Practitioners from free hospitals were more likely to prescribe
ORS and zinc (OR 4.94, 95% CI 2.45-9.96, P < 0.001) and less
likely to prescribe antibiotics (OR 0.01, 95% CI 0.01-0-04, P <
0.001) compared to practitioners from other hospitals
Accompanying symptoms (fever, pain, blood in the stool, and
vomiting) significantly increased antibiotic prescribing.
*Published in:
BMC Infect Dis. 2011 Jan 28;11:32. PubMed PMID: 21276243
Funding: Swedish Research Council
Scholarship: Erasmus Mundus Lot 15 India to 1st, 2nd and 4th authors
Travel Grant: Axel Hirsch´s travel fund, Karolinska Institutet to Ashish Pathak
Fig: ORT in a child