Treatment patterns of childhood diarrhoea in rural Uganda: a cross-sectional survey

BMC International Health and Human Rights

Birger C Forsberg¹  Francis Kyakulaga²  Elin Larsson¹  Wenjing Tao¹  Jenny Löfgren¹ 

[1] Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden;Department of Health Sciences, Uganda Christian University, Mukono, Uganda

关键词: Uganda;    Child health;    Oral rehydration;    Diarrhoea control;    Diarrhoea case management;    Diarrhoea;   

Others  :  855525
DOI  :  10.1186/1472-698X-12-19

 received in 2011-12-14, accepted in 2012-08-27,  发布年份 2012

【 摘 要 】

Background

Diarrhoea is the second leading cause of death in children under five accounting for 1.8 million deaths yearly. Despite global efforts to reduce diarrhoea mortality through promotion of proper case management, there is still room for ample improvement. In order to seek options for such improvements this study explored the knowledge and practices of diarrhoea case management among health care providers at health centres and drug shops in Uganda.

Methods

Records were reviewed for case management and structured interviews concerning knowledge and practices were conducted with the staff at all health centres and at all identified drug shops in the rural district of Namutumba, Uganda.

Results

There was a significant gap between knowledge and documented practices among staff. Antibiotics, antimalarials and antipyretics were prescribed or recommended as frequently as Oral Rehydration Solution (ORS). In almost a third of the health facilities, ORS was out of stock. 81% of staff in health centres and 87% of staff in drug shops stated that they prescribed antibiotics for common diarrhoea. Zinc was not prescribed or recommended in any case.

Conclusions

The findings indicate that many children presenting with diarrhoea are inadequately treated. As a result they may not get the rehydration they need and are at risk of potential side effects from unjustified usage of antibiotics. Practices must be improved at health centres and drug shops in order to reduce childhood mortality due to diarrhoeal diseases.

【 授权许可】

   
2012 Löfgren et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization: The global burden of disease, update 2004. Geneva: World Health Organization; 2008.
• [2]The United Nations Children’s Fund (UNICEF)/World Health Organization (WHO). Diarrhoea: Why children are still dying and what can be done. Geneva: World Health Organization; 2009.
• [3]Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T, Bryce J, et al.: Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival. Lancet 2010, 375:2032-44.
• [4]Merson MH: The WHO Diarrhoeal Diseases Control Program: the practical application of oral rehydration therapy. USAID; 1983:23-28. [Proceedings of the International Conference on Oral Rehydration Therapy - Washington]
• [5]Snyder JD, Merson MH: The magnitude of the global problem of acute diarrhoeal disease: a review of active surveillance data. Bull World Health Organ 1982, 60(4):605-13.
• [6]Richards L, Claeson M, Pierce NF: Management of acute diarrhoea in children: lessons learned. Pediatr Infect Dis J 1993, 12:5-9.
• [7]Victora CG, Olinto MTA, Barros FC, Nobre L: Falling diarrhoea mortality in Northeastern Brazil: did ORT play a role? Health Policy Plan 1996, 11(2):132-141.
• [8]Victora CG, Bryce J, Fontaine O, Monasch R: Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ 2000, 78:1246-1255.
• [9]Forsberg BC, Petzold MG, Tomson G, Allebeck P: Diarrhoea case management in low- and middle-income countries – an unfinished agenda. Bull World Health Organ 2007, 85:42-48.
• [10]WHO/UNICEF: Joint statement on the clinical management of acute diarrhoea. Geneva: World Health Organization; 2004.
• [11]Bhutta ZA, Bird SM, Black RE, Brown KH, Gardner JM, Hidayat A, et al.: Therapeutic effects of oral zinc in acute and persistent diarrhoea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr 2000, 72:1516-22.
• [12]Fischer Walker CL, Black RE: Zinc for the treatment of diarrhoea: effect on diarrohea morbidity, mortality and incidence of future episodes. Int J Epidemiol 2010, 39:i63-i69.
• [13]Yakoob MY, Theodoratou E, Jabeen A, Imdad A, Eisele TP, Ferguson J, et al.: Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria. BMC Publ Health 2011, 11(Suppl 3):S23. BioMed Central Full Text
• [14]Larson CP, Rani Saha U, Islam R, Roy N: Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care. Int J Epidemiol 2006, 35(6):1430-9.
• [15]Ellis AA, Winch P, Daou Z, Gilroy KE, Swedberg E: Home management of childhood diarrhoea in southern Mali - Implications for the introduction of zinc treatment. Soc Sci Med 2007, 64:701-12.
• [16]Ross-Degnan D, Soumerai SB, Goel PK, Bates J, Makhulo J, Dondi N, et al.: The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. Health Policy Plan 1996, 11:308-18.
• [17]Raghu MB, Balasubramanian S, Balasubramanian G, Ramnath A, Indumathy : Drug therapy of acute diarrhoea: in children- actual practice and recommendations. Indian J Pediatr 1995, 62:433-437.
• [18]Mittal SK, Mathew JL: Regulating the use of drugs in diarrhoea. J Pediatr Gastroenterol Nutr 2001, 33:26-30.
• [19]Tomson G, Sterky G: Self-prescribing by way of pharmacies in three Asian developing countries. Lancet 1986, 2:620-2.
• [20]Haak H, Claeson M: Regulatory actions to enhance appropriate drug use: the case of antidiarrhoeal medicines. Soc Sci Med 1996, 42:1011-9.
• [21]WHO: The rational use of medicines in the management of acute diarrhoea in children. Geneva: World Health Organization; 1990.
• [22]Harris S, Black R: How useful are pharmaceuticals in managing diarrhoeal diseases in developing countries? Health Policy Plan 1991, 6(2):141-147.
• [23]Winch P, FitzGerald MF: Formative research in preparation for promotion of zinc treatment for childhood diarrhoea: Cross-country comparison of diarrhoea treatment practices and implications for programs. Baltimore, Maryland: Johns Hopkins Bloomberg School of Public Health; 2004:22-23. [Background document prepared for the meeting “Planning for Implementation of Zinc for Treatment of Diarrhoea]
• [24]Ahs J, Tao W, Löfgren J, Forsberg BC: Diarrhoeal diseases in low- and middle income countries: incidence, prevention and management. Open Infect Diseases Journal 2010, 4:113-124.
• [25]Okeke IN, Laxmanarayan R, Bhutta ZA, Duse AG, Jenkins P, O’Brien TF, et al.: Antimicrobial resistance in developing countries. Part 1: recent trends and current status. Lancet Infect Dis 2005, 5:481-493.
• [26]Albert MJ, Faruque ASG, Faruque SM, Sack RB, Mahalanabis D: Case–control study of enteropathogens associated with childhood diarrhoea in Dhaka, Bangladesh. J Clin Microbiol 1999, 11:3458-3464.
• [27]Baqui AH, Black RE, El Arifeen S, Yunus M, Zaman K, Begum N, et al.: Zinc therapy for diarrhoea increased the use of oral rehydration therapy and reduced the use of antibiotics in Bangladeshi children. J Health Popul Nutr 2004, 22:440-2.
• [28]Awasthi S: INCLEN Childnet Zinc Effectiveness for Diarrhoea (IC-ZED) group. Zinc supplementation in acute diarrhoea is acceptable, does not interfere with oral rehydration and reduces the use of other medications: a randomized trial in five countries. J Pediatr Gastroenterol Nutr 2006, 42:300-5.
• [29]Pathak D, Pathak A, Marrone G, Divan V, Stålsby Lundborg C: Adherence to treatment guidelines for acute diarrhoea in children up to 12 years in Ujjain, India - a crossectional prescription analysis. BMC Infect Dis 2011., 11(32)
• [30]Fischer Walker CL, Fontaine O, Young MW, Black RE: Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. Bull World Health Organ 2009, 87:780-786.
• [31]Pariyo GW, Gouws E, Bryce J, Burnham G: The Uganda IMCI impact study team. Improving facility-based care for sick children in Uganda: training is not enough. Oxford: Oxford university press; 2005.
• [32]Källander K, Hildenwall H, Waiswa P, et al.: Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ 2008, 86(5):332-8.
• [33]Fontaine O, Kosek M, Bhatnagar S, Boschi-Pinto C, Chan KY, Duggan C, et al.: Setting research priorities to reduce global mortality from childhood diarrhoea by 2015. PLoS Med 2009, 6(3):e1000041.
• [34]Clinton arrives to fight diarrhea in Uganda. Kampala: Daily Monitor; 2012.