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Save Rural Children from Wrong treatments, Suggests UK Study

Revealing for the first time that a large number of children die from diarrhoea and pneumonia in rural India due to wrong treatments provided by medical practitioners, a study has suggested better healthcare to save these kids.

Rural India faces acute shortage of qualified doctors and quacks prevail all over these villages providing incorrect treatments for childhood diarrhoea and pneumonia – two leading killers of children worldwide – and even when they do, they rarely prescribe them properly, the researchers said.

Manoj Mohanan

Manoj Mohanan

“Our results show that in order to reduce child mortality, we need new strategies to improve diagnosis and treatment of these key childhood illnesses,” said lead author of the study, Manoj Mohanan, professor at Duke University in the US.

Often, these private medical practitioners fail to prescribe lifesaving treatments such as oral rehydration salts (ORS) and instead prescribe unnecessary antibiotics or other potentially harmful drugs, Mohanan said.

According to September 2014 bulletin of Sample Registration System (SRS), India has an infant mortality rate of 40 per 1,000 live births and in Bihar, where the study was conducted, infant mortality rate is 42 per 1,000 live births, according to the report.

“Eighty percent in our study had no medical degree. But much of India’s rural population receives care from such untrained providers, and very few studies have been able to rigorously measure the gap between what providers know and what they do in practice,” Mohanan said.

The study involved 340 health care providers on whom researchers conducted “vignette” interviews with providers to assess how they would diagnose and treat a hypothetical case, followed by visits made unannounced by individuals who portrayed patients presenting the same symptoms as in the interviews.

The experiment enabled researchers to measure the gap between what providers know and what they actually do – the “know-do” gap as providers exhibited low levels of knowledge about both diarrhoea and pneumonia during the interviews and performed even worse in practice.

For example, for diarrhoea, 72 percent of providers reported they would prescribe oral rehydration salts – a life-saving, low-cost and readily available intervention – but only 17 percent actually did so and those who did prescribe ORS also added other unnecessary or harmful drugs.

In practice, none of the providers gave the correct treatment: only ORS, with or without zinc, and no other potentially harmful drugs. Instead, almost 72 percent of providers gave antibiotics or potentially harmful treatments without ORS.

The study has identified 360 eligible study areas in 12 districts and house listing (to finalize sampling frame) conducted across  30,780 households during June-October 2011.

“Our evidence on the gap between knowledge and practice suggests that training alone will be insufficient. We need to understand what incentives cause providers to diverge from proper diagnosis and treatment,” Mohanan added.

The study was published in the journal JAMA Pediatrics.

Funded by the Bill & Melinda Gates Foundation, the project is a cluster-randomized evaluation of the foundation-financed World Health Partners (WHP) social franchising and telemedicine program in Bihar to provide experimental evidence on how the WHP program influences

a. disease-specific outcomes (per four of the foundation’s priorities in Bihar: childhood diarrhea, childhood pneumonia, tuberculosis (TB), and visceral leishmaniasis (VL));
b. broader population health measures; and
c. clinician knowledge and quality of medical care.

“Additionally, we will conduct prospective experimental studies of how households choose doctors (assessing how they understand and value improvements in health care quality) and the effectiveness of financial incentives for improvement in overall health. In doing so, the project will addresses broader issues of financial sustainability, affordability, replicability, and future Government support,” said Mohanan on his profile in the university website.

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