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Predictors of Rational Management of Diarrhea in an Endemic Setting: Observation from India

Author

Listed:
  • Tanmay Mahapatra
  • Sanchita Mahapatra
  • Barnali Banerjee
  • Umakanta Mahapatra
  • Sandip Samanta
  • Debottam Pal
  • Nandini Datta Chakraborty
  • Byomkesh Manna
  • Dipika Sur
  • Suman Kanungo

Abstract

Background: Decades after the establishment of clear guidelines for management, mostly due to irrational approach, diarrhea is still a major concern in the developing world, including India. The scenario is even worse in urban slums owing to poor health-seeking and socio-environmental vulnerability. Determining the distribution of rational diarrhea management by practitioners and identification of its important predictors seemed urgent to minimize the potential for antibiotic resistance, diarrhea-related mortality and morbidity in these areas. Methods: Between May 2011 and January 2012, 264 consenting, randomly selected qualified and non-qualified practitioners (including pharmacists) were interviewed in the slums of Kolkata, a populous city in eastern India, regarding their characteristics, diarrhea-related knowledge (overall and in six separate domains: signs/symptoms, occurrence/spread, management, prevention/control, cholera and ORS), prescribed antibiotics, intravenous fluid (IVF) and laboratory investigations. Rationality was established based on standard textbooks. Results: Among participants, 53.03% had no medical qualifications, 6.06% were attached to Governmental hospitals, 19.32% had best knowledge regarding diarrhea. While treating diarrhea, 7.20%, 17.80% and 20.08% respectively advised antibiotics, IVF and laboratory tests rationally. Logistic regression revealed that qualified and Governmental-sector practitioners managed diarrhea more rationally. Having best diarrhea-related knowledge regarding signs/symptoms (OR=5.49, p value=0.020), occurrence/spread (OR=3.26, p value=0.035) and overall (OR=6.82, p value=0.006) were associated with rational antibiotic prescription. Rational IVF administration was associated with best knowledge regarding diarrheal signs/symptoms (OR=3.00, p value=0.017), occurrence/spread (OR=3.57, p value=0.004), prevention/control (OR=4.89, p value=0.037), ORS (OR=2.55, p value=0.029) and overall (OR=4.57, p value

Suggested Citation

  • Tanmay Mahapatra & Sanchita Mahapatra & Barnali Banerjee & Umakanta Mahapatra & Sandip Samanta & Debottam Pal & Nandini Datta Chakraborty & Byomkesh Manna & Dipika Sur & Suman Kanungo, 2015. "Predictors of Rational Management of Diarrhea in an Endemic Setting: Observation from India," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-13, April.
    • Handle: RePEc:plo:pone00:0123479
    DOI: 10.1371/journal.pone.0123479
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    References listed on IDEAS

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    1. Ahmed, Syed Masud & Hossain, Md. Awlad, 2007. "Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: Implications for the HRH problem," Health Policy, Elsevier, vol. 84(2-3), pages 332-343, December.
    2. Paredes, Patricia & de la Peña, Manuela & Flores-Guerra, Enrique & Diaz, Judith & Trostle, James, 1996. "Factors influencing physicians' prescribing behaviour in the treatment of childhood diarrhoea: Knowledge may not be the clue," Social Science & Medicine, Elsevier, vol. 42(8), pages 1141-1153, April.
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