Despite the availability of a cost-effective solution for treating diarrhea in children, a recent analysis has revealed that too few children are receiving the necessary treatment. The study suggests that misconceptions among healthcare providers may be contributing to this crisis. Diarrhea is the second-leading cause of death among children under 5 globally, with approximately 1,200 children dying every day due to diarrheal disease in 2021, according to UNICEF. Oral rehydration salts (ORS), a glucose and electrolyte solution that prevents dehydration, is the recommended treatment for diarrhea in children and is listed as an essential medicine by the World Health Organization (WHO). However, the study published in the journal Science indicates that misconceptions among providers are leading to underprescription of this inexpensive cure. This issue is particularly prevalent in South Asia and sub-Saharan Africa, and children in wealthier urban areas are more likely to receive treatment compared to their counterparts in poorer rural areas.
To investigate this problem further, researchers conducted a study involving 2,282 healthcare providers in two regions of India: Karnataka, which has above-average per capita income and higher ORS usage, and Bihar, which has high poverty rates and below-average ORS usage. The researchers recruited and trained actors to visit these providers and seek care for a 2-year-old child with rotavirus-related diarrhea lasting two days. The standard of care for such cases would typically involve prescribing ORS rather than antibiotics or other medications. During the visits, some actors expressed a preference for ORS, while others expressed a preference for antibiotics or stated no preference at all. To ensure that financial incentives did not influence the providers to prescribe more expensive treatments, the actors informed them that they would purchase medication from a different pharmacy.
The study findings revealed that patients who expressed a preference for ORS increased the prescription rates by 27 percent. Surprisingly, many providers who did not prescribe ORS assumed that patients did not want it, accounting for 42 percent of underprescription. This highlights the importance of addressing misconceptions among healthcare providers to improve prescription rates. Interestingly, eliminating financial incentives led to higher ORS prescription rates at pharmacies but not at clinics. Additionally, attempts to ensure that clinics had on-site stocks of ORS only resulted in a slight increase in dispensing.
Based on these findings, the researchers suggest implementing interventions that target healthcare providers and encourage patients and caretakers to request ORS for diarrhea treatment. Improving prescription rates could not only save children’s lives but also help reduce the over-prescription of antibiotics, which is contributing to antibiotic resistance in diarrhea cases worldwide.
In conclusion, the low prescription rates of oral rehydration salts for diarrhea in children are linked to provider misconceptions, as revealed by a recent study. Diarrhea remains a significant cause of death among children under 5 globally, and ORS is a cost-effective and essential treatment. However, misconceptions among healthcare providers, particularly in South Asia and sub-Saharan Africa, contribute to the underprescription of this life-saving remedy. The study emphasizes the need to address these misconceptions and implement interventions that target both providers and patients to increase ORS prescription rates. By doing so, not only can children’s lives be saved, but the overuse of antibiotics can also be reduced, mitigating the growing problem of antibiotic resistance in diarrhea cases worldwide.
