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  1. 1
    Peer Reviewed

    Study to assess the knowledge and health seeking behaviour of mothers of under 5 children in the catchment area of G.M.C., Bhopal.

    Lodha RS; Pal DK; Verma S; Melwani V; Khan A; Sawlani H; Nair AR

    International Journal of Community Medicine and Public Health. 2018 Oct; 5(10):4456-4460.

    Background: Under 5 mortality rate is considered as the best indicator of social development and well being. Low U5MR indicates better social development as children are most vulnerable during the first 5 years. Almost 1/3rd die of infectious cause, nearly all of which are preventable. Methods: A cross- sectional interventional study was done on 105 mothers with children under the age group of 5 years. Knowledge and practice about diarrhoea, pneumonia and immunization was assessed first followed by and educational intervention which was later followed by post intervention interview of the same mothers after a gap of 1 month. The increment in the knowledge was then assessed. Results: 41.9% belonged to the age group of 20-25 years. 94.11% of the mothers knew what diarrhoea is and only 47.61% could tell minimum 3 signs of dehydration. 32.38% could tell the specific signs of pneumonia. 90.47% mothers knew that immunisation prevents children from diseases. The overall knowledge scores improved significantly (p<0.0001) after a gap one month. Conclusions: The knowledge appeared to improve significantly after an education intervention. The immunization coverage was found to be adequate.
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  2. 2
    Peer Reviewed

    Knowledge regarding diarrhoea and its management among mothers of under-five children in an urban area of Amritsar, Punjab.

    Kaur A; Kaur H; Kur H; Devgun P

    International Journal of Community Medicine and Public Health. 2018 Nov; 5(11):4751-4755.

    Background: Diarrhoeal diseases are a leading cause of childhood morbidity and mortality in developing countries, and an important cause of malnutrition. In 2003 an estimated 1.87 million children below 5 years died from diarrhoea. In India nearly 1.5 million under-fives are dying every year only due to acute gastroenteritis. Therefore the present study was conducted to find the knowledge about diarrhoea and its management among the mothers of under-five children. Methods: A total of 400 mothers of under-five children were interviewed. The mothers were selected by adopting simple random sampling method. A pre-designed and pre tested questionnaire was used to collect the information. House to house survey was done to collect the information. Statistical analysis was done by using SPSS 20.0. Results: Majority of the mothers (72.8%) were in age group of 21-30 years. Out of total 53% knew that diarrhoea is passage of three or more loose stool in a day. Education status of mother has significant relation with the knowledge about diarrhoea and its spread (p=.000). 69.5% of the mothers knew that ORS should be given in dehydration. Only 66.3% could tell the correct method of preparing ORS solution. Source of knowledge about ORS for the mothers was mass media (45%), health workers (40.7%), books (29.7%), neighbours (28.2%) and family member (22.2%). Conclusions: The study concludes that there is lack of knowledge among mothers regarding diarrhoea and its management. There is a need of health education for mothers about diarrhoea and its management. IEC activities should be increased to educate the community about the principles of environmental hygiene.
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  3. 3

    Occurrence of diarrhea and utilization of zinc bundled with ORS among caregivers of children less than five years in Addis Ababa, Ethiopia.

    Hassen S; Haidar J; Bogale AL

    Journal of Public Health and Epidemiology. 2018 Sep; 10(9):348-355.

    In response to the high occurrence of diarrhea in Ethiopia, the Federal Ministry of Health employed an effective strategy that included administration of zinc together with oral rehydration salt to treat children suffered diarrhea since 2013. Nonetheless, information on zinc bundled with ORS uptake is limited and thus this study has examined zinc utilization among beneficiaries. A community based cross-sectional study was conducted among 422 households whose under-five- children (U5C) had diarrhea in Akaki sub city from February to March, 2016. Prior to selection of households, participants were identified through health facilities and were traced using their household number. Relevant sociodemographic and other important health information were collected from respective caretakers using a pre-tested structured questionnaire through interview. Data were then entered using Epi Info Version 3.5.4, exported and analyzed using SPSS version 20 software. Both bivariate and multivariate regression analyses were used to identify the factors related to zinc utilization and a p-value below 0.05 was considered as statistically significant. All recruited subjects participated in the study with 100% response rate. Of the 422 participants, 283 (67.1%) caretakers used zinc bundles with ORS when the under-five-child had diarrhea. The majority (82.2%) sought treatment from health centers though their major (80.90%) source for zinc was private pharmacies. Following zinc intake, diarrhea subsided within 1-3 days in most (76.3%) of them. About the same proportion of caretakers recommended the zinc for watery diarrhea and the vast majority (90.5%) were satisfied with zinc supplement. Caregivers' whose child diarrhea stopped were more likely (AOR=10.29; 95% CI=2.52-42.05) to use zinc while those whose child diarrhea stopped after six days (AOR=0.09; 95% CI=0.02-0.45) and had mucoid diarrhea (AOR=0.32; 95% CI=0.10-0.97) were less likely to give their children the zinc than their counterparts. The study thus revealed that slightly over two in three children were given diluted zinc and the major augmenting factors for the zinc bundled with ORS uptake were withholding to administer the full dose, stopping the drug when diarrhea improved and recommending zinc therapy. It is thus essential to consider the above determinants, avail the zinc in the government facilities, improve zinc bundled with ORS intake and ultimately reduce deaths emanating from diarrhea.
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  4. 4

    Hypernatraemic dehydration in infants with acute gastroenteritis at King Edward VIII Hospital, Durban, South Africa.

    Hariram T; Naidoo KL; Ramji S

    South African Journal of Child Health. 2018; 12(1):10-14.

    Background. Acute gastroenteritis (AGE) is a leading cause of infant mortality, with hypernatraemic dehydration contributing to increased morbidity and mortality. Objectives. To determine the prevalence of hypernatraemia secondary to AGE in admitted infants in Durban, South Africa. To describe the feeding choices, nutritional status and outcomes of these patients. To determine the association between admission sodium (Na) level, the rate of Na correction and clinical outcomes Methods. A retrospective chart review was conducted on cases of hypernatraemic dehydration admitted in 2014 to a South African hospital. Serum Na levels were corroborated with National Health Laboratory Services results. Descriptive and analytical statistics were done using Statistical Package for Social Sciences version 22. Results. A 12.3% prevalence of hypernatraemia (n=41/334) was found. The majority of infants were formula-fed (76%) with a 21% incidence of malnutrition and 66% HIV exposure rate in this cohort. A high rate of neurological abnormalities (63%), and a 4.9% case fatality rate was found. Shock on admission was present in 92% of patients who developed severe neurological complications. The mean admission Na was higher in those with severe neurological complications (164.2 v. 158.4 mmol/L, p=0.08). The mean rate of Na change was not faster in those with severe neurological morbidity (0.61 v. 0.91 mmol/L/hr; p=0.1). Conclusion. Hypernatraemic dehydration remains a significant problem in South Africa. High rates of formula feeding may be a contributory factor and the correlation with HIV infection needs investigation. Poor neurological outcomes were noted particularly in those patients presenting with hypernatraemia and shock. Although the mean admission Na level was higher in patients with severe neurological complications, this was not statistically significant in this sample. This study supports the hypotheses that neurological complications in diarrhoea-related hypernatraemia are largely associated with the severity of the dehydration that occurs prior to presentation rather than following rehydration.
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  5. 5
    Peer Reviewed

    Nutritional status, exclusive breastfeeding and management of acute respiratory illness and diarrhea in the first 6 months of life in infants from two regions of Indonesia.

    Oktaria V; Lee KJ; Bines JE; Watts E; Satria CD; Atthobari J; Nirwati H; Kirkwood CD; Soenarto Y; Danchin MH

    BMC Pediatrics. 2017 Dec 21; 17(1):211.

    BACKGROUND: Infant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years. We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants from two regions of Indonesia during the first 6 months of life. METHODS: This study was an observational study conducted in parallel to an immunogenicity and efficacy trial of an oral rotavirus vaccine (RV3-BB) in the Klaten and Yogyakarta regions, Indonesia. Mothers were interviewed at 3 time points: within the first 6 days of their infant's life, and at 8-10 and 22-24 weeks of age. Questions asked included pregnancy history, infant nutritional status, feeding status and health of infants within up to 2 weeks prior to the assessment. RESULTS: Between February 2013 and January 2014, 233 mother-infant pairs were recruited. 60% (136/223) of infants were exclusively breastfed (EBF) until 6 months of age with the strongest support for EBF reported by mothers themselves 70% (101/223) and 25% (36/223) from their partners. At 6 months, 6% (14/223) of infants were underweight and severely underweight; 4% (8/ 223) wasted and severely wasted; and 12% (28/223) were stunted and severely stunted. Non-recommended medication use was high, with 54% (21/39) of infants with reported cough within 2 weeks of an assessment receiving cough medication, 70% (27 /39) an antihistamine, 26% (10/39) a mucolytic and 15% (6 /39) an oral bronchodilator. At age 22-24 week, infants with reported diarrhea within 2 weeks of an assessment had low use of oral rehydration solutions (ORS) (3/21;14%) and zinc therapy (2/ 21;10%). CONCLUSION: In this unique observational study, breastfeeding rates of 60% at 6 months were below the Indonesian national target of >75%. Adherence to WHO guidelines for management of ARI and diarrhea was poor, with high use of non-recommended cough medications and oral bronchodilators in the first 6 months of life and low use of ORS and zinc therapy. Ongoing education of primary health care workers and parents regarding management of common illness is needed in Indonesia.
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  6. 6
    Peer Reviewed

    Community pharmacists’ views of the use of oral rehydration salt in Nigeria.

    Oyetunde O; Williams V

    International Journal of Clinical Pharmacy. 2018; 1-9.

    Background Oral rehydration salt (ORS) is an affordable and effective intervention for the management of acute watery diarrhoea (AWD), especially in children under 5 years. A knowledge/practice gap exists among community pharmacists (CPs) in Lagos, Nigeria, and in many low to middle income countries. This gap results in underutilization of ORS for diarrhoea management. Objective The objective was to explore CPs’ views of the barriers and facilitators to the use of ORS in practice. Setting Community pharmacy practices, Lagos, Nigeria. Methods Qualitative methods were used to explore pharmacists’ views. Recruitment of participants were mainly at zonal meetings. A total of ten CPs participated based on maximum variation and snowballing sampling. Semi-structured interviews conducted covered knowledge, experiences and contextual issues. Interviews were audiorecorded, transcribed and analysed using framework approach to thematic analysis. Main outcome measure Pharmacists’ views of barriers and facilitators to the use of ORS. Results Barriers to the use of ORS include caregivers’ expectation for an antimicrobial, which was often explicitly and specifically for metronidazole. Also, CPs seemed to doubt applicability of ORS alone, therefore, responded to caregivers’ complaints about ORS, by dispensing metronidazole. These barriers appeared to have normalised metronidazole for AWD treatment in this setting. Current facilitators include the caregivers’ improved awareness of ORS and access to primary health centers that often resulted in increased demand for ORS in pharmacies. Conclusion CPs’ views showed that caregivers’ expectations for an antimicrobial may be the main barrier to the use of ORS in their practices. © 2018 Springer International Publishing AG, part of Springer Nature
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  7. 7

    Role of maternal factors in prevention and management of diarrheal diseases in children under the age of 5 years living in Islamabad, Pakistan.

    Maken ZH; Ghazanfar A; Imtiazuddin QI; Wahab A; Malik W; Yasir AB; Mahmood R

    Rawal Medical Journal. 2017 Jul-Sep; 42(3):408-413.

    Objective: To identify knowledge-practice gaps about management of diarrheal diseases and to ascertain the underlying socioeconomic factors contributing to this gap. Methodology: We conducted a cross-sectional study in Pakistan Institute of Medical Sciences, Islamabad from June 2016 to November 2016. Only those mothers whose children had suffered from diarrhea within the past 3 months and were under the age of 5 years were included in the study through systematic random sampling. Data were analyzed in SPSS version 22. Results: The mean age of the children was 2.24±1.49 years. About 37.8% of participants increased water intake and only 12.5% increased dietary intake of their child during diarrhea. Community type was found to be significantly associated with having oral rehydration solution packets at home and knowing where to buy oral rehydration solution. Male children were more likely to be breastfed or given medication during diarrhea. Mothers who tend to seek advice regarding management of diarrheal cases or who knew where to get oral rehydration solution packets were more likely to use some measures to ensure adequate quality of drinking water. Conclusion: There is a lack of maternal knowledge regarding diarrheal management especially in regards to feeding practices during diarrheal episodes. There is a need to introduce and implement plans to increase awareness about diarrheal management.
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  8. 8

    Assessing critical gaps in implementation of WHO and UNICEF'S 7-point diarrhea control and prevention strategy in Uttar Pradesh, India.

    Ali F; Singh OP; Dutta A; Haq ZU; Ghatak A; Ashtankar T

    Annals of Tropical Medicine and Public Health. 2017 May-Jun; 10(3):571-579.

    Context: Diarrhea is one of the leading causes of under-five mortality globally and also in India. In the state of Uttar Pradesh, the prevalence of childhood diarrhea is 12.43% and only around half of the children with diarrhea have access to health-care services. Aims: The aim of this study is to understand the critical gaps at the public health system and community levels for the effective implementation of comprehensive diarrhea control. Settings and Design: This study was conducted in the rural settings and data collection was done at health facility and community levels. Subjects and Methods: A mixed methodology was used to conduct this study. Quantitative data were collected through a household survey with 1350 households in four districts and qualitative data were collected through focused group discussions and in-depth interviews at health facility and community levels. Statistical Analysis Used: SPSS was used for quantitative data analysis. Thematic analysis was performed for qualitative data. Results: Mothers are largely aware of use of oral rehydration solution (ORS) but only a third of the children with diarrhea were treated with ORS. Only a fifth of the mothers knew about the use of zinc and just 7% of children with diarrhea were treated with zinc. Majority of the mothers do not wash their hands with soap at critical times. The use of toilet and safe drinking water were also found minimal. There were challenges related to procurement, supply chain of ORS and zinc and also with respect to health human resource capacity at facility and community level. Conclusions: For comprehensive diarrhea control and prevention, health systems and community-level barriers largely related to supplies, training of staff, and community behavior and practices should be addressed.
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  9. 9

    Dispensing pattern for acute non-infectious diarrhoea in children at community pharmacies in Thailand.

    Jaisue S; Phomtavong S; Eua-Anant S; Borlace GN

    Journal of Pharmacy Practice and Research. 2017 Oct 12; 47(5):383-388.

    Background: In cases of non-infectious diarrhoea in children, the WHO and the Thai Antibiotic Smart Use (ASU) project recommend that no antibiotics should be given and drinking water should be replaced with oral rehydration salt (ORS) solution until the diarrhea is finished. Aim: To survey the dispensing pattern for non-infectious diarrhoea treatment in children in Thailand. Methods: Simulated clients visited 91 Class I community pharmacies in five districts in Khon Kaen province and asked for advice to treat non-infectious diarrhoea in a 14-month-old child. The patient history questions asked by the dispensers, the medications dispensed and non-pharmacological advice given were recorded by the simulated clients immediately after leaving the pharmacy. Results: In this study, ORS solution was correctly dispensed to the simulated clients in only 7.7%; of pharmacies with 68.1%; incorrectly dispensing antibiotics. More than half of the dispensers (57.1%;) did not give any advice regarding non-pharmacological treatment. Conclusion: The results of this study indicate the need to implement a program to emphasise the importance of providing ORS and discourage the dispensing of antibiotics in this circumstance.
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  10. 10
    Peer Reviewed

    Appropriate Management of Acute Diarrhea in Children Among Public and Private Providers in Gujarat, India: A Cross-Sectional Survey.

    Walker CL; Taneja S; LeFevre A; Black RE; Mazumder S

    Global Health: Science and Practice. 2015 May 07; 3(2):230-41.

    Diarrhea remains a leading cause of morbidity and mortality among children under 5 years of age in low- and middle-income countries. In 2006, the Indian government formally endorsed the World Health Organization guidelines that introduced zinc supplementation and low-osmolarity oral rehydration salts (ORS) for the treatment of diarrhea. Despite this, zinc is rarely prescribed and has not been available in the public sector in India until very recently. The Diarrhea Alleviation Through Zinc and ORS Treatment (DAZT) project was implemented in Gujarat between 2011 and 2013 to accelerate the uptake of zinc and ORS among public and private providers in 6 rural districts. As part of an external evaluation of DAZT, we interviewed 619 randomly selected facility- and community-based public and private providers 2-3 months after a 1-day training event had been completed (or, in the case of private providers, after at least 1 drug-detailing visit by a pharmaceutical representative had occurred) and supplies were in place. The purpose of the interviews was to assess providers' knowledge of appropriate treatment for diarrhea in children, reported treatment practices, and availability of drugs in stock. More than 80% of all providers interviewed reported they had received training or a drug-detailing visit on diarrheal treatment in the past 6 months. Most providers in all cadres (range, 68% to 100%) correctly described how to prepare ORS and nearly all (range, 90% to 100%) reported routinely prescribing it to treat diarrhea in children. Reported routine prescription of zinc was lower, ranging from 62% among private providers to 96% among auxiliary nurse-midwives. Among providers who reported ever not recommending zinc (n = 242), the 2 most frequently reported reasons for not doing so were not completely understanding zinc for diarrhea treatment and not having zinc in stock at the time of contact with the patient. In a multiple logistic regression analysis, recent training or drug-detailing visits and having zinc in stock were associated with reported zinc prescribing (P<.05). Recent training among public providers was significantly associated with having correct knowledge of zinc treatment duration and dosage, but the same was not true of drug-detailing visits among private providers. Treating diarrhea with zinc and low-osmolarity ORS is new for public and private providers in India and other low- and middle-income countries. Sufficient training and logistics support to ensure consistent supplies are critical if providers are to begin routinely treating all diarrhea episodes with zinc and ORS.
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  11. 11

    Role of maternal factors in prevention and management of diarrheal diseases in children under the age of 5 years living in Islamabad, Pakistan.

    Maken ZH; Ghazanfar A; Imtiazuddin QI; Wahab A; Malik W; Yasir AB; Mahmood R

    Rawal Medical Journal. 2017 Jul-Sep; 42(3):408-413.

    Objective: To identify knowledge-practice gaps about management of diarrheal diseases and to ascertain the underlying socioeconomic factors contributingtothis gap. Methodology: We conducted a cross-sectional study in Pakistan Institute of Medical Sciences, Islamabad from June 2016 to November 2016. Only those mothers whose children had suffered from diarrhea within the past 3 months and were under the age of 5 years were included inthe study through systematic random sampling. Data were analyzed inSPSS version 22. Results: The mean age of the children was 2.24±1.49 years. About 37.8% of participants increased water intake and only 12.5% increased dietary intake of their child during diarrhea. Community type was found to be significantly associated with having oral rehydration solution packets at home and knowing where to buy oral rehydration solution. Male children were more likely to be breastfed or given medication during diarrhea. Mothers who tend to seek advice regarding management of diarrheal cases or who knew where to get oral rehydration solution packetswere more likely to use some measures to ensure adequate quality of drinking water. Conclusion: There is a lack of maternal knowledge regarding diarrheal management especially in regards to feeding practices during diarrheal episodes. There is a need to introduce and implement plans to increase awareness about diarrheal management.
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  12. 12
    Peer Reviewed

    Modelling the cost of community interventions to reduce child mortality in South Africa using the Lives Saved Tool (LiST).

    Nkonki LL; Chola LL; Tugendhaft AA; Hofman KK

    BMJ Open. 2017 Aug 28; 7(8):e011425.

    OBJECTIVE: To estimate the costs and impact on reducing child mortality of scaling up interventions that can be delivered by community health workers at community level from a provider's perspective. SETTING: In this study, we used the Lives Saved Tool (LiST), a module in the spectrum software. Within the spectrum software, LiST interacts with other modules, the AIDS Impact Module, Family Planning Module and Demography Projections Module (Dem Proj), to model the impact of more than 60 interventions that affect cause-specific mortality. PARTICIPANTS: DemProj Based on National South African Data. INTERVENTIONS: A total of nine interventions namely, breastfeeding promotion, complementary feeding, vitamin supplementation, hand washing with soap, hygienic disposal of children's stools, oral rehydration solution, oral antibiotics for the treatment of pneumonia, therapeutic feeding for wasting and treatment for moderate malnutrition. PRIMARY AND SECONDARY OUTCOME MEASURES: Reducing child mortality. RESULTS: A total of 9 interventions can prevent 8891 deaths by 2030. Hand washing with soap (21%) accounts for the highest number of deaths prevented, followed by therapeutic feeding (19%) and oral rehydration therapy (16%). The top 5 interventions account for 77% of all deaths prevented. At scale, an estimated cost of US$169.5 million (US$3 per capita) per year will be required in community health worker costs. CONCLUSION: The use of community health workers offers enormous opportunities for saving lives. These programmes require appropriate financial investments. Findings from this study show what can be achieved if concerted effort is channelled towards the identified set of life-saving interventions. (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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  13. 13

    Understanding potential uptake of a proposed mHealth program to support caregiver home management of childhood illness in a resource-poor setting: a qualitative evaluation.

    Calderon TA; Martin H; Volpicelli K; Frasso R; Diaz Arroyo EC; Gozzer E; Buttenheim AM

    MHealth. 2017; 3:19.

    BACKGROUND: Extensive uptake of mobile phones offers an unprecedented opportunity to improve global healthcare delivery, especially among underserved populations. Mobile health (mHealth) has been increasingly recognized as a promising approach to addressing challenges in global maternal-child health and may play an important role in accelerating progress towards improved outcomes. However, more evidence guiding development of mHealth interventions is needed. The current study explores factors that may support or hinder adoption and use of a proposed mHealth intervention to improve caregiver home management of common childhood illnesses in order to shape program development. METHODS: Elicitation interviews were conducted with a convenience sample of 25 mothers recruited from a larger cluster-randomized survey sample in the Cono Norte region of Arequipa, Peru. Interview data were analyzed in Spanish to preserve important cultural nuances. RESULTS: Thematic analysis revealed potential facilitators of and barriers to uptake of the proposed mHealth program. Potential facilitators of caregiver participation include opportunity to engage in two-way communication with healthcare providers, development of instrumental and support knowledge to care for sick children, and healthcare challenges faced in a resource-poor community. Potential barriers include preference for in-person healthcare visits, program cost, text messaging abilities, and concern around program legitimacy. CONCLUSIONS: This study underscores the potential for mHealth to improve global healthcare delivery in the area of maternal-child health. It demonstrates that mHealth interventions can meet the needs of vulnerable populations by offering novel approaches to promoting evidence-based care. This in-depth understanding of factors that may influence participation and use of this proposed mHealth program will help shape development of the intervention in this community.
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  14. 14
    Peer Reviewed

    The influence of customer-medicine seller transactional dynamics on childhood diarrhoea management: a qualitative study in Ghana.

    Rosapep L; Sanders E; Banke K

    Health Policy and Planning. 2017 May; 32(4):527-537.

    In 2004, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) jointly revised the recommended treatment for acute pediatric diarrhea to specify supplementing reduced osmolarity oral rehydration salts (ORS) with zinc. In many countries, however, a significant knowledge-practice gap persists in appropriate diarrhea management among private healthcare providers. For example, the United States Agency for International Development (USAID)-funded Strengthening Health Outcomes through the Private Sector (SHOPS) project recently demonstrated that over-the-counter medicine sellers (MS) in Ghana recommended inappropriate diarrhea treatments, despite their demonstrated knowledge of appropriate treatment protocols. To explore and explain these results, we conducted 26 focus groups with MS and their customers using an indirect elicitation approach, presenting simulated drug shop transaction scenarios for each group to analyze and discuss. Through inductive and deductive data analysis, we found that the pattern of customer-MS interactions within the transactional context plays a critical role in shaping dispensing outcomes, not only in diarrhea management but in other contexts as well. MS who engaged and negotiated with their customers were better able to introduce and promote the appropriate diarrhea treatment protocol. Several factors hinder optimal interactions. Although MS in fact serve as frontline medical providers, they lack the perceived status of a clinician. Moreover, the need to maintain their customer base creates a power imbalance that favors accommodating customer requests and discourages educational interaction. Finally, many MS lack a complete understanding of the recommended treatment, limiting their ability to educate and negotiate. These findings have important implications for efforts to position community-level private providers to improve outcomes across a number of health areas; the study recommends three broad approaches related to training design, marketing, and professional linkages. More generally, behavior change initiatives should recognize the potential impact of provider interaction dynamics in facilitating or impeding desired health outcomes.
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  15. 15
    Peer Reviewed

    Low osmolar oral rehydration solution (ORS) for treating diarrhea in children: a systematic review and meta-analysis.

    Rupani MP; Gaonkar NT; Bhatt GS

    Online Journal of Health and Allied Sciences. 2015 Jul-Sep; 14(3):[6] p.

    Context: Standard WHO-ORS reduces dehydration, but does not reduce stool volume and duration of diarrhea. Low osmolar ORS produce maximal water absorption. This meta-analysis was conducted to evaluate the efficacy of low osmolar ORS in comparison to standard WHO-ORS. Evidence acquisition: A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) comparing efficacy of low osmolar ORS and standard WHO-ORS in childhood diarrhea was carried out. RCTs were searched in PubMed, Cochrane CENTRAL, DOAJ, Google Scholar and Google. The data was extracted in Excel and entered in Review Manager 5.3 for calculation of effect sizes. Results: The outcome of stool output was reported in 9 trails. Reduced osmolarity ORS resulted in significantly reduced stool output as compared with standard WHO-ORS (pooled standardized mean difference -0.44, 95% CI -0.72 to -0.15). Information for the outcome of duration of diarrhea was available from 6 trials. The pooled standardized mean difference was -0.21 (95% CI -0.79 to 0.37), suggesting that reduced osmolarity ORS did not have significant effect on the duration of diarrhea as compared to standard WHO-ORS. The outcome of need for intravenous fluid therapy was reported in 8 trials. The meta-analysis revealed that reduced osmolarity ORS when compared to WHO standard ORS was associated with fewer unscheduled intravenous infusions (Odds Ratio 0.62, 95% CI 0.47 to 0.83). The meta-analysis for the outcome of vomiting reported in 5 clinical trials showed that children treated with low osmolar ORS were less likely to vomit than children treated with standard WHO-ORS (Odds Ratio 0.74, 95% CI 0.57 to 0.97). Conclusion: Low osmolar ORS when compared to standard WHO-ORS is associated with reduced stool output, reduction in need for unscheduled intravenous infusion and lesser episodes of vomiting. However, there was no significant difference in duration of diarrhea.
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  16. 16

    Fluid Intake of Pregnant and Breastfeeding Women in Indonesia: A Cross-Sectional Survey with a Seven-Day Fluid Specific Record.

    Bardosono S; Prasmusinto D; Hadiati DR; Purwaka BT; Morin C; Pohan R; Sunardi D; Chandra DN; Guelinckx I

    Nutrients. 2016 Nov 22; 8(11)

    During pregnancy and lactation, the adequate intake (AI) for total water intake is increased. This cross-sectional survey aimed to assess Total Fluid Intake (TFI; sum of drinking water and all other fluids) of 300 pregnant and 300 breastfeeding women in Indonesia. A seven-day fluid specific record was used to assess TFI. Mean TFI of pregnant and breastfeeding women were 2332 +/- 746 mL/day and 2525 +/- 843 mL/day, respectively. No significant difference in TFI between pregnancy trimesters was observed, while TFI of women breastfeeding for 12-24 months postpartum (2427 +/- 955 mL/day) was lower than that of the two other groups (0-5 months: 2607 +/- 754 mL/day; 6-11 months: 2538 +/- 807 mL/day, respectively). Forty-two and 54% of the pregnant and breastfeeding subjects, respectively, did not reach the AI of water from fluids. These AI were actually known by only 14% and 23% of the pregnant and breastfeeding subjects. However, having the knowledge about the AI did not increase the odds of reaching the AI. Concluding that a high proportion of the pregnant and breastfeeding subjects did not reach the AI of water from fluid, it seems pertinent to further assess the fluid intake, as well as their hydration status, in other countries.
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  17. 17

    Management of acute diarrhoea among children aged 6 - 59 months admitted at Juba Teaching Hospital.

    Stephen AJ; Murila FV; Wamalwa D

    South Sudan Medical Journal. 2017 Feb; 10(1):8-12.

    INTRODUCTION: Diarrhoea is a leading cause of mortality and morbidity in children under five worldwide and accounts for 42.9% of under-5 mortality in South Sudan. Clinical outcomes for diarrhoea correlate with the quality of hospital care. METHODOLOGY: The standard WHO/IMCI for assessment of health workers’ performance in the management of illnesses in children under 5years was adapted and used in the study. Questionnaires and interviews were used to collect data on health workers’ knowledge and practice in the management of acute diarrhoea. Descriptive analysis was used to determine the means, frequencies and proportions of the variables. RESULTS: Thirty nine health workers were interviewed and 202 medical records of children admitted with acute diarrhoea between March and June 2014 were examined. The majority (75.74%) of the children were 6-24 months old. Most assessments were incomplete; the commonest sign assessed was sunken eyes (75.12%) and the least assessed was ability to drink/breastfeed (34.32%). Seventy five percent of patients were classified correctly according to WHO guidelines and 61% of health workers administered fluid therapy correctly. Health workers’ knowledge of how to assess the hydration state was poor (below 50%). CONCLUSION: There was inadequate assessment and documentation of the signs and symptoms of dehydration and inappropriate use of rehydration fluid therapy in the children admitted with acute watery diarrhoea. Regular in-house training and feedback and provision of supplies should be given to the clinicians in order to improve the quality of care.
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  18. 18

    Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden.

    Cooke ML; Nel ED; Cotton MF

    South African Journal of Child Health. 2013; 7(3):84-47.

    Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described. Objectives. To document pre-hospital home and primary care management of diarrhoea, and certain risk factors and complications of diarrhoea. Methods. We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital, Parow, Cape Town, between 1 February 2007 and 31 May 2008. Caregivers were interviewed, and demographic, clinical and laboratory variables were collected. Results. We recruited 142 children, median age 8.9 months. A third had moderate malnutrition. Twenty–four (16.9%) were HIV-exposed, with 9 (6.3%) HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed, uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2% stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines. Conclusions. Most caregivers do give ORT, but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition, and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies, prehospital management and nutritional rehabilitation.
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  19. 19
    Peer Reviewed

    Management of childhood diarrhea by healthcare professionals in low income countries: An integrative review.

    Diallo AF; Cong X; Henderson WA; McGrath J

    International Journal of Nursing Studies. 2017 Jan; 66:82-92.

    Background The significant drop in child mortality due to diarrhea has been primarily attributed to the use of oral rehydration solutions, continuous feeding and zinc supplementation. Nevertheless uptake of these interventions have been slow in developing countries and many children suffering from diarrhea are not receiving adequate care according to the World Health Organization recommended guidelines for the clinical management of childhood diarrhea. Objectives The aim of this integrative review is to appraise healthcare professionals’ management of childhood diarrhea in low-income countries. Design Whittemore and Knafl integrative review method was used, in conjunction with the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting observational cohort, case control and cross sectional studies. Method A comprehensive search performed from December 2014 to April 2015 used five databases and focused on observational studies of healthcare professional's management of childhood diarrhea in low-income countries. Results A total of 21 studies were included in the review. Eight studies used a survey design while three used some type of simulated client survey referring to a fictitious case of a child with diarrhea. Retrospective chart reviews were used in one study. Only one study used direct observation of the healthcare professionals during practice and the remaining eight used a combination of research designs. Studies were completed in South East Asia (n = 13), Sub-Saharan Africa (n = 6) and South America (n = 2). Conclusion Studies report that healthcare providers have adequate knowledge of the etiology of diarrhea and the severe signs of dehydration associated with diarrhea. More importantly, regardless of geographical settings and year of study publication, inconsistencies were noted in healthcare professionals’ physical examination, prescription of oral rehydration solutions, antibiotics and other medications as well as education provided to the primary caregivers. Factors other than knowledge about diarrhea were shown to significantly influence prescriptive behaviors of healthcare professionals. This review demonstrates that “knowledge is not enough” to ensure the appropriate use of oral rehydration solutions, zinc and antibiotics by healthcare professionals in the management of childhood diarrhea.
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  20. 20

    Myths, experiences and home managment of childhood diarrhea among nursing mothers in Federal Medical Center Abeokuta, Nigeria.

    Oluwatosin A; Olaogun A; Oluseye O

    Journal of Community Medicine and Primary Health Care. 2015 Sep; 27(2):1-11.

    Background: Diarrhea is a major threat to child survival due to its devastating complication of dehydration. Several home remedies inclusive of oral rehydration therapy have benefited many people. This study assessed nursing mothers' knowledge and experiences of home management of childhood diarrhea. Methodology: Descriptive cross sectional design was adopted and consecutive sampling technique was utilized to select 223 nursing mothers with babies over three months old on the immunization clinic days at Federal Medical Center, Abeokuta. Structured questionnaire was used for data collection. Frequency, percentages and Chi square were utilized for analysis. Results: Most 154(69.1%) of the respondents had good knowledge about diarrhea. However 34.5% indicated that sunken fontanel is not related to diarrhea or dehydration, and that it is the sign of a local disease. While 97(43.5%) also indicated that teething is a major cause of diarrhea. Only 56(25.1%) considered Salt Sugar Solution (SSS) / Oral Rehydration Solution (ORS) as home management. There is significant association between mothers' perception of myths associated with developmental mile stones and mothers' age, occupation and educational level, p< 0.05. Conclusion: Findings of the study have implications for mothers' home management of diarrhea. It is therefore essential for health care providers to educate the mothers on diarrhea with emphasis on early management with ORS/SSS to prevent complications.
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  21. 21

    Assessing the capacity of community health workers on the current management of childhood diarrhea in Jigawa State, Nigeria.

    Abdu HA; Olosunde ZO; Awogbenja MD; Zango AA

    Jos Journal of Medicine. 2013; 7(1):27-31.

    Background: Even though the lives of an estimated three quarters of a million children are being saved each year, over three million children are still dying from readily preventable diarrheal disease and this may partly be due to insufficient knowledge and skills by the healthcare provider to make diagnosis, provide appropriate care and take give major home key messages. Methods: The study was descriptive cross sectional involving all the Primary Health Care centers in six LGAs of Jigawa State in January 2013. Two health workers from each PHC were assessed using a pre-test self-administered questionnaire. Data was analyzed using SPSS 16.0. Results: Among 335 interviewed Community health workers,54.9% were CHOS/CHEWS,22.1% JCHEWS,5.7% nurses and others (EHA, CA etc) made up 17.3%.Correct definition ,types and key messages of diarrhea was known by 50%. In practice 48% would give an antibiotic combination with ORS.30% constituted Salt sugar Solution correctly and about 20% would add zinc tablet as an adjunct therapy. Across individuals educational cadre, there was no statistical difference in knowledge and practices in management of diarrhea except in classification of dehydration (p=0.00) where CHO/CHEWS performed better and composition of Low ORS (p=0.00) were nurses responded better. Conclusion: The identified gap in this study among these healthcare providers in managing childhood diarrhea at the community is a clarion call for immediate action to improve their knowledge and practice capacity at all levels through series or training and continuous retraining.
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  22. 22
    Peer Reviewed

    Oral zinc provision in acute diarrhea.

    Lazzerini M

    Current Opinion in Clinical Nutrition and Metabolic Care. 2016 May; 19(3):239-43.

    PURPOSE OF REVIEW: The clinical management of acute diarrhea is based on the use of oral rehydration salts and appropriate nutrition. In addition, the WHO and The United Nations Children's Fund recommend zinc supplementation for diarrhea in children below 5 years. This article aims at reviewing recent literature on the effects of oral zinc for treating acute diarrhea in children. RECENT FINDINGS: Recent studies confirm that zinc supplementation has a benefit in children below 5 years with acute diarrhea in countries at medium or high risk of zinc deficiency. A few small trials have reported a benefit of zinc in children at low risk of zinc deficiency, with heterogeneity in results. No recent study has explored the effects of zinc in children younger than 6 months, and in this age group previous research refuted any benefit from zinc. SUMMARY: Current literature supports the use of oral zinc in treating diarrhea in children older than 6 months, especially if at risk of zinc deficiency, such as children with poor diets exposed to recurrent gastrointestinal infections. More research is needed to confirm findings in children at low risk of zinc deficiency. Currently there is no evidence that zinc benefits children younger than 6 months.
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  23. 23
    Peer Reviewed

    Summary indices for monitoring universal coverage in maternal and child health care.

    Wehrmeister FC; Restrepo-Mendez MC; Franca GVA; Victora CG; Barros AJD

    Bulletin of the World Health Organization. 2016 Dec 12; 94(12):903-912.

    Objective To compare two summary indicators for monitoring universal coverage of reproductive, maternal, newborn and child health care. Methods Using our experience of the Countdown to 2015 initiative, we describe the characteristics of the composite coverage index (a weighted average of eight preventive and curative interventions along the continuum of care) and co-coverage index (a cumulative count of eight preventive interventions that should be received by all mothers and children). For in-depth analysis and comparisons, we extracted data from 49 demographic and health surveys. We calculated percentage coverage for the two summary indices, and correlated these with each other and with outcome indicators of mortality and undernutrition. We also stratified the summary indicators by wealth quintiles for a subset of nine countries. Findings Data on the component indicators in the required age range were less often available for co-coverage than for the composite coverage index. The composite coverage index and co-coverage with 6+ indicators were strongly correlated (Pearson r = 0.73, P < 0.001). The composite coverage index was more strongly correlated with under-five mortality, neonatal mortality and prevalence of stunting (r = -0.57, -0.68 and -0.46 respectively) than was co-coverage (r = -0.49, -0.43 and -0.33 respectively). Both summary indices provided useful summaries of the degrees of inequality in the countries’ coverage. Adding more indicators did not substantially affect the composite coverage index. Conclusion The composite coverage index, based on the average value of separate coverage indicators, is easy to calculate and could be useful for monitoring progress and inequalities in universal health coverage.
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  24. 24
    Peer Reviewed

    Factors affecting healthcare service utilization of mothers who had children with diarrhea in Ethiopia: evidence from a population based national survey.

    Azage M; Haile D

    Rural and Remote Health. 2015; 15(4):3493.

    INTRODUCTION: Appropriate healthcare-seeking practices of mothers are important to prevent child death. This study aimed to investigate factors associated with mothers' healthcare services utilization for managing childhood diarrhea (CDD) in Ethiopia. METHODS: A secondary data analysis was performed using data from the Ethiopian Demographic and Health Survey 2011. Binary and multivariable logistic regressions were carried out to identify factors associated with mothers' healthcare services utilization for CDD. RESULTS: About 35% (95% confidence interval (CI): 32.67-37.33%) of mothers visited healthcare institutions (HCIs) for CDD. Those mothers with children aged 6-11 months were 2.16 times more likely to use HCIs for CDD (adjusted odds ratio (AOR)=2.16, 95%CI: 1.32-3.53) compared to mothers who had children under 6 months of age. Urban mothers were 1.68 times more likely to use HCIs for CDD compared to rural mothers (AOR=1.68, 95%CI: 1.06-2.67). Those mothers who had information about oral rehydration salts (ORSs) were 2.66 times more likely to use HCIs for CDD compared to those mothers who had no information about ORS (AOR=2.66, 95%CI: 1.93-3.67). Mothers who attended antenatal care were 1.34 times more likely to use HCIs for CDD than mothers who never attended antenatal care (AOR=1.34, 95%CI: 1.04-1.74). Mothers who had postnatal checkups were 1.53 times more likely to use HCIs for CDD compared to mothers who had no postnatal checkups (AOR=1.53, 95%CI: 1.02-2.30). Those mothers who participated in community conversation were 1.67 times more likely to use HCIs for CDD than those mothers who had no information about community conversation (AOR=1.67, 95%CI: 1.15-2.39). CONCLUSIONS: Healthcare services utilization for CDD was found to be poor in Ethiopia. Urban residency, older age of the child, awareness of ORSs, antenatal care attendance, postnatal check and attending community conversation were factors associated with healthcare services utilization for CDD. Interventions to improve mothers' healthcare service utilization for CDD treatment should target rural households. Promotions of appropriate CDD treatment during ANC, postnatal checkup and community conversation are the recommended interventions.
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  25. 25
    Peer Reviewed

    Economic costs to caregivers of diarrhoea treatment among children below 5 in rural Gujarat India: findings from an external evaluation of the DAZT programme.

    Shillcutt SD; LeFevre AE; Fischer Walker CL; Taneja S; Black RE; Mazumder S

    Health Policy and Planning. 2016 Dec 1; 31(10):1411-1422.

    INTRODUCTION: Diarrhoea is a leading cause of mortality among young children in India although few receive the recommended treatment. The diarrhoea alleviation through zinc and oral rehydration salts (ORS) therapy (DAZT) team initiated a programme in Gujarat from 2011 to 2013 to increase coverage of these interventions through public and private providers at scale. This study evaluates the economic impact of diarrhoea to caregivers before and after the introduction of zinc and ORS at scale through the DAZT programme. METHODS: The DAZT programme evaluation took a before-and-after study design using a two-stage clustered cross-sectional survey. Factors associated with the odds of caregivers incurring economic costs and their amounts were evaluated in a two-part modelling approach. RESULTS: The DAZT programme lowered unadjusted economic costs to caregivers of treating a diarrhoeal episode from $4.04 to $2.49 in 2 years. Controlling for covariates, analysis showed no association between the programme and a change in odds of incurring an economic cost but did show an association with a reduction in economic cost of $2.15 (95% confidence interval (CI) $1.20-$3.11) per diarrhoea episode. A more than 4-fold increase in care-seeking from public community health workers, reduction in care-seeking from higher levels of the health system and reduced spending on drugs besides ORS and zinc may explain these results. DISCUSSION: This study found an association between zinc introduction and a reduction in economic burden of diarrhoea treatment to caregivers in underserved rural areas of Gujarat through more efficient patterns of care-seeking and content of care.
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