Many children do not have access to effective and cheap treatment for diarrhea

Many children do not have access to effective and cheap treatment for diarrhea

Although effective and inexpensive treatment for the deadly diarrheal disease is widely available, too few children are receiving treatment, according to an analysis that suggests misconceptions among providers may be driving the crisis.

Diarrhea is the second leading cause of death among children under five years of age worldwide, according to the World Health Organization. UNICEF estimated that about 9% of all deaths of young children worldwide – about 1,200 children under the age of five every day – were caused by diarrheal diseases in 2021.

Oral rehydration salts (ORS), a solution of glucose and electrolytes that prevents dehydration, are a front-line treatment for diarrhea in children and are on the World Health Organization’s list of essential medicines. But the study, published in the journal Science, suggests that misconceptions among providers are leading doctors to underprescribe the inexpensive treatment.

The problem is particularly acute in South Asia and sub-Saharan Africa, where children in wealthier urban areas are more likely to receive treatment than their counterparts in poor and rural areas.

The researchers studied ORS prescription among 2,282 providers in two regions in India: Karnataka, which has above-average per capita income and above-average ORS use; and Bihar, which has high poverty rates and below-average use of oral rehydration salts. They recruited and trained representatives to visit providers, and say they were seeking care for a 2-year-old with rotavirus-related diarrhea for two days.

The usual standard of care for such a condition is oral rehydration salts, rather than antibiotics or other medications. Some representatives expressed a preference for ORS, while others expressed a preference for antibiotics or said they did not. To reduce the chances that financial incentives would prompt providers to prescribe more expensive treatments, representatives told providers that they would purchase the drugs from a pharmacy elsewhere.

Overall, patients who expressed a preference for ORS increased their ORS prescription rates by 27 percent. Many providers who did not prescribe ORS assumed that patients did not want them, and this misperception accounted for 42% of the prescription shortage, the study said.

Eliminating financial incentives increased the likelihood of ORS prescriptions being filled in pharmacies but not in clinics. The research revealed that attempts to ensure that clinics had a stock of ORS on site only resulted in a slight increase in medication dispensing.

The researchers suggested pursuing interventions that target providers and encourage patients and caregivers to request oral rehydration salts to treat diarrhea. Improving prescription rates could save children’s lives, but researchers note another potential benefit: reducing antibiotic overprescription, which drives antibiotic-resistant diarrhea worldwide.

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