The Association between Provider Practice and Knowledge of ORS and Zinc Supplementation for the Treatment of Childhood Diarrhea in Bihar, Gujarat and Uttar Pradesh, India: A Multi-Site Cross-Sectional Study

Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice. A diarrhea managemen...

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Vydané v:	PloS one Ročník 10; číslo 6; s. e0130845
Hlavní autori:	Lamberti, Laura M., Fischer Walker, Christa L., Taneja, Sunita, Mazumder, Sarmila, Black, Robert E.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Public Library of Science 22.06.2015 Public Library of Science (PLoS)
Predmet:	Care and treatment Child mortality Child, Preschool Childhood Childhood diarrhea Children Children & youth Cross-sectional studies Diarrhea Diarrhea - drug therapy Diarrhea - epidemiology Dietary supplements Fluid Therapy - methods Gastrointestinal agents Health Knowledge, Attitudes, Practice Humans India - epidemiology Knowledge Medical personnel Medical research Pharmacy Principal Component Analysis Principal components analysis Private sector Program Evaluation Public health Public Health Practice - standards Public sector R&D Regression Analysis Rehydration Research & development Rural areas Salts Supply chains Surveys and Questionnaires Training Workers Zinc Zinc (Nutrient) Zinc - administration & dosage Zinc - therapeutic use India Vietnam Uttar Pradesh India United States > US Gambia Bihar India Gujarat India Maryland Baltimore Maryland
ISSN:	1932-6203, 1932-6203
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Shrnutí:	Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice. A diarrhea management program implemented in Bihar, Gujarat and Uttar Pradesh, India trained private sector rural medical practitioners (RMPs) and public sector Accredited Social Health Activists (ASHAs) and Anganwadi workers (AWWs) in adequate treatment of childhood diarrhea with oral rehydration salts (ORS) and zinc. We used cross-sectional program evaluation data to determine the association between observed diarrhea treatment practices and reported knowledge of ORS and zinc among each provider cadre. We conducted principal components analysis on providers' responses to diarrhea treatment questions in order to generate a novel scale assessing ORS/zinc knowledge. We subsequently regressed a binary indicator of whether ORS/zinc was prescribed during direct observation onto the resulting knowledge scores, controlling for other relevant knowledge predictors. There was a positive association between ORS/zinc knowledge score and prescribing ORS and zinc to young children with diarrhea among private sector RMPs (aOR: 2.32; 95% CI: 1.29-4.17) and public sector ASHAs and AWWs (aOR 2.48; 95% CI: 1.90-3.24). Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector. In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing. To enhance the management of childhood diarrhea in India, programmatic activities should center on increasing knowledge of ORS and zinc among public and private sector providers through biannual trainings but should also focus on ensuring sustained access to an adequate supply chain.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Conceived and designed the experiments: LML CFW ST SM REB. Performed the experiments: LML CFW ST SM REB. Analyzed the data: LML. Wrote the paper: LML CFW ST SM REB.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0130845