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 |
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United States
Public Library of Science
22.06.2015
Public Library of Science (PLoS) |
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| ISSN: | 1932-6203, 1932-6203 |
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| Abstract | 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. |
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| AbstractList | 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. Introduction 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. Methods 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. Results 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. Conclusions 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. 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. Introduction 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. Methods 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. Results 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. Conclusions 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. INTRODUCTIONPrograms 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.METHODSWe 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.RESULTSThere 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.CONCLUSIONSTo 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. |
| Audience | Academic |
| Author | Fischer Walker, Christa L. Taneja, Sunita Lamberti, Laura M. Mazumder, Sarmila Black, Robert E. |
| AuthorAffiliation | 1 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America Johns Hopkins Bloomberg School of Public Health, UNITED STATES 2 Center for Health Research and Development, Society for Applied Studies, New Delhi, India |
| AuthorAffiliation_xml | – name: Johns Hopkins Bloomberg School of Public Health, UNITED STATES – name: 1 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America – name: 2 Center for Health Research and Development, Society for Applied Studies, New Delhi, India |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26098305$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1016_j_cegh_2022_100998 crossref_primary_10_29392_001c_12252 crossref_primary_10_1186_s12961_019_0427_0 crossref_primary_10_1371_journal_pone_0307657 crossref_primary_10_4103_ijcm_ijcm_782_22 crossref_primary_10_1186_s12889_021_12279_2 crossref_primary_10_1371_journal_pone_0247772 crossref_primary_10_1111_tmi_13365 crossref_primary_10_1097_QCO_0000000000000261 |
| Cites_doi | 10.1016/S0140-6736(12)60560-1 10.1007/s10728-007-0060-x 10.1016/S0140-6736(98)03010-4 10.1016/j.nut.2013.05.014 10.1371/journal.pone.0074882 10.1093/heapol/czl029 10.1111/j.0006-341X.2000.00645.x |
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| Copyright | COPYRIGHT 2015 Public Library of Science 2015 Lamberti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2015 Lamberti et al 2015 Lamberti et al |
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| Notes | 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. |
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| References_xml | – volume: 379 start-page: 2151 issue: 9832 year: 2012 ident: ref2 article-title: Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000 publication-title: Lancet doi: 10.1016/S0140-6736(12)60560-1 – ident: ref4 – volume: 15 start-page: 223 issue: 3 year: 2007 ident: ref7 article-title: Inequity in health care delivery in India: the problem of rural medical practitioners publication-title: Health Care Anal doi: 10.1007/s10728-007-0060-x – year: 2007 ident: ref9 article-title: A Parallel Health Care Market: Rural Medical Practitioners in West Bengal, India – year: 2014 ident: ref1 article-title: Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis publication-title: The Lancet – volume: 44 start-page: 380 year: 2007 ident: ref3 article-title: IAP Guidelines 2006 on management of acute diarrhea publication-title: Indian Pediatr – year: 2011 ident: ref8 article-title: Unregulated but Unfree Market Relations: Ambivalent Views from Informal Providers in Rural South India publication-title: Presentation – volume: 351 start-page: 1265 issue: 9111 year: 1998 ident: ref5 article-title: Country profile: India publication-title: Lancet doi: 10.1016/S0140-6736(98)03010-4 – volume: 29 start-page: 1368 issue: 11–12 year: 2013 ident: ref10 article-title: The use of oral rehydration salt in managing children under 5 y old with diarrhea in the Gambia: Knowledge, attitude, and practice publication-title: Nutrition doi: 10.1016/j.nut.2013.05.014 – volume: 8 start-page: e74882 issue: 10 year: 2013 ident: ref11 article-title: Improving Pharmacy Staff Knowledge and Practice on Childhood Diarrhea Management in Vietnam: Are Educational Interventions Effective? publication-title: PLoS One doi: 10.1371/journal.pone.0074882 – year: 2007 ident: ref6 article-title: National Family Health Survey (NFHS-3), 2005–06, India: Key Findings – year: 1933 ident: ref16 article-title: The human problems of an industrial civilization – year: 2005 ident: ref15 article-title: The use of discrete data in PCA: Theory, simulations, and applications to socioeconomic indices – ident: ref12 – volume: 21 start-page: 459 issue: 6 year: 2006 ident: ref13 article-title: Constructing socio-economic status indices: how to use principal components analysis publication-title: Health Policy Plan doi: 10.1093/heapol/czl029 – volume: 56 start-page: 645 issue: 2 year: 2000 ident: ref14 article-title: A note on robust variance estimation for cluster-correlated data publication-title: Biometrics doi: 10.1111/j.0006-341X.2000.00645.x – reference: 17922199 - Health Care Anal. 2007 Sep;15(3):223-33 – reference: 17030551 - Health Policy Plan. 2006 Nov;21(6):459-68 – reference: 9643763 - Lancet. 1998 Apr 25;351(9111):1265-75 – reference: 22579125 - Lancet. 2012 Jun 9;379(9832):2151-61 – reference: 24103515 - Nutrition. 2013 Nov-Dec;29(11-12):1368-73 – reference: 17536143 - Indian Pediatr. 2007 May;44(5):380-9 – reference: 10877330 - Biometrics. 2000 Jun;56(2):645-6 – reference: 25280870 - Lancet. 2015 Jan 31;385(9966):430-40 – reference: 24098355 - PLoS One. 2013;8(10):e74882 |
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| SubjectTerms | 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 |
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| Title | 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 |
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