The use of oral rehydration solutions, an effective, safe and inexpensive remedy for childhood diarrhea, is still low worldwide. Complications caused by the condition, which could be avoided with the use of medication, lead to half a million children dying every year, according to the WHO (World Health Organization).
To try to understand why prescriptions for solutions are low around the world, researchers from USC (Southeastern California University) conducted a study in India to identify the main reasons that lead to low adherence, especially in low-income countries, which concentrate cases of hospitalization and death from childhood diarrhea.
According to the authors, there are three main causes: the wrong perception of health professionals and care providers that parents have a preference for other treatments, such as antibiotics and vaccination (42%); lack of product stock in clinics (6%) and financial issues (5%).
“It’s a cheap and effective treatment, but even though it’s available, many doctors or healthcare professionals don’t prescribe it, and as a result, children are dying. What we discovered, surprisingly, is that what matters most is what the doctors think patients want it or not,” says Neeraj Sood, lead author of the study and researcher at USC.
The solution is available as a powder, must be diluted in water and taken in small sips throughout the day or at two-hour intervals, explains the researcher. One reason caregivers do not express their desire to receive the oral solution is fear of challenging a doctor or provider’s opinion, or because they do not feel comfortable.
“When you actually ask the parent or caregiver openly if they believe it is a good option, most patients agree with that statement,” says Sood.
Doctors estimate that, overall, 18% of parents and caregivers prefer oral solutions as a treatment for diarrhea in children up to five years of age. An even lower rate, 16%, refers to parents and caregivers who express a desire for the oral solution. When asked about their preferences, however, this figure goes to 48%.
About 9 in 10 (86%) healthcare professionals say that oral rehydration solutions are the most effective method of treatment for diarrhea and would prescribe them more frequently.
The study was published last Thursday (8) in the journal Science.
Childhood diarrhea can be caused by different pathogens, but around a third (33.5%) has rotavirus as its main etiological agent, a type of virus with common circulation and high contagion, especially in school environments. The main form of prevention is vaccination before the first six months of life.
A Sheetthe study’s corresponding author, Zachary Wagner, a researcher in the department of Economics, Sociology and Statistics at the Rand Corporation in Santa Monica, says that the research, conducted in some municipalities in India, can be extrapolated to other low- and middle-income locations with a high burden of the disease, provided that some observations are made.
“Although the situation in other countries with a high burden of childhood diarrhea is similar, the reasons that lead to the low use of oral solutions are not the same, as there may be other factors, such as greater assistance in the public service than in the private sector. [cerca de três quartos dos atendimentos de crianças com diarreia na Índia são em consultórios particulares]. Therefore, we hope that our results can be extrapolated to other contexts, [mas] with caution,” he said.
Finally, the authors conclude that as it is a solution that has been on the market for over 40 years and is low-cost, both for production and sale, it is important to reinforce the role of professionals in prescribing effective treatments.
“Sometimes providers will seek to prescribe a more expensive and ineffective medication, such as antibiotics for diarrhea caused by viruses,” they add.