Fig: GIS map of Ujjain city showing the participating pharmacies and hospitals

Adherence to Treatment Guidelines for Acute Diarrhoea in Children up to 12 Years in Ujjain, India*

Ashish Pathak(1,2) , Deepali Pathak (1,3), Gaetano Marrone(1), Vishal Diwan(1,4), and Cecilia Stålsby Lundborg(1)

1. IHCAR, Division of Global Health, Karolinska Institutet, Sweden, India;

2. Department of Paediatrics, R.D. Gardi Medical College, Ujjain, India;

3. Grasim Trust‘s G.D. Birla Memorial Hospital, Ujjain, India;

4. Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India

E-mail: ashish.pathak@.ki.se

Policy implications and conclusions:

Low adherence to treatment guidelines, low use of zinc and the high use of antibiotics

To improve case management of acute diarrhoea, continuing professional development targeting practitioners of all systems of medicine is

necessary.

IntroductionIn India, diarrhoea accounts for 20% of all

paediatric deaths

WHO recommendations, the Indian Academy of

Paediatrics, and the Government of India treatment

guidelines are in place, but adherence to these

guidelines is not analyzed

Objective: To analyze prescriptions for adherence to

treatment guidelines

Results: Information was collected from 843 diarrhoea

prescriptions.

Only 6 prescriptions adhered with the recommended treatment

(ORS along with zinc) with no additional probiotics, antibiotics,

racecadotril, or antiemetics (except Domperidone for vomiting)

ORS alone was prescribed to 58% and ORS with zinc to 22%

Antibiotics were prescribed in 71% of prescriptions. Broad-

spectrum antibiotics were prescribed in illogical fixed-dose

combinations, such as ofloxacin with ornidazole (22% of antibiotics

prescribed).

Practitioners from alternate systems of medicine and IHPs were

significantly less likely (OR 0.13, 95% CI 0.04-0.46, P = 0.003) to

prescribe ORS and zinc than pediatricians

Practitioners from free hospitals were more likely to prescribe

ORS and zinc (OR 4.94, 95% CI 2.45-9.96, P < 0.001) and less

likely to prescribe antibiotics (OR 0.01, 95% CI 0.01-0-04, P <

0.001) compared to practitioners from other hospitals

Accompanying symptoms (fever, pain, blood in the stool, and

vomiting) significantly increased antibiotic prescribing.

*Published in:

BMC Infect Dis. 2011 Jan 28;11:32. PubMed PMID: 21276243

Funding: Swedish Research Council

Scholarship: Erasmus Mundus Lot 15 India to 1st, 2nd and 4th authors

Travel Grant: Axel Hirsch´s travel fund, Karolinska Institutet to Ashish Pathak

Fig: ORT in a child