Children Health

Many children don’t get cheap, effective treatment for diarrhea

Despite the wide availability of a cheap, effective remedy for potentially fatal diarrheal disease, too few children receive the treatment, according to an analysis that suggests provider misconceptions may be driving the crisis.

Diarrhea is the second-leading cause of death among children under 5 worldwide, according to the World Health Organization. UNICEF estimated that about 9 percent of all deaths of young children worldwide — about 1,200 children under 5 every day — occurred because of diarrheal disease in 2021.

Oral rehydration salts (ORS), a solution of glucose and electrolytes that prevents dehydration, is the front-line treatment for diarrhea in kids and is on the WHO List of Essential Medicines. But the study, published in the journal Science, suggests that misconceptions among providers lead physicians to underprescribe the inexpensive cure.

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

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

The usual standard of care for such a case would be oral rehydration salts, rather than antibiotics or other medications. Some of the actors expressed a preference for oral rehydration salts, while others expressed a preference for antibiotics or said they had no preference. To reduce the chances that financial incentives could push providers to prescribe costlier treatments, the actors told the providers they would purchase medication from a pharmacy elsewhere.

Overall, the patients who expressed a preference for oral rehydration salts increased ORS prescription rates by 27 percent. Many providers who didn’t prescribe ORS assumed patients didn’t want them, with that misperception accounting for 42 percent of underprescription, the study said.

Eliminating financial incentives drove up the likelihood of ORS prescriptions at pharmacies but not at clinics. Attempts to make sure clinics had on-site ORS stocks only led to a small increase in dispensing, the research revealed.

The researchers suggested pursuing interventions that target providers and encourage patients and caretakers to request ORS for diarrhea. Better prescription rates could save children’s lives, but the researchers noted another potential benefit: reducing over-prescription of antibiotics, which is leading to antibiotic resistance to diarrhea worldwide.

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