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Diarrhea training and treatment unit: experience from a teaching hospital
A K Patwari1, H Kumar, V K Anand
1Diarrhea Training and Treatment Centre, Kalawati Saran Children's Hospital, New Delhi.
Insights
Establishing a Diarrhea Training and Treatment Unit (DTU) reduced hospital admissions by 13%. Effective home management with oral rehydration solution (ORS) significantly cut costs and antibiotic use in pediatric diarrhea cases.
Area of Science:
- Pediatrics
- Public Health
- Infectious Diseases
Background:
- Diarrhea remains a leading cause of childhood mortality globally.
- Effective case management protocols are crucial for reducing morbidity and mortality.
- The establishment of specialized units can improve diarrhea care delivery.
Purpose of the Study:
- To evaluate the impact of a Diarrhea Training and Treatment Unit (DTU) on pediatric diarrhea case management.
- To assess changes in hospital admissions, treatment protocols, and healthcare costs.
- To determine the effectiveness of oral rehydration solution (ORS) in managing dehydration and associated symptoms.
Main Methods:
- A prospective study evaluating one year of experience at a DTU in Kalawati Saran Children's Hospital, New Delhi.
- Analysis of hospital admission rates, patient management strategies (home management, ORT area, intravenous fluids), and rehydration success rates.
- Assessment of treatment costs, including rehydration, drug therapy (antibiotics, antiemetics), and duration of hospital stay.
Main Results:
- Hospital admissions for diarrhea decreased by 13% post-DTU establishment.
- 69.5% of cases were managed with home fluids/ORS after maternal education.
- 81.2% of dehydrated patients received ORS, with successful oral rehydration in over 85% of cases with vomiting.
- Average cost per patient reduced from Rs. 31.69 to Rs. 18.54.
- Drug expenditure per patient decreased from Rs. 17.60 to Rs. 4.92 due to rationalized therapy.
Conclusions:
- The DTU model significantly improved pediatric diarrhea case management, reducing hospitalizations and healthcare costs.
- Emphasis on home-based management with ORS and early feeding is effective and cost-efficient.
- Rationalized drug therapy, including reduced antibiotic and antiemetic use, further contributed to cost savings and improved patient outcomes.
Abstract:
Case management of children with diarrhea has been evaluated after the establishment of a Diarrhea Training and Treatment Unit (DTU) in Kalawati Saran Children's Hospital, New Delhi. Our one year experience has shown a decrease in hospital admissions on account of diarrhea by 13%. With the help of proper treatment protocol, 69.5% of total cases have been managed with home available fluids/ORS after educating the mothers on home management of diarrhea. Majority of admitted cases (80.7%) were managed in the ORT area and rehydrated under proper monitoring and supervision between 3-8 hours (mean duration of stay 4.28 +/- 1.8 hours). Out of 1951 cases with dehydration, 1585 patients (81.2%) were rehydrated with ORS and only 366 cases (18.8%) received intravenous fluids. In more than 85% of cases with associated vomiting, successful oral rehydration was achieved with ORS. Use of ORS and early feeding even in those patients who initially received intravenous fluids for rehydration significantly reduced the average duration of stay in the diarrhea ward (P = less than 0.001). During the first year of its inception the average cost of rehydrating one patient of diarrhea in the DTU came down to Rs. 18.54 from Rs. 31.69 in the preceding year. Rationalising drug therapy in the case management helped to significantly reduce the consumption of antibiotics (P = less than 0.001) and antiemetics (P = less than 0.001), which has helped to reduce the expenditure on drugs on an average from Rs. 17.60 to Rs. 4.92 per patient.