Treatment by untrained providers among sick infants in rural Odisha, India

This study assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants.

In rural India, lack of trained providers causes inopportune treatment of sick infants and results in increase in child morbidity and mortality. The untrained providers deliver a significant proportion of health care for rural infants; however, there is a paucity of information on their treatment practice.

A cross-sectional study was conducted in three rural blocks of Odisha. A total of 337 prescriptions recommended for sick infants were collected from the 15 untrained providers using pre-designed prescription form - designed as per the Integrated Management of Neonatal and Childhood Illness (IMNCI) guideline. The forms were collected through the periodic visit and regular follow-up to the providers.

A total of 68% of infants were diagnosed with the possible serious bacterial infection, 56% fever, 10% feeding problems, 9% dysentery and 9% local bacterial infection. A total of 61% of sick infants prescribed antibiotics - cephalosporin was commonly prescribed (56%). Among severe persistent diarrhea-diagnosed infants, 76% prescribed oral rehydration salt (ORS), 48% zinc and 62% of them received various antibiotics. The untrained providers referred 23% of sick infants to trained providers/facilities. In rural settings, most of the sick infants sought care from untrained providers; however, none of them followed any standard treatment protocol. This study suggests there is a need for training on common disease algorithm and treatment using a standard guideline for untrained providers to reduce inopportuneness in the treatment of sick infants, promoting early diagnosis and referral services to public health systems.