Assessment of prescription pattern of under-five diarrhea cases in Western Odisha
Manasee Panda1, Sushree Priyadarsini Satapathy1, Pradip Kumar Bhue1
1Department of Community Medicine, Bhima Bhoi Medical College and Hospital, Balangir, Odisha, India.
Insights
Healthcare providers often over-prescribe medications for childhood diarrhea, failing to document key details. Improving prescription quality is essential for better child health outcomes and adherence to treatment protocols.
Area of Science:
- Pediatrics
- Public Health
- Pharmacology
Background:
- Diarrhea is a leading cause of mortality in children under five globally.
- Effective prescription practices are crucial for managing childhood diarrhea and preventing deaths.
- Adherence to established treatment protocols ensures optimal patient care and resource utilization.
Purpose of the Study:
- To assess the prescription patterns for under-five diarrhea cases in Odisha's aspirational districts.
- To identify factors contributing to nonadherence to established prescription protocols.
- To evaluate the quality of medical prescriptions for pediatric diarrhea management.
Main Methods:
- A cross-sectional study utilizing mixed methods was conducted in health facilities across two aspirational districts in Odisha.
- Data collection involved in-depth interviews with doctors and pharmacists, and a review of secondary data from various health records.
- Prescriptions from secondary- and tertiary-level health institutions and primary health centers were analyzed.
Main Results:
- Prescriptions frequently lacked essential details like illness duration and dehydration status.
- A majority of prescriptions (67.3%) included 2-4 medications, with 17.5% including more than four.
- While Oral Rehydration Salts (ORS) and zinc were commonly prescribed, healthcare providers often prescribed more medicines than necessary, indicating a gap in protocol adherence and knowledge of management plans.
Conclusions:
- Prescriptions for under-five diarrhea cases require improvement, including documentation of examination findings, child's weight, comorbidities, and feeding advice.
- Healthcare providers' tendency to over-prescribe suggests a need for enhanced training on diarrhea management protocols.
- Strengthening prescription review mechanisms is vital for improving the quality of care for childhood diarrhea.
Introduction:
Diarrhea is the second leading cause of death among under-five children. Prescription review by the authorities of the health facilities every month for the improvement of the quality of prescription writing of Medical practitioners is very essentials. With this background, the present study was conducted to assess the prescription patterns of healthcare providers for under-five diarrhea cases and to study the factors responsible for nonadherence to protocol of prescription patterns.
Methodology:
This cross-sectional study was conducted in the health facilities of two aspirational districts of Odisha. All secondary- and tertiary-level health institutions with 2-3 randomly selected PHCs of that blocks of the two districts were the study units. Mixed methods were used for data collection. Primary data were collected by in-depth interview of doctor and pharmacist. Secondary data were collected by review of records such as OPD ticket, IPD ticket, OPD register, dispensing register, and stock registers.
Results:
Of the 64 health facilities visited, a total of 516 prescriptions [217 (42%)] scanned/carbon copy of OPD ticket, 238 (46%) data from register on drug prescription, and 61 (11.8%) IPD record data were collected. Duration of diarrhea illness was not mentioned in any of the prescriptions which is important criteria for classifying the type of diarrhea and treatment. Signs of dehydration and degree of dehydration were mentioned in very few prescriptions of both the district. For the treatment of diarrhea cases, 2 to 4 medicines were prescribed in majority of 146 (67.3%), followed by more than four medicines in 38 (17.5%) prescriptions, and less than two medicines were prescribed in 33 (15.2%) cases. All prescriptions from MCH and SDH had ORS and zinc. Though all of them knew about the management protocol as per IMNCI, to be on the safe onside they used to prescribe more medicines to under-five diarrhea cases. None had the knowledge on five types of management plan.
Conclusion:
For under-five diarrhea cases, care should be taken to write the detail examination finding, weight of the child, associated comorbid condition, and advice on feeding in the prescription.
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