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Pharmacy approach to a case of acute diarrhoea with dehydration in Antalya, Turkey
M Aktekin1, C Erozgen, L Donmez
1Faculty of Medicine, Department of Public Health, Akdeniz University, Antalya, Turkey.
Insights
Pharmacies in Antalya, Turkey, frequently provided inappropriate advice for childhood diarrhea. Most pharmacy attendants failed to assess dehydration or differential diagnosis, often dispensing medication or incorrect advice, potentially harming children.
Area of Science:
- Pediatrics
- Pharmacy Practice
- Public Health
Background:
- Diarrheal diseases remain a significant cause of childhood morbidity and mortality globally.
- Inappropriate management of childhood diarrhea can lead to severe complications, including dehydration and increased mortality.
- Community pharmacies play a crucial role in primary healthcare, but their practices in managing pediatric conditions require evaluation.
Purpose of the Study:
- To assess the pharmaceutical approach to managing acute diarrhea in infants in Antalya, Turkey.
- To evaluate whether pharmacy attendants appropriately diagnose, recommend treatment, or refer cases of childhood diarrhea.
- To identify potential risks associated with pharmacy-based management of pediatric diarrheal diseases.
Main Methods:
- A simulated case of a 10-month-old infant with acute diarrhea and moderate dehydration was presented to 214 pharmacies in Antalya.
- Medical students, posing as relatives, sought advice from pharmacy attendants regarding the hypothetical case.
- The responses, including questions asked, treatments recommended, and advice given, were systematically recorded and analyzed.
Main Results:
- A majority of pharmacy attendants (57.7%) did not inquire about differential diagnosis or dehydration severity.
- Inappropriate recommendations were common: 44.4% dispensed medication only, 67.2% dispensed antidiarrheals, and 14% dispensed antibiotics.
- Only 21.6% advised consulting a doctor or health center; some advised reducing fluid intake or stopping breastfeeding.
Conclusions:
- Pharmacy practices in managing childhood diarrhea in Antalya were largely inappropriate and potentially harmful.
- There is a critical need for improved training and guidelines for pharmacy attendants on pediatric diarrheal disease management.
- Interventions are required to ensure appropriate patient counseling, correct diagnosis, and timely referral to healthcare professionals.
Abstract:
A study examining the approach of pharmacies to diarrhoeal disease in childhood was carried out in Antalya, Turkey. A fictitious case history of a 10 month infant with an acute diarrhoea of three days duration, which was clinically identical with viral diarrhoea and accompanied by moderate dehydration was hypothesised. Following this, final semester students of the medical faculty posed as relatives of the infant and sought the advice of pharmacy attendants. The approach, to this hypothesised case, of all 214 pharmacies in the Antalya municipality district was examined. Most of the pharmacy attendants (57.7%) did not ask any questions to determine a differential diagnosis or establish the degree of dehydration. Only 21.6% of the pharmacy attendants recommended consulting a doctor or health centre, 6.5% recommended Oral Rehydration Solution (ORS) without giving an explanation about the amount needed or for how long it should be administered, 44.4% only dispensed a drug, 23.8% dispensed a drug with ORS and 3.7% recommended infant formula. Antidiarrhoeals were dispensed by 67.2% of the pharmacies and 14% gave antibiotics. Also 5.6% of the pharmacy attendants advised a reduction in the infant's fluid intake, 17.3% said that they could not give an opinion regarding breast feeding 19.2% advised stopping breast feeding and 7.0% did not know. All the pharmacies except the ones with the appropriate recommendation 'consult a doctor or a health centre' responded with advice given without hesitation although they did not intend to inspect or examine the infant. The approaches for acute diarrhoea of the pharmacies were determined as inappropriate and harmful.