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Misuse of drugs in acute diarrhoea in under-five children
M B Alam1, F U Ahmed, M E Rahman
1Deptt. of Paediatrics, Chittagong Medical College.
Insights
Drug misuse is prevalent in treating acute diarrhea in Bangladeshi children under five. Inappropriate treatments, including antibiotics, were common, increasing illness duration and necessitating improved prescribing practices.
Area of Science:
- Pediatrics
- Public Health
- Pharmacology
Background:
- Acute diarrhea is a leading cause of under-five mortality globally.
- Inappropriate drug use for pediatric diarrhea can lead to adverse effects and antimicrobial resistance.
- Community-based surveys are crucial for understanding local healthcare practices.
Purpose of the Study:
- To determine the extent of drug misuse in treating acute diarrhea among children under five in Chittagong, Bangladesh.
- To analyze treatment patterns and adherence to World Health Organization (WHO) guidelines.
- To identify factors associated with inappropriate drug prescription.
Main Methods:
- A community-based, thirty-cluster survey involving 360 mothers of children under five with acute diarrhea.
- Data collection on diarrhea type, duration, and treatment received, including consultations and prescribed medications.
- Analysis of treatment appropriateness based on WHO recommendations.
Main Results:
- 94.2% of cases were acute watery diarrhea; 5.8% were dysentery.
- Only 26.7% of acute watery diarrhea cases and 23.8% of dysentery cases received WHO-recommended treatment.
- 73.5% of cases received inappropriate treatment, with metronidazole and antibiotics being commonly prescribed.
- Drug use was associated with a significantly increased duration of acute watery diarrhea.
Conclusions:
- High prevalence of drug misuse in treating acute diarrhea among under-five children in Chittagong.
- Current prescribing patterns deviate significantly from WHO recommendations.
- Interventions are urgently needed to improve drug prescription practices for pediatric diarrhea.
Abstract:
This was a community based, thirty cluster survey, carried out in Chittagong metropolitan area of Bangladesh, aimed to determine the extent of misuse of drugs in acute diarrhoea among under-five children. Data were collected from 360 mothers whose under-five children had suffered from acute diarrhoea during the preceding two weeks of interview. Data were pertained to type and duration of diarrhoea and treatment received. There were 339(94.2%) cases of acute watery diarrhoea and 21 (5.8%) cases of dysentery i.e. blood in stool. The mean duration of the diarrhoeal episode was 3.17 +/- 1.69 days (95% CI, 2.99-3.34). Three hundred twenty eight (91.1%) cases received treatment. There was a total of 401 consultations, out of which 328(81.8%) had first, 69(17.2%) had second and 4(1.0%) had third consultations. The first and second treatment were provided predominantly by care-providers (43.3%) and physicians (5.5%) respectively. Only 82(26.7%) cases of acute watery diarrhoea received WHO recommended treatment and only 5(23.8%) cases of dysentery received appropriate antibiotics. The rest 241(73.5%) cases received inappropriate treatment either antibiotic or drugs other than WHO recommendation. The average number of drugs prescribed per patient was 1.5 during the episode. The commonly prescribed drugs were metronidazole (38.6%) and antibiotics (17.3%). Those who consulted health professionals were at 5.7 times higher risk of receiving drugs. The mean duration of the episode of acute watery diarrhoea was increased significantly when drug is used in the treatment. It is concluded that there was high prevalence of misuse of drugs in the treatment of acute diarrhoea among under-five children which calls for intervention to improve the prescribing pattern as per WHO recommendation.