In many developing nations, healthcare providers recognize Oral Rehydration Salts (ORS) as an effective and affordable remedy for childhood diarrhea, yet they often fail to prescribe it. Delving deeper into this disparity between knowledge and action, a recent study reveals that providers often assume patients are disinterested in ORS, significantly contributing to its under-prescription.

Under-Prescription of ORS in Childhood Diarrhea

Diarrhea remains a leading cause of child mortality globally, with ORS offering a cost-effective solution. Despite its potential, nearly half of diarrheal cases worldwide lack access to ORS, as highlighted by researchers from esteemed institutions in the U.S. and India. Utilizing a randomized controlled trial, the study, published in Science, examined three primary factors influencing ORS under-prescription: patient preferences for non-ORS treatments, financial incentives favoring alternative medications, and ORS availability (1).

Over 2,000 healthcare providers across 253 towns in Karnataka and Bihar participated in the study, where standardized patients presented with a simulated case of diarrhoea. Notably, provider misconceptions about patient preferences emerged as the primary driver behind ORS under-prescription, accounting for 42% of cases. Comparatively, stock-outs and financial incentives contributed only 6% and 5%, respectively.

Interestingly, providers were more likely to prescribe ORS when patients expressed a preference for it, indicating a disconnect between perceived and actual patient preferences. Despite this, providers tended to underestimate patient demand for ORS, with only 18% believing it was the preferred treatment, contrary to household survey data.

Strategies to Overcome Barriers in ORS Utilization and Improve Child Health

The study’s findings underscore the importance of addressing provider misperceptions and encouraging patients to express their treatment preferences. By enhancing awareness and fostering dialogue between patients and providers, interventions can promote the uptake of ORS and ultimately improve childhood diarrhoea management.

Moreover, the research emphasizes the critical role of ORS in mitigating the global burden of childhood diarrhoea. As a simple, cost-effective solution, ORS has the potential to save countless lives, particularly in resource-limited settings where access to advanced medical interventions is limited.

However, despite its effectiveness, ORS remains underutilized due to various barriers, including provider misconceptions and systemic challenges. By understanding and addressing these barriers, healthcare systems can better harness the full potential of ORS and enhance child health outcomes worldwide.

To this end, interventions should focus on multiple levels, including provider training, community education, and health system strengthening. Providers need to be educated about the efficacy and importance of ORS, dispelling misconceptions and emphasizing its role as a frontline treatment for childhood diarrhoea.

Simultaneously, community-level interventions can raise awareness about the benefits of ORS and empower caregivers to demand it when seeking healthcare services. By empowering patients and caregivers to advocate for ORS, healthcare systems can better align with patient preferences and improve treatment outcomes.

Furthermore, health system strengthening efforts are essential to ensure the consistent availability and accessibility of ORS in healthcare facilities. Supply chain management, procurement practices, and distribution networks must be optimized to prevent stock-outs and ensure uninterrupted access to ORS for those in need.

In addition to addressing barriers to ORS utilization, efforts should also focus on advancing research and innovation in diarrhoeal disease management. New formulations, delivery mechanisms, and packaging innovations can enhance the acceptability, accessibility, and effectiveness of ORS, further improving its impact on child health.

Ultimately, the study’s findings underscore the urgent need for concerted action to overcome barriers to ORS utilization and maximize its potential to save lives. By addressing provider misconceptions, empowering patients, and strengthening health systems, we can ensure that ORS reaches every child in need, contributing to a healthier and more resilient future for all.

References:

1. Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review
   
   Ezezika O, Ragunathan A, El-Bakri Y, Barrett K. Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review. PLoS One. 2021 Apr 22;16(4):e0249638. doi: 10.1371/journal.pone.0249638. PMID: 33886584; PMCID: PMC8062013.

Source-Medindia