Misconception denies kids ORS treatment in serious diarrhoea cases: Study

New Delhi: Thousands of children with severe diarrhoea are denied the crucial oral rehydration salt treatment because doctors mistakenly believe that parents don’t prefer ORS for their wards, a new study has found, after probing doctors from Bihar and Karnataka.

The novel study employs the services of “actors” who visited doctors and pharmacies in 253 small and mid-sized towns in the two states seeking treatment for their (imaginary) kids having either moderate or severe diarrhoea – both requiring ORS as the best clinical option.

But surprisingly the study reports 42 per cent under-prescription of ORS due to the doctors’ perceptions of patient preference.

“A long-standing puzzle in global health has been that providers (doctors) do not prescribe oral rehydration salts for child diarrhoea, even though they know it is the standard of care,” said Neeraj Sood, co-author of the study and a professor at the Price School of Public Policy, at the University of Southern California.

“This study provides new insights that now allow us to pursue interventions that can address this problem.”

While the life-saving benefits of ORS have been known for decades, public health researchers are also aware of inadequate prescription of the crucial salt combo to tackle the killer disease.

The study was planned by an Indo-US team to understand the gap, as that could translate saving millions of young lives.

Researchers from RAND, the University of Southern California, Duke University and the Indian Institute of Management, Bengaluru used a unique approach for the study.

They trained 25 actors to pose as child caregivers so that they could visit doctors and pharmacies to seek help for children in distress with diarrhoea. The extensive two-week training included memorising both a script and responses to common questions, as well as practice visits with real health care providers.

The “actors” visited 2,282 private doctors and caregivers across 253 medium-sized towns in Bihar and Karnataka, presenting a case of a 2-year-old child who had been having uncomplicated diarrhoea for two days.

Half the actors presented a moderate case (4-5 loose stools in a day) and the other half a severe case (10-12 loose stools), with both types of cases being severe enough to require oral rehydration salts.

Researchers estimate that doctors’ having pre-conceived notion that patients don’t want ORS explained 42 per cent of under-prescribing, whereas being out of stock and financial incentives explain only 6 per cent and 5 per cent, respectively.

When patients expressed a preference for oral rehydration salts, prescribing of the treatment increased by 27 percentage points. Assuring that oral rehydration salts were in stock increased prescription of the treatment by 7 percentage points.

Removing financial incentives for health providers to prescribe higher-profit medicines did not affect prescribing of oral rehydration salts on average, but did increase oral rehydration salts prescribing at pharmacies.

“We found that providers avoided prescribing oral rehydration salts because they thought caregivers wanted something different for their child,” Zachary Wagner, the study’s lead author and an economist at RAND, a non-profit research organization said in a statement. “But oral rehydration salts were the most preferred treatment when we asked caregivers directly about their preferences.

“Interventions to change providers’ perceptions of patients’ preferences about oral rehydration therapy have the potential to increase its use and reduce child mortality from diarrhoea.”

The findings offer possible new pathways to address an illness that annually kills more than 500,000 children under age 5 around the world, even though most could be successfully treated with inexpensive oral rehydration salts.

The study has been published in Science.