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The Association between Provider Practice and Knowledge of ORS and Zinc Supplementation for the Treatment of Childhood Diarrhea in Bihar, Gujarat and Uttar Pradesh, India: A Multi-Site Cross-Sectional Study.

Lamberti LM, Fischer Walker CL, Taneja S, Mazumder S, Black RE - PLoS ONE (2015)

Bottom Line: Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice.Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector.In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing.

View Article: PubMed Central - PubMed

Affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

ABSTRACT

Introduction: Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice. A diarrhea management program implemented in Bihar, Gujarat and Uttar Pradesh, India trained private sector rural medical practitioners (RMPs) and public sector Accredited Social Health Activists (ASHAs) and Anganwadi workers (AWWs) in adequate treatment of childhood diarrhea with oral rehydration salts (ORS) and zinc. We used cross-sectional program evaluation data to determine the association between observed diarrhea treatment practices and reported knowledge of ORS and zinc among each provider cadre.

Methods: We conducted principal components analysis on providers' responses to diarrhea treatment questions in order to generate a novel scale assessing ORS/zinc knowledge. We subsequently regressed a binary indicator of whether ORS/zinc was prescribed during direct observation onto the resulting knowledge scores, controlling for other relevant knowledge predictors.

Results: There was a positive association between ORS/zinc knowledge score and prescribing ORS and zinc to young children with diarrhea among private sector RMPs (aOR: 2.32; 95% CI: 1.29-4.17) and public sector ASHAs and AWWs (aOR 2.48; 95% CI: 1.90-3.24). Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector. In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing.

Conclusions: To enhance the management of childhood diarrhea in India, programmatic activities should center on increasing knowledge of ORS and zinc among public and private sector providers through biannual trainings but should also focus on ensuring sustained access to an adequate supply chain.

No MeSH data available.


Related in: MedlinePlus

Boxplots* showing ORS, zinc and combined ORS and zinc knowledge index scores for public sector ASHAs and AWWs.*Boxplots are centered on the mean, which is approximately zero, and display a horizontal line at the median. ** Skewness and kurtosis estimates generated in Stata 12.0 [12]: Zinc (-0.91; 3.56); ORS (-0.40; 2.81); Combined (-1.08; 4.14).
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pone.0130845.g001: Boxplots* showing ORS, zinc and combined ORS and zinc knowledge index scores for public sector ASHAs and AWWs.*Boxplots are centered on the mean, which is approximately zero, and display a horizontal line at the median. ** Skewness and kurtosis estimates generated in Stata 12.0 [12]: Zinc (-0.91; 3.56); ORS (-0.40; 2.81); Combined (-1.08; 4.14).

Mentions: In general, the distributions of knowledge index scores were approximately normal, an expected result of PCA [15], but showed slight negative skew among ASHAs/AWWs and slight positive skew among RMPs (Figs 1 and 2). These skew patterns indicate that providers achieving low knowledge scores were outliers among public sector ASHAs/AWWs; whereas, RMPs with high scores deviated from the expected level of knowledge of their RMP counterparts.


The Association between Provider Practice and Knowledge of ORS and Zinc Supplementation for the Treatment of Childhood Diarrhea in Bihar, Gujarat and Uttar Pradesh, India: A Multi-Site Cross-Sectional Study.

Lamberti LM, Fischer Walker CL, Taneja S, Mazumder S, Black RE - PLoS ONE (2015)

Boxplots* showing ORS, zinc and combined ORS and zinc knowledge index scores for public sector ASHAs and AWWs.*Boxplots are centered on the mean, which is approximately zero, and display a horizontal line at the median. ** Skewness and kurtosis estimates generated in Stata 12.0 [12]: Zinc (-0.91; 3.56); ORS (-0.40; 2.81); Combined (-1.08; 4.14).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4476718&req=5

pone.0130845.g001: Boxplots* showing ORS, zinc and combined ORS and zinc knowledge index scores for public sector ASHAs and AWWs.*Boxplots are centered on the mean, which is approximately zero, and display a horizontal line at the median. ** Skewness and kurtosis estimates generated in Stata 12.0 [12]: Zinc (-0.91; 3.56); ORS (-0.40; 2.81); Combined (-1.08; 4.14).
Mentions: In general, the distributions of knowledge index scores were approximately normal, an expected result of PCA [15], but showed slight negative skew among ASHAs/AWWs and slight positive skew among RMPs (Figs 1 and 2). These skew patterns indicate that providers achieving low knowledge scores were outliers among public sector ASHAs/AWWs; whereas, RMPs with high scores deviated from the expected level of knowledge of their RMP counterparts.

Bottom Line: Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice.Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector.In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing.

View Article: PubMed Central - PubMed

Affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

ABSTRACT

Introduction: Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice. A diarrhea management program implemented in Bihar, Gujarat and Uttar Pradesh, India trained private sector rural medical practitioners (RMPs) and public sector Accredited Social Health Activists (ASHAs) and Anganwadi workers (AWWs) in adequate treatment of childhood diarrhea with oral rehydration salts (ORS) and zinc. We used cross-sectional program evaluation data to determine the association between observed diarrhea treatment practices and reported knowledge of ORS and zinc among each provider cadre.

Methods: We conducted principal components analysis on providers' responses to diarrhea treatment questions in order to generate a novel scale assessing ORS/zinc knowledge. We subsequently regressed a binary indicator of whether ORS/zinc was prescribed during direct observation onto the resulting knowledge scores, controlling for other relevant knowledge predictors.

Results: There was a positive association between ORS/zinc knowledge score and prescribing ORS and zinc to young children with diarrhea among private sector RMPs (aOR: 2.32; 95% CI: 1.29-4.17) and public sector ASHAs and AWWs (aOR 2.48; 95% CI: 1.90-3.24). Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector. In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing.

Conclusions: To enhance the management of childhood diarrhea in India, programmatic activities should center on increasing knowledge of ORS and zinc among public and private sector providers through biannual trainings but should also focus on ensuring sustained access to an adequate supply chain.

No MeSH data available.


Related in: MedlinePlus