Appropriate Management of Acute XXXX in @entity1 Among Public and Private Providers in Gujarat, India: A Cross-Sectional Survey.

@entity1 @entity294 @entity219
@entity294 remains a leading cause of morbidity and mortality among @entity1 under 5 years of age in low- and middle-income countries. In 2006, the Indian government formally endorsed the World Health Organization guidelines that introduced @entity219 supplementation and low-osmolarity oral rehydration salts (ORS) for the treatment of @entity294 . Despite this, @entity219 is rarely prescribed and has not been available in the public sector in India until very recently. The @entity294 Alleviation Through @entity219 and ORS Treatment (DAZT) project was implemented in Gujarat between 2011 and 2013 to accelerate the uptake of @entity219 and ORS among public and private providers in 6 rural districts. As part of an external evaluation of DAZT, we interviewed 619 randomly selected facility- and community-based public and private providers 2-3 months after a 1-day training event had been completed (or, in the case of private providers, after at least 1 drug-detailing visit by a pharmaceutical representative had occurred) and supplies were in place. The purpose of the interviews was to assess providers' knowledge of appropriate treatment for @entity294 in @entity1 , reported treatment practices, and availability of drugs in stock. More than 80% of all providers interviewed reported they had received training or a drug-detailing visit on diarrheal treatment in the past 6 months. Most providers in all cadres (range, 68% to 100%) correctly described how to prepare ORS and nearly all (range, 90% to 100%) reported routinely prescribing it to treat @entity294 in @entity1 . Reported routine prescription of @entity219 was lower, ranging from 62% among private providers to 96% among auxiliary nurse-midwives. Among providers who reported ever not recommending @entity219 (n=242), the 2 most frequently reported reasons for not doing so were not completely understanding @entity219 for @entity294 treatment and not having @entity219 in stock at the time of contact with the @entity1 . In a multiple logistic regression analysis, recent training or drug-detailing visits and having @entity219 in stock were associated with reported @entity219 prescribing (P<.05). Recent training among public providers was significantly associated with having correct knowledge of @entity219 treatment duration and dosage, but the same was not true of drug-detailing visits among private providers. Treating @entity294 with @entity219 and low-osmolarity ORS is new for public and private providers in India and other low- and middle-income countries. Sufficient training and logistics support to ensure consistent supplies are critical if providers are to begin routinely treating all @entity294 episodes with @entity219 and ORS.
