@article {Walker230, author = {Christa L Fischer Walker and Sunita Taneja and Amnesty LeFevre and Robert E Black and Sarmila Mazumder}, title = {Appropriate Management of Acute Diarrhea in Children Among Public and Private Providers in Gujarat, India: A Cross-Sectional Survey}, volume = {3}, number = {2}, pages = {230--241}, year = {2015}, doi = {10.9745/GHSP-D-14-00209}, publisher = {Global Health: Science and Practice}, abstract = {Training public-sector providers to treat diarrhea in children with low-osmolarity oral rehydration salts and zinc appeared to be effective. Among private providers, drug-detailing visits by pharmaceutical representatives seemed less effective, particularly in improving knowledge of the correct dosage and duration of zinc treatment. Consistent supplies and sufficient attention to training all health care cadres, especially community health workers who may be new to diarrhea treatment and informal-sector providers who are typically excluded from formal training, are critical to improving knowledge and prescribing behaviors.Diarrhea remains a leading cause of morbidity and mortality among children 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 zinc supplementation and low-osmolarity oral rehydration salts (ORS) for the treatment of diarrhea. Despite this, zinc is rarely prescribed and has not been available in the public sector in India until very recently. The Diarrhea Alleviation Through Zinc and ORS Treatment (DAZT) project was implemented in Gujarat between 2011 and 2013 to accelerate the uptake of zinc 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{\textendash}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{\textquoteright} knowledge of appropriate treatment for diarrhea in children, 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 diarrhea in children. Reported routine prescription of zinc was lower, ranging from 62\% among private providers to 96\% among auxiliary nurse-midwives. Among providers who reported ever not recommending zinc (nā€Š=ā€Š242), the 2 most frequently reported reasons for not doing so were not completely understanding zinc for diarrhea treatment and not having zinc in stock at the time of contact with the patient. In a multiple logistic regression analysis, recent training or drug-detailing visits and having zinc in stock were associated with reported zinc prescribing (P\<.05). Recent training among public providers was significantly associated with having correct knowledge of zinc treatment duration and dosage, but the same was not true of drug-detailing visits among private providers. Treating diarrhea with zinc 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 diarrhea episodes with zinc and ORS.}, URL = {https://www.ghspjournal.org/content/3/2/230}, eprint = {https://www.ghspjournal.org/content/3/2/230.full.pdf}, journal = {Global Health: Science and Practice} }