TABLE 2. Diarrhea Management Knowledge and Reported Prescribing Behaviors Among Public and Private Providers, Gujarat, India
Public-Sector Providers
ASHAs (n=165)AWWs (n=165)ANMs (n=66)MOs (n=33)PPs (n=190)
No. (%) reporting a child with diarrhea should:
 Increase fluid intake* (correct response)106 (64.2)118 (71.5)49 (74.2)24 (72.7)147 (77.4)
 Maintain usual fluid intake48 (29.1)40 (24.2)17 (25.8)9 (27.3)40 (21.1)
 Reduce fluid intake* 11 (6.7)7 (4.2)0 (0)0 (0)3 (1.6)
 Maintain usual or increase breastfeeding/food intake* (correct response) 146 (88.5)150 (90.1)59 (89.3)28 (84.8)136 (71.6)
 Reduce food intake*19 (11.5)15 (9.1)7 (10.6)5 (15.2)54 (28.4)
No. (%) recalling ≥ 2 signs/symptoms requiring referral to higher-level facility*a141 (85.5)154 (93.3)65 (98.5)30 (90.9)162 (85.3)
No. (%) recalling ≥ 4 signs/symptoms requiring referral to higher-level facility*a40 (24.2)56 (33.9)26 (39.4)5 (15.2)44 (23.2)
No. (%) reporting usually recommending zinc treatment* 137 (83.0)146 (88.5)63 (95.5)29 (87.9)117 (61.6)
No. (%) correctly stating the dose and duration of zinc syrup or tablet
 Duration of 14 days*140 (85.0)144 (87.0)63 (95)31 (94)90 (47.0)
 Correct dose for children 2–5 months old (10 mg/day, i.e., 1/2 tablet or 5 mL)*b60 (36.0)53 (32.0)47 (71)20 (61)33 (17.0)
 Correct dose for children 6–59 months old (20 mg/day, i.e., 1 tablet or 10 mL)*b88 (53.0)84 (51.0)49 (74)22 (67)47 (25.0)
 Refused to answer/did not know correct dosea18 (11.0)10 (6.0)0 (0)0 (0)146 (77.0)
No. (%) reporting routinely recommending ORS* 164 (99.4)164 (99.4)66 (100)32 (97.0)170 (89.5)
No. (%) correctly describing how to prepare ORS (i.e., 1 L packet in 1 L water or 200 mL packet in 1 cup of water) * 157 (95.7)153 (93.3)62 (93.9)33 (100)114 (67.5)
  • Abbreviations: ANMs, accredited nurse-midwives; ASHAs, Accredited Social Health Activists; AWWs, Anganwadi workers; MOs, medical officers; ORS, oral rehydration salts; PPs, private providers.

  • * Signifies differences in response by provider type using chi-squared test for multiple proportions (P<.05).

  • a Signs/symptoms included: unconscious, lethargic, convulsions, unable to drink or breastfeed, persistent diarrhea, sunken eyes, skin pinch goes back slowly, irritable/restless, blood in stool, signs of mild dehydration, fast breathing, difficulty breathing, and vomiting.

  • b Government and training documents state infant dosing is from 2 months and up to 6 months of age. We considered 2–5 months and 2–6 months as correct responses. For this reason, we also accepted 6 or 7 months as the lower bound of the older age category. Zinc should be given until 5 years of age, and thus 59 or 60 months were accepted as the upper bound for the older age category.