Fig: GIS map of Ujjain city showing the participating pharmacies and hospitals

1. Adherence to Treatment Guidelines for Acute Diarrhoea in Children up to 12 Years in Ujjain, India* Ashish Pathak(1,2) , Deepali Pathak (1,3), Gaetano Marrone(1), Vishal Diwan(1,4), and Cecilia Stålsby Lundborg(1) • Policy implications and conclusions: • Low adherence to treatment guidelines, low use of zinc and the high use of antibiotics • To improve case management of acute diarrhoea, continuing professional development targeting practitioners of all systems of medicine is necessary. Fig: ORT in a child Objective: To analyze prescriptions for adherence to treatment guidelines • Results: Information was collected from 843 diarrhoea prescriptions. • Only 6 prescriptions adhered with the recommended treatment (ORS along with zinc) with no additional probiotics, antibiotics, racecadotril, or antiemetics (except Domperidone for vomiting) • ORS alone was prescribed to 58% and ORS with zinc to 22% • Antibiotics were prescribed in 71% of prescriptions. Broad-spectrum antibiotics were prescribed in illogical fixed-dose combinations, such as ofloxacin with ornidazole (22% of antibiotics prescribed). • Practitioners from alternate systems of medicine and IHPs were significantly less likely (OR 0.13, 95% CI 0.04-0.46, P = 0.003) to prescribe ORS and zinc than pediatricians • Practitioners from free hospitals were more likely to prescribe ORS and zinc (OR 4.94, 95% CI 2.45-9.96, P < 0.001) and less likely to prescribe antibiotics (OR 0.01, 95% CI 0.01-0-04, P < 0.001) compared to practitioners from other hospitals • Accompanying symptoms (fever, pain, blood in the stool, and vomiting) significantly increased antibiotic prescribing. • Design: Cross-sectional study done between June to August 2010 • Setting: Pharmacies and major hospitals of Ujjain, Madhya Pradesh, India. Pharmacists in pharmacies and resident medical officers in hospitals transferred the information of the diarrhoeal episode and the treatment given to a data collection instrument • Study population: Prescriptions for children up to 12 years of age with diarrhoea from practitioners of modern medicine, ayurveda, homeopathy, and informal health care providers (IHPs) • Outcome measures: • Prescription of ORS alone and ORS with zinc • Prescriptions containing antibiotics • Factors affecting prescription of ORS and zinc and antibiotics Fig: GIS map of Ujjain city showing the participating pharmacies and hospitals • Introduction • In India, diarrhoea accounts for 20% of all paediatric deaths • WHO recommendations, the Indian Academy of Paediatrics, and the Government of India treatment guidelines are in place, but adherence to these guidelines is not analyzed • IHCAR, Division of Global Health, Karolinska Institutet, Sweden, India; • Department of Paediatrics, R.D. Gardi Medical College, Ujjain, India; • 3. Grasim Trust‘s G.D. Birla Memorial Hospital, Ujjain, India; • 4. Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India E-mail: ashish.pathak@.ki.se Funding: Swedish Research Council Scholarship: Erasmus Mundus Lot 15 India to 1st, 2nd and 4th authors Travel Grant: Axel Hirsch´s travel fund, Karolinska Institutet to Ashish Pathak *Published in: BMC Infect Dis. 2011 Jan 28;11:32. PubMed PMID: 21276243