Use of drugs and cost of treatment of diarrhea in secondary level government hospitals in maharashtra

Intervention to improve diarrhea related knowledge and practices among informal healthcare providers in slums of Kolkata

Background

In the densely populated slums of Kolkata, informal healthcare providers’ (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance.

Methods

A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation.

Results

Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved.

Conclusions

Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up.

Prescription audit of outpatient attendees of secondary level government hospitals in Maharashtra

OBJECTIVE

The main objective of the prescription audit of the secondary level government hospitals under the Maharashtra Health Systems Development Project (MHSDP) was to develop a list of essential drugs. Other objectives were to articulate measures for improving the prescription practices and to generate information on the core prescribing indicators proposed by the World Health Organization (WHO).

MATERIALS AND METHODS

The study was conducted among a representative sample of 31 secondary level hospitals under MHSDP. A copy of the prescription was obtained with the help of a pre-inserted carbon, in a special format. Data for only 'first encounter prescriptions' was collected for all patients attending the Outpatient Department (OPD).

RESULTS

About 77 percent of the prescriptions contained only one diagnosis. The average number of drugs per prescription was 3.1. About 60 percent of the drugs were prescribed by generic names and about 23 percent of the prescribed drugs were in combination. About 25 percent of the prescriptions contained at least one injection, while 35 percent contained at least one antibiotic. In 16 percent of the prescriptions a vitamin or tonic was prescribed. About 46 percent of the single ingredient formulations were as per the WHO 2003, Essential Medicines List (EML). Based on the findings of the Prescription Audit an EML was prepared for each category of the secondary level hospitals, for use in the OPD.

CONCLUSIONS

Prescription audits are useful in generating data on morbidity, which forms the basis for preparing the list of essential medicines. Mechanisms necessary for improving prescription practices are suggested.