'Wrong treatments major killer in rural India'

A large number of children die from diarrhoea and pneumonia in rural India due to wrong treatments provided by medical practitioners, says a study.

Few health care providers in rural India know the correct treatments for childhood diarrhoea and pneumonia - two leading killers of children worldwide - and even when they do, they rarely prescribe them properly, the researchers said.

"Our results show that in order to reduce child mortality, we need new strategies to improve diagnosis and treatment of these key childhood illnesses," said lead author of the study, Manoj Mohanan, professor at Duke University in the US.

Medical practitioners typically fail to prescribe lifesaving treatments such as oral rehydration salts (ORS).

Instead, they typically prescribe unnecessary antibiotics or other potentially harmful drugs, Mohanan said.

According to September 2014 bulletin of Sample Registration System (SRS), India has an infant mortality rate of 40 per 1,000 live births.

In Bihar, where the study was conducted, infant mortality rate is 42 per 1,000 live births, according to the report.

"Eighty percent in our study had no medical degree. But much of India's rural population receives care from such untrained providers, and very few studies have been able to rigorously measure the gap between what providers know and what they do in practice," Mohanan added.

The study involved 340 health care providers. Researchers conducted "vignette" interviews with providers to assess how they would diagnose and treat a hypothetical case.

Later, standardised patients - individuals who portrayed patients presenting the same symptoms as in the interviews - made unannounced visits.

This strategy enabled researchers to measure the gap between what providers know and what they actually do - the "know-do" gap.

Providers exhibited low levels of knowledge about both diarrhoea and pneumonia during the interviews and performed even worse in practice.

For example, for diarrhoea, 72 percent of providers reported they would prescribe oral rehydration salts - a life-saving, low-cost and readily available intervention - but only 17 percent actually did so.

Those who did prescribe ORS also added other unnecessary or harmful drugs.

In practice, none of the providers gave the correct treatment: only ORS, with or without zinc, and no other potentially harmful drugs. Instead, almost 72 percent of providers gave antibiotics or potentially harmful treatments without ORS.

"Our evidence on the gap between knowledge and practice suggests that training alone will be insufficient. We need to understand what incentives cause providers to diverge from proper diagnosis and treatment," Mohanan added.

The study was published in the journal JAMA Pediatrics.