Health Utilization for Childhood Gastroenteritis in Southern India

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To the Editor: Diarrheal disease causes 334,000 deaths in under-five children in India annually [1]. Although the use of oral and intravenous rehydration have substantially decreased diarrheal mortality [2], the fact that children still die of diarrhea indicate the need to understand the beliefs and practices of households regarding its cause and management. We conducted a 30-cluster survey [3], involving 210 households with under-five children in Vellore, Tamil Nadu, India, to document healthcare utilization for acute childhood diarrhea, using a protocol developed and field-tested by the World Health Organization (WHO) [4]. The study was approved by the Institutional Review Board, and verbal consent obtained from all respondents. Knowledge about symptoms (90.9 %) and transmission (88.6 %) of diarrhea was high, although nearly all respondents still continued to hold traditional beliefs regarding its causation. Over 80 % were aware of oral rehydration solution (ORS), but despite the high awareness, only 16.7 % reported ORS use for diarrheal management, similar to the usage rates reported elsewhere in India [5]. Alarmingly, the majority of respondents (68.1 %) felt that antibiotics should be given during a diarrheal episode, with one-third expressing disappointment if no medications were prescribed. Most respondents (71.4 %) preferred private practitioners for management of childhood diarrhea; only 9.5 % preferred using government facilities. Perceived quality of care (99.5 %), friendly staff (91.4 %) and less waiting time (67.1 %) were considered important factors for utilization of a healthcare facility. Of the 210 households, 8.1 % had children with a diarrheal episode during the 2-wk recall period. A third of the children with diarrhea were taken to private practitioners, all of whom received antibiotics. This study highlights lacunae in knowledge and practices about childhood diarrhea in southern India. The challenge of reducing excessive antibiotic usage in an era of increasing resistance needs to be addressed, despite the expected difficulties of countering both demand from patients and promotion of use by doctors, pharmacists and manufacturers. A multi-pronged approach using appropriate communication tools for education of the community and local private practitioners regarding prevention and management of diarrheal diseases in children will be needed to reduce the disease burden and the inappropriate use of antibiotics.