Abstract
This study assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants. In rural India, lack of trained providers causes inopportune treatment of sick infants and results in increase in child morbidity and mortality. The untrained providers deliver a significant proportion of health care for rural infants; however, there is a paucity of information on their treatment practice. A cross-sectional study was conducted in three rural blocks of Odisha. A total of 337 prescriptions recommended for sick infants were collected from the 15 untrained providers using pre-designed prescription form - designed as per the Integrated Management of Neonatal and Childhood Illness (IMNCI) guideline. The forms were collected through the periodic visit and regular follow-up to the providers. A total of 68% of infants were diagnosed with the possible serious bacterial infection, 56% fever, 10% feeding problems, 9% dysentery and 9% local bacterial infection. A total of 61% of sick infants prescribed antibiotics - cephalosporin was commonly prescribed (56%). Among severe persistent diarrhea-diagnosed infants, 76% prescribed oral rehydration salt (ORS), 48% zinc and 62% of them received various antibiotics. The untrained providers referred 23% of sick infants to trained providers/facilities. In rural settings, most of the sick infants sought care from untrained providers; however, none of them followed any standard treatment protocol. This study suggests there is a need for training on common disease algorithm and treatment using a standard guideline for untrained providers to reduce inopportuneness in the treatment of sick infants, promoting early diagnosis and referral services to public health systems.
Highlights
The Sustainable Development Goals (SDG3) focused on comprehensive primary health care (Pettigrew et al, 2015)
Access to primary health care is allied with cost-effectiveness and equity of health systems considering the underprivileged populations (Corscadden et al, 2017)
We assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants
Summary
The Sustainable Development Goals (SDG3) focused on comprehensive primary health care (Pettigrew et al, 2015). The Alma Ata Declaration promotes comprehensive primary health care addressing social determinants of health through inter-sectoral integration, community participation, implementation and regulation (Topp and Abimbola, 2018). Access to primary health care is allied with cost-effectiveness and equity of health systems considering the underprivileged populations (Corscadden et al, 2017). While access to primary care is often demarcated with timeliness, distance and costs, it can be considered broadly as the capacity of the general public for obtaining appropriate services as per their need (Jacobs et al, 2011; Corscadden et al, 2017). In the absence of required number of trained providers in rural setting (Sharma, 2015), a parallel health-care system has been run by untrained providers (Datta, 2013)
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