Use of ‘Diarrhea Stool Card’ in acute diarrhea management in under 5 Years children in resource constraints country

Abstract

BackgroundAntibiotics are often overused in the management of diarrhea, despite few indications. Lack of confidence regarding the causative organism and limited access to diagnostic facilities contribute to the misuse of antibiotics in acute watery diarrhea (AWD). ObjectiveThe present study aims to assess the variation in diarrhea management before and after implementing the 'Diarrhea Stool Card'. MethodsThis cross-sectional retro-prospective study was conducted at the Department of Pediatrics, Sylhet M. A. G Osmani Medical College Hospital, Bangladesh, from June 2022 to March 2023. It included all children less than 5 years who were admitted into the inpatient department with acute diarrhea. During the prospective phase of the study, all doctors working in the diarrhea unit were oriented first how to utilize the ‘Diarrhea Stool Card’ for assuming the causative organism of diarrhea and to decide whether antibiotic will be given or not. Previous data regarding use of antibiotic in the same diarrheal unit by same doctors were collected retrospectively and compared with prospective data. The study analyzed the data and compared antibiotic prescription rates before the introduction of the 'Diarrhea Stool Card'. ResultsA total of 368 patients were analyzed, among them 177 children were included during the prospective part of the study period and 191 were included from the hospital record as the retrospective sample. Socio-demographic factors of studied populations were analyzed only for prospective samples. Before using the 'Diarrhea Stool Card’, antibiotics were used in 59% (112) of AWD cases. By using the 'Diarrhea stool card' antibiotic prescription declined to 20.8%, (p- 0.0001). ConclusionAntibiotic misuse can be significantly reduced by using a ‘Diarrhea Stool Card’, which can provide confidence to the attending physician in managing diarrhea, especially in low-resource country like Bangladesh.