scholarly journals From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala

2017 ◽  
Vol 41 ◽  
pp. 1 ◽  
Author(s):  
Rachel Hall-Clifford ◽  
Roxanne Amerson
Keyword(s):  
Community Health ◽  
Zinc Supplementation ◽  
Oral Rehydration Therapy ◽  
Essential Medicines ◽  
World Health ◽  
Local Context ◽  
Local Health ◽  
Who Guidelines ◽  
Community Members ◽  
Oral Rehydration

Objective. Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. Methods. In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation. Results. Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. Conclusions. Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system’s structure must support availability of essential medicines in order to effectively implement those guidelines.

Rational and Irrational Drug Use: Factors, Impacts and Strategies to Combat Irrational Drug Use: A Narrative Review

2021 ◽  
Vol 2 (1) ◽  
pp. 6-17
Author(s):  
Zahra Hassan AL Qamariat ◽  
Keyword(s):  
Drug Use ◽  
Health System ◽  
Essential Medicines ◽  
World Health ◽  
Local Health ◽  
Rational Drug Use ◽  
Inappropriate Use ◽  
Rational Drug ◽  
The World ◽  
Health Organization

Misuse of drugs is a serious health problem all around the world. Rational drug use can be characterized as follows: patients receive drugs that meet their clinical needs, at doses that meet their requirements, promptly and at the lowest cost to themselves and their region. Drug abuse, polypharmacy, and misuse are the most prominent drug use problems today. Misuse of drugs can occur for a variety of reasons at different levels, including recommended mistakes and over-the- counter medications. Inappropriate use of income can lead to real negative benefits and financial results. There are many irrational drug mixtures available. Appropriate rational use of medicines will increase personal satisfaction and lead to better local health services. A list of essential medicines recommended by the World Health Organization (WHO) can assist the countries around the globe in rationalizing the distribution and purchasing of medicines, thus decreasing the costs to healthcare systems. Irrational drug use has been a subject of concern for years as it affects the health system and patients badly. Irrational use of drugs can result from several factors such as patient, prescriber, dispenser, health system, supply system, or regulations. Thus, diverse strategies have been used to promote rational drug use and also to tackle irrational use. Thereby the concept of rational and irrational drug use and factors that lead to either result should be identified and monitored.

scholarly journals Barriers and facilitators to implementation of oral rehydration therapy in low- and middle-income countries: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249638
Author(s):  
Obidimma Ezezika ◽  
Apira Ragunathan ◽  
Yasmine El-Bakri ◽  
Kathryn Barrett
Keyword(s):  
Systematic Review ◽  
Implementation Research ◽  
Oral Rehydration Therapy ◽  
Barriers And Facilitators ◽  
World Health ◽  
Successful Implementation ◽  
Middle Income ◽  
Oral Rehydration ◽  
Middle Income Countries ◽  
Low And Middle Income

Background Oral rehydration therapy (ORT) is an effective and cheap treatment for diarrheal disease; globally, one of the leading causes of death in children under five. The World Health Organization launched a global campaign to improve ORT coverage in 1978, with activities such as educational campaigns, training health workers and the creation of designate programming. Despite these efforts, ORT coverage remains relatively low. The objective of this systematic review is to identify the barriers and facilitators to the implementation of oral rehydration therapy in low and middle-income countries. Methods A comprehensive search strategy comprised of relevant subject headings and keywords was executed in 5 databases including OVID Medline, OVID Embase, OVID HealthStar, Web of Science and Scopus. Eligible studies underwent quality assessment, and a directed content analysis approach to data extraction was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR) to facilitate narrative synthesis. Results The search identified 1570 citations and following removal of duplicates as well as screening according to our inclusion/exclusion criteria, 55 articles were eligible for inclusion in the review. Twenty-three countries were represented in this review, with India, Bangladesh, Egypt, Nigeria, and South Africa having the most representation of available studies. Study dates ranged from 1981 to 2020. Overarching thematic areas spanning the barriers and facilitators that were identified included: availability and accessibility, knowledge, partnership engagement, and design and acceptability. Conclusion A systematic review of studies on implementation of ORT in low- and middle-income countries (LMICs) highlights key activities that facilitate the development of successful implementation that include: (1) availability and accessibility of ORT, (2) awareness and education among communities, (3) strong partnership engagement strategies, and (4) adaptable design to enhance acceptability. The barriers and facilitators identified under the CIFR domains can be used to build knowledge on how to adapt ORT to national and local settings and contribute to a better understanding on the implementation and use of ORT in LMICs. The prospects for scaling and sustaining ORT (after years of low use) will increase if implementation research informs local applications, and implementers engage appropriate stakeholders and test assumptions around localized theories of change from interventions to expected outcomes. Registration A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD420201695).

scholarly journals PERANAN ZINC PADA PENANGANAN KASUS PENYAKIT DIARE YANG DIALAMI BAYI MAUPUN BALITA

2017 ◽  
Vol 1 (1) ◽  
pp. 22-29
Author(s):  
Riskiyah Riskiyah
Keyword(s):  
Zinc Supplementation ◽  
Severe Disease ◽  
Age Groups ◽  
Oral Rehydration Therapy ◽  
Stool Frequency ◽  
Oral Rehydration ◽  
Beneficial Effects ◽  
Nutritional Immunity ◽  
Cell Immunity ◽  
Speed Up

In Indonesia, diarrhea still is one of top problem public health for causing morbidity and  many deaths. All age groups can be attacked by diarrhea, but severe disease with high mortality especially in infants and toddlers. WHO and UNICEF recommend about management of diarrhea in children namely by adding a supplementation of zinc (Zn) on oral rehydration therapy. Zinc functions in the immune system as a second messenger in signal transduction, cell immunity and nutritional immunity. Zinc also plays an important role in reducing the risk and severity of diarrhea. From some research shows that the effects of therapeutic zinc supplementation can reduce the duration of diarrhea, stool output and stool frequency. The supplementation of 20 mg of zinc per day on the eradication of child diarrhea are less than 5 years and 10 mg per day for infants less than 6 months for 10-14 days. The beneficial effects of zinc supplementation in diarrhea that can speed up the regeneration of the epithelium lining the intestine, increasing the absorption of water and electrolytes in the intestine, increase enzyme levels enterocyte brush-border, and enhance the immune response that can speed up clearance of pathogens from the gut.

scholarly journals Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review

2017 ◽  
Vol 2 ◽  
pp. 66 ◽  
Author(s):  
Kirsty A. Houston ◽  
Jack G. Gibb ◽  
Kathryn Maitland
Keyword(s):  
Systematic Review ◽  
Severe Acute Malnutrition ◽  
Significant Risk ◽  
Acute Malnutrition ◽  
World Health ◽  
Who Guidelines ◽  
Oral Rehydration ◽  
Malnourished Children ◽  
Rehydration Solutions ◽  
Severe Hyponatraemia

Background: Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods: We conducted a systematic review of randomised controlled trials (RCTs) on 18th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results: Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions: Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines

Diarrhea Care in Private Practice

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 980-980
Author(s):  
MARK L. TOCHEN ◽  
DON TSUKAMAKI
Keyword(s):  
Kansas City ◽  
Oral Rehydration Solution ◽  
Oral Rehydration Therapy ◽  
World Health ◽  
Oral Rehydration ◽  
Rehydration Solutions ◽  
The Us ◽  
The World ◽  
Rehydration Solution ◽  
Health Organization

To the Editor.— The article by Dr Snyder, "Use and Misuse of Oral Rehydration Therapy for Diarrhea,"1 led us to review our treatment of gastroenteritis, revise our telephone protocols, and seek out rehydration solutions. Our difficulty in obtaining adequate supplies mirrored that of Dr O'Banion.2 Expense to the patient is also an important factor: commercial premixed solutions sell for $4 to $6 per quart in our area, which many families cannot pay. Our solution was to obtain from the World Health Organization the name of the US supplier of oral rehydration solution (ORS) packets and order direct from the supplier (Jianas Bros Packaging Co, 2533 SW Blvd, Kansas City, MO 64108).

scholarly journals Impact of the Liberian National Community Health Assistant Program on Childhood Illness Treatment in Grand Bassa County, Liberia: A Difference-in-Differences Analysis of Population-Based Data

2021 ◽  
Author(s):  
Emily White ◽  
Savior Mendin ◽  
Featha R. Kolubah ◽  
Robert Karlay ◽  
Ben Grant ◽  
...  
Keyword(s):  
Community Health ◽  
Maternal Education ◽  
Oral Rehydration Therapy ◽  
Household Wealth ◽  
Population Based ◽  
Difference In Differences ◽  
Oral Rehydration ◽  
National Community ◽  
Malaria Rapid Diagnostic Tests ◽  
Health Assistant

Liberia launched its National Community Health Assistant Program in 2016, which seeks to ensure that all people living 5 kilometers or farther from a health facility have access to trained, supplied, supervised, and paid community health workers (CHWs). This study aims to evaluate the impact of the national program following implementation in Grand Bassa County in 2018 using data from population-based surveys. We measured before-to-after changes in childhood treatment from qualified providers in a portion of the county that implemented in a first phase compared to those which had not yet implemented. We also assessed changes in whether children received oral rehydration therapy for diarrhea and malaria rapid diagnostic tests if they had a fever by a qualified provider (facility based or CHW). For these analyses, we used a difference-in-differences approach and adjusted for potential confounding using inverse probability of treatment weighting. We also assessed changes in the source from which care was received and examined changes by key dimensions of equity (distance from health facilities, maternal education, and household wealth). We found that treatment of childhood illness by a qualified provider increased by 60.3 percentage points (95%CI 44.7-76.0) more in intervention than comparison areas. Difference-in-differences for oral rehydration therapy and malaria rapid diagnostic tests were 37.6 (95%CI 19.5-55.8) and 38.5 (95%CI 19.9-57.0) percentage points, respectively. In intervention areas, treatment by a CHW increased from 0 to 81.6% and care from unqualified providers dropped. Increases in treatment by a qualified provider did not vary significantly by household wealth, remoteness, or maternal education. This evaluation found evidence that the Liberian National Community Health Assistant Program has increased access to effective treatment in rural Grand Bassa County. Improvements were approximately equal across three measured dimensions of marginalization.  

Child Survival in the Third World: A Functional Analysis of Oral Rehydration Therapy Dissemination Campaigns

1991 ◽  
Vol 8 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Yolanda Suarez de Balcazar ◽  
Fabricio E. Balcazar
Keyword(s):  
Child Survival ◽  
Acute Diarrhoea ◽  
Skills Training ◽  
Oral Rehydration Therapy ◽  
World Health ◽  
Oral Rehydration ◽  
The Past ◽  
The World ◽  
Health Organization ◽  
The Third World

About 4 million children die every year as a result of dehydration caused by acute diarrhoea. Oral rehydration therapy (ORT) is designed to prevent dehydration. In the past 10 years, several campaigns have been conducted throughout the world, mostly sponsored by the World Health Organization, to disseminate ORT, particularly in developing countries. This paper presents a review of 14 ORT campaigns categorising their components according to whether the researchers used antecedents, behaviours, and/or consequences. Only three campaigns manipulated all three components. Antecedent events were manipulated in all of the studies. A skills training component appears to influence the effectiveness of the campaign, since several new behaviours and complex discriminations need to be learned for people to use ORT correctly. The benefits of functionally analysing the components of current ORT campaigns are highlighted.

Think Globally, Prescribe Locally: How Rational Pharmaceutical Policy in the U.S. Can Improve Global Access to Essential Medicines

2008 ◽  
Vol 34 (2-3) ◽  
pp. 125-139 ◽  
Author(s):  
Aaron S. Kesselheim
Keyword(s):  
Care Delivery ◽  
Policy Issue ◽  
International Health ◽  
Developed Countries ◽  
Essential Medicines ◽  
World Health ◽  
Health Priorities ◽  
Local Health ◽  
Middle Income ◽  
Access To Essential Medicines

Improving access to essential medicines in low- and middle-income countries (LMICs) has become a critical health policy issue. Millions more people die each year in poorer countries from diseases that are treated by pharmaceutical agents currently available in higher income nations. Recent medical innovation has tended to focus on problems affecting populations in developed countries and avoid those found exclusively or predominantly in LMICs. The etiology of these disparities is multifactorial, and can include high costs of products, inadequate cooperation between governments and aid agencies, rigid protection of intellectual property rights, and poor local health leadership regarding dissemination of products.Over the past two decades, there have been growing efforts to reduce global disparities in availability of essential medicines. At the forefront of these efforts have been international agencies such as the World Health Organization, or groups like Médicins Sans Frontières and Partners in Health, which have helped set international health priorities and sought to improve local health care delivery systems.

scholarly journals A Study of Prescription Practice for Drugs in Rural Area of Dehradun, Uttarakhand, Using WHO Indicators

1970 ◽  
Vol 7 (1) ◽  
pp. 37-45
Author(s):  
Nautiyal Himani ◽  
Bani Pankaj ◽  
Prajapati Himani ◽  
Shakir Saleem
Keyword(s):  
Developing Countries ◽  
Drug Use ◽  
Rural Area ◽  
Generic Drugs ◽  
Care Delivery ◽  
Essential Medicines ◽  
World Health ◽  
Who Guidelines ◽  
The World ◽  
Study Population

Background It has been seen in recent decades that there is a lot of development in the field of medicine all over the world. This leads to flooding of medicines in the market. Developing countries are also not behind in this regard but there is lack of standards at all levels for medical treatment. The health care delivery system should be improved to secure the quality of life. In the case of Indian markets, it is also consumed with more than 70,000 formulations, compared to approximately 350 formulations listed in the World Health Organization (WHO) Essential Drug List. Several studies conducted in different regions of India have reported that most prescriptions in India are of drugs with “unclear efficiency.” Developing countries need to promote rational drug use which can be achieved by assessing the drug use patterns with the WHO drug use indicators Objective The present study was conducted in a rural area of Dehradun to assess the medicine prescriptions patterns among health facilities in this area using WHO Medication Use indicators. Material and Method: In this study, one hundred patients were interviewed about their socioeconomic statues along with complete medication history and ongoing medications, in a prescribed format. WHO guidelines were used for analyzing the data using Microsoft excel. The study was conducted in danda lakhond a rural area of Dehradun, Uttarakhand. Result We encountered various astonishing results in this study. The gender ratio for the present study was (78:22) for male: female subjects. Socioeconomic status of the study population was significantly good concerning literacy as only 03% of people were illiterate. Total prescribed drug products were 152; this indicates that an average number of drugs per prescription was 1.52. The generic drugs prescribed in this study were 113 which are 74% of the total number of drugs prescribed. When compared with (National List of essential medicines) of India nearly all prescribed drugs (n=152, 98 %) were included in the list. The present study included 10 therapeutic categories of the Prescribed drug, most prescribed drugs (n=34, 34%) were antibiotics in the study area and least prescribed drugs were antiviral drugs i.e. Only (n=03, 3%). Discussion The present study was an attempt to identify the prescribing pattern of drugs in a rural area of Dehradun Uttarakhand. A small study population was interviewed for this assessment. We concluded that prescription practices were good and WHO standards were followed in prescribing the medicines. Although, some parameters should also be corrected for WHO guidelines such as usage of antibiotics in prescriptions practices, average medicines prescribed per patient, and information regarding dosage form prescribed to patients.

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