Providers' Assumptions Limit Use of Child Diarrhea Treatment

Healthcare providers' assumptions about patient preferences drive underutilization of lifesaving oral hydration salts (ORS) in treating childhood diarrhea in low- and middle-income countries (LMICs), according to a new report. Interventions to change provider's perceptions of patients' ORS preferences could increase ORS use and reduce child mortality from diarrhea worldwide, the findings suggest. OHS are a widely available, highly effective, and low-cost treatment for child diarrhea. However, despite diarrhea being the second leading cause of death for children in LMICs – with nearly half a million children under five dying from the condition each year – few healthcare providers prescribe their use, even though the vast majority know that ORS are a lifesaving treatment. For example, in India, where nearly a quarter of all childhood deaths from diarrhea occur, more than 75% of caretakers seek care from private providers, and of these, 45% do not receive ORS. Understanding why this "know-do" gap occurs could translate to millions of young lives saved. To determine the factors underlying this gap, Zachary Wagner and colleagues designed and implemented several randomized controlled trials among 2,282 private healthcare providers across 253 towns in India where trained actors were asked to play the role of a father seeking care for their two-year-old child who had diarrhea. Wagner et al. discovered three barriers driving underutilization of ORS – providers assuming patients weren't interested in ORS; incentives to prescribe more lucrative but inappropriate medicines, like antibiotics; or incentives to sell non-ORS alternatives when ORS were out of stock. According to the findings, provider perceptions of patient preference play the largest role in underperceiving ORS – assuming a patient's lack of interest in receiving ORS accounted for 42% of underprescribing. Financial incentives and stock-outs explain only 6% and %5, respectively. Patients who indicated a preference for ORS doubled the likelihood of receiving them. The findings reveal the importance of interventions to change providers' perceptions to achieve best patient outcomes.