Background: The reason I started HIFA and CHIFA goes back to when I was working as a volunteer doctor in rural Peru in 1987. A dead child was brought to my health post. The child had died minutes before from dehydration, because the parent believed that if a child has diarrhoea then they should not receive fluids. I subsequently learned that this false belief is commonplace worldwide. Furthermore, I learned that many health workers fail to provide oral reydration solution and instead prescribe antibiotics, which typically do more harm than good. Since then I have dedicated my career to the goal of universal access to reliable healthcare information.
I was therefore interested to read about this new paper in Science (below). Regrettably, the full text is restricted-access so most of us cannot read it.
Below is the editor's summary and a comment from me. Th URL is: https://www.science.org/doi/10.1126/science.adj9986
'Diarrhea is a leading cause of child mortality in India. It becomes deadly when excretions exacerbate severe dehydration and loss of electrolytes. Most health care providers in India know that oral rehydration salts (ORS) are an inexpensive, lifesaving treatment for child diarrhea, yet they are widely underused. Wagner et al. undertook randomized controlled trials involving standardized patients (actors trained to seek care for a child’s diarrhea) who visited 2282 private health care providers in India. Trials were designed to identify three barriers driving underutilization: assuming patients lack interest in ORS, incentives to prescribe more lucrative (but inappropriate) medicines, and incentives to sell non-ORS medicines in stock when ORS are unavailable. The dominant barrier was assuming that patients were uninterested, showing that simple interventions could save many lives.'
COMMENT (NPW): Indeed it would be hard to imagine a health worker could go through years of training and *not* know that oral rehydration solution can be lifesaving for a child with diarrhoea. The #1 barrier in this new study is that health workers 'assume patients lack interest in OR'. Extrapolating this globally, the implication is that 500,000 children die every year worldwide due to dehydration from diarrhoea, largely because their parents are 'not interested' (or, rather, that health workers *assume* they are not interested). Either way, something is seriously wrong. If anyone has access to the full text, we would be very interested to learn more.
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
