Children living in rural India are treated wrongly for diarrhea and pneumonia, which are the 2 leading killers of young ones worldwide. Manoj Mohanan, a professor at Duke University and lead author of the study, said that medical practitioners typically fail to prescribe lifesaving treatments such as oral rehydration salts (ORS). Instead, they typically prescribe unnecessary antibiotics or other potentially harmful drugs.
Diarrhea and pneumonia accounted for 24 percent of deaths among children 1 to 4 years old, totaling approximately 2 million deaths worldwide in 2011. Bihar, India, where the study was conducted, has an infant mortality rate of 55 per 1000 live births, the highest in the country.
Mohanan said that 80 percent medical providers in their study had no medical degree. But much of India’s rural population receives care from such untrained providers, and very few studies have been able to rigorously measure the gap between what providers know and what they do in practice.
The study involved 340 health care providers. Researchers conducted “vignette” interviews with providers to assess how they would diagnose and treat a hypothetical case. Later, standardized patients – individuals who portrayed patients presenting the same symptoms as in the interviews – made unannounced visits. This strategy enabled researchers to measure the gap between what providers know and what they actually do – the “know-do” gap.
Providers exhibited low levels of knowledge about both diarrhea and pneumonia during the interviews and performed even worse in practice. In practice, none of them gave the correct treatment: only ORS, with or without zinc, and no other potentially harmful drugs. Instead, almost 72 percent of providers gave antibiotics or potentially harmful treatments without ORS.
The results show that in order to reduce child mortality, there was a need of strategies to improve diagnosis and treatment of these key childhood illnesses. They needed to understand what incentives cause providers to diverge from proper diagnosis and treatment, Mohanan said.