Intervention to Improve Diarrhea-Related Knowledge and Practices Among Informal Healthcare Providers in Slums of Kolkata

Overview

Journal J Infect Dis

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2021 Oct 31

PMID 34718638

Citations 1

Authors

Tanmay Mahapatra

Sanchita Mahapatra

Nandini Datta Chakraborty

Aparna Raj

Bhawani Bakshi

Barnali Banerjee

Snehasish Saha

Abhijit Guha

Shanta Dutta

Suman Kanungo

Affiliations

Soon will be listed here.

Abstract

Background: In the densely populated slums of Kolkata, informal healthcare providers' (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance.

Methods: A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation.

Results: Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved.

Conclusions: Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up.

Citing Articles

Leveraging the social networks of informal healthcare providers for universal health coverage: insights from the Indian Sundarbans.

Brahmachari R, Mishra M, Gotsadze G, Mandal S Health Policy Plan. 2024; 39(Supplement_2):i105-i120.

PMID: 39552346 PMC: 11570831. DOI: 10.1093/heapol/czae060.

References

Tawfik Y, Nsungwa-Sabitii J, Greer G, Owor J, Kesande R, Prysor-Jones S . Negotiating improved case management of childhood illness with formal and informal private practitioners in Uganda. Trop Med Int Health. 2006; 11(6):967-73. DOI: 10.1111/j.1365-3156.2006.01622.x. View

Dutta A, Pattanaik S, Choudhury R, Nanda P, Sahu S, Panigrahi R . Impact of involvement of non-formal health providers on TB case notification among migrant slum-dwelling populations in Odisha, India. PLoS One. 2018; 13(5):e0196067. PMC: 5965830. DOI: 10.1371/journal.pone.0196067. View

Sharma D . India still struggles with rural doctor shortages. Lancet. 2015; 386(10011):2381-2. DOI: 10.1016/S0140-6736(15)01231-3. View

Allen L, Nicholson B, Yeung B, Goiana-da-Silva F . Implementation of non-communicable disease policies: a geopolitical analysis of 151 countries. Lancet Glob Health. 2019; 8(1):e50-e58. PMC: 7024987. DOI: 10.1016/S2214-109X(19)30446-2. View

Lakshminarayanan S, Jayalakshmy R . Diarrheal diseases among children in India: Current scenario and future perspectives. J Nat Sci Biol Med. 2015; 6(1):24-8. PMC: 4367049. DOI: 10.4103/0976-9668.149073. View

Das S, Barnwal P . The need to train uncertified rural practitioners in India. J Int Med Res. 2017; 46(1):522-525. PMC: 6011317. DOI: 10.1177/0300060517724948. View

Das J, Chowdhury A, Hussam R, Banerjee A . The impact of training informal health care providers in India: A randomized controlled trial. Science. 2016; 354(6308). DOI: 10.1126/science.aaf7384. View

. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018; 18(11):1211-1228. PMC: 6202444. DOI: 10.1016/S1473-3099(18)30362-1. View

Rogawski E, Westreich D, Becker-Dreps S, Adair L, Sandler R, Sarkar R . Antibiotic treatment of diarrhoea is associated with decreased time to the next diarrhoea episode among young children in Vellore, India. Int J Epidemiol. 2015; 44(3):978-87. PMC: 4607743. DOI: 10.1093/ije/dyv040. View

10.

Bhatnagar S, Lodha R, Choudhury P, Sachdev H, Shah N, Narayan S . IAP Guidelines 2006 on management of acute diarrhea. Indian Pediatr. 2007; 44(5):380-9. View

11.

Kataria I, Siddiqui M, Gillespie T, Goodman M, Dhillon P, Bann C . A research agenda for non-communicable disease prevention and control in India. Health Res Policy Syst. 2020; 18(1):126. PMC: 7597004. DOI: 10.1186/s12961-020-00639-0. View

12.

Rao P, Kabra S . Use of drugs and cost of treatment of diarrhea in secondary level government hospitals in maharashtra. Indian J Pharm Sci. 2010; 72(3):404-8. PMC: 3003182. DOI: 10.4103/0250-474X.70498. View

13.

Sudhinaraset M, Ingram M, Lofthouse H, Montagu D . What is the role of informal healthcare providers in developing countries? A systematic review. PLoS One. 2013; 8(2):e54978. PMC: 3566158. DOI: 10.1371/journal.pone.0054978. View

14.

Das M, Angeli F, Krumeich A, van Schayck O . The gendered experience with respect to health-seeking behaviour in an urban slum of Kolkata, India. Int J Equity Health. 2018; 17(1):24. PMC: 5813424. DOI: 10.1186/s12939-018-0738-8. View

15.

Ghimire M, Pradhan Y, Maskey M . Community-based interventions for diarrhoeal diseases and acute respiratory infections in Nepal. Bull World Health Organ. 2010; 88(3):216-21. PMC: 2828786. DOI: 10.2471/BLT.09.065649. View

16.

Kaboru B, Uplekar M, Lonnroth K . Engaging informal providers in TB control: what is the potential in the implementation of the WHO Stop TB Strategy? A discussion paper. World Health Popul. 2011; 12(4):5-13. DOI: 10.12927/whp.2011.22235. View

17.

Mishra K, Mohapatra I, Kumar A . A study on the health seeking behavior among caregivers of under-five children in an urban slum of Bhubaneswar, Odisha. J Family Med Prim Care. 2019; 8(2):498-503. PMC: 6436246. DOI: 10.4103/jfmpc.jfmpc_437_18. View

18.

Gautham M, Shyamprasad K, Singh R, Zachariah A, Singh R, Bloom G . Informal rural healthcare providers in North and South India. Health Policy Plan. 2014; 29 Suppl 1:i20-9. PMC: 4095923. DOI: 10.1093/heapol/czt050. View

19.

Shah D, Choudhury P, Gupta P, Mathew J, Gera T, Gogia S . Promoting appropriate management of diarrhea: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr. 2012; 49(8):627-49. DOI: 10.1007/s13312-012-0134-1. View

20.

Patel R, Stoklosa H, Shitole S, Shitole T, Sawant K, Nanarkar M . The high cost of diarrhoeal illness for urban slum households-a cost-recovery approach: a cohort study. BMJ Open. 2013; 3(4). PMC: 3641490. DOI: 10.1136/bmjopen-2012-002251. View