Skip to main content Accessibility help
×
Home

Treatment by untrained providers among sick infants in rural Odisha, India

  • Mousumi Samal (a1), Nabin Khara (a2), Sanghamitra Pati (a1) and Krushna Chandra Sahoo (a1)

Abstract

Aim:

This study assessed the diagnosis, treatment and referral service provided by untrained providers for sick infants.

Background:

In rural India, lack of trained providers causes inopportune treatment of sick infants and results in increase in child morbidity and mortality. The untrained providers deliver a significant proportion of health care for rural infants; however, there is a paucity of information on their treatment practice.

Method:

A cross-sectional study was conducted in three rural blocks of Odisha. A total of 337 prescriptions recommended for sick infants were collected from the 15 untrained providers using pre-designed prescription form – designed as per the Integrated Management of Neonatal and Childhood Illness (IMNCI) guideline. The forms were collected through the periodic visit and regular follow-up to the providers.

Findings:

A total of 68% of infants were diagnosed with the possible serious bacterial infection, 56% fever, 10% feeding problems, 9% dysentery and 9% local bacterial infection. A total of 61% of sick infants prescribed antibiotics – cephalosporin was commonly prescribed (56%). Among severe persistent diarrhea-diagnosed infants, 76% prescribed oral rehydration salt (ORS), 48% zinc and 62% of them received various antibiotics. The untrained providers referred 23% of sick infants to trained providers/facilities. In rural settings, most of the sick infants sought care from untrained providers; however, none of them followed any standard treatment protocol. This study suggests there is a need for training on common disease algorithm and treatment using a standard guideline for untrained providers to reduce inopportuneness in the treatment of sick infants, promoting early diagnosis and referral services to public health systems.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Treatment by untrained providers among sick infants in rural Odisha, India
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Treatment by untrained providers among sick infants in rural Odisha, India
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Treatment by untrained providers among sick infants in rural Odisha, India
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Krushna Chandra Sahoo, Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India. E-mail: sahookrushna@yahoo.com

References

Hide All
Bloom, G, Standing, H, Lucas, H, Bhuiya, A, Oladepo, O and Peters, DH (2011) Making health markets work better for poor people: the case of informal providers. Health Policy and Planning 26 (Suppl. 1), i452. Available at: http://www.heapol.oxfordjournals.org/cgi/doi/10.1093/heapol/czr025.
Corscadden, L, Levesque, JF, Lewis, V, Breton, M, Sutherland, K, Weenink, JW, Haggerty, J and Russell, G (2017) Barriers to accessing primary health care: comparing Australian experiences internationally. Australian Journal of Primary Health 23, 223–8.
Das, J, Chowdhury, A, Hussam, R and Banerjee, AV (2016) The impact of training informal health care providers in India: a randomized controlled trial. Science 354, aaf7384. Available at: http://www.sciencemag.org/cgi/doi/10.1126/science.aaf7384.
Das, J and Mohpal, A (2016) Socioeconomic status and quality of care in rural India: new evidence from provider and household surveys. Health Affairs 35, 1764–73. Available at: http://content.healthaffairs.org/cgi/doi/10.1377/hlthaff.2016.0558.
Datta, R (2013) The world of quacks: a parallel health care system in rural West Bengal. IOSR Journal of Humanities and Social Science 14, 4453.
De Costa, A and Diwan, V (2007) Where is the public health sector? Health Policy 84, 269–76. Available at: http://linkinghub.elsevier.com/retrieve/pii/S016885100700098X.
Gautham, M, Binnendijk, E, Koren, R and Dror, DM (2011) ‘First we go to the small doctor’: first contact for curative health care sought by rural communities in Andhra Pradesh &amp; Orissa, India. The Indian Journal of Medical Research 134, 627. Available at: http://www.ijmr.org.in/text.asp?2011/134/5/627/90987.
Gautham, M, Shyamprasad, KM, Singh, R, Zachariah, A, Singh, R and Bloom, G (2014) Informal rural healthcare providers in North and South India. Health Policy and Planning 29 (Suppl 1), i20–9. Available at: http://heapol.oxfordjournals.org/content/29/suppl_1/i20.full.
George, A and Iyer, A (2013) Unfree markets: socially embedded informal health providers in northern Karnataka, India. Social Science and Medicine 96, 297304. Available at: http://dx.doi.org/10.1016/j.socscimed.2013.01.022.
Gopalan, SS, Mutasa, R, Friedman, J and Das, A (2014) Social Science & Medicine Health sector demand-side financial incentives in low- and middle-income countries : a systematic review on demand- and supply-side effects. Social Science & Medicine 100, 7283. Available at: http://dx.doi.org/10.1016/j.socscimed.2013.10.030.
Govt. of India (2011) Census.
Govt. of India (2005) Integrated management of neonatal and childhood illness.
Govt. of India (2011) Janani shishu surakhya karyakram.
Govt. of India (2012) Ministry of health and family welfare.
Islam, QS, Ahmed, SM, Islam, MA, Chowdhury, AS, Siddiquea, BN and Husain, MA (2014) Informal allopathic provider knowledge and practice regarding control and prevention of TB in rural Bangladesh. International Health 6, 225–31. Available at: http://inthealth.oxfordjournals.org/cgi/doi/10.1093/inthealth/ihu025.
Jacobs, B, Bigdeli, M, Annear, PL and Van Damme, W (2011) Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy and Planning 27, 288300.
Jarhyan, P, Singh, B, Rai, SK and Nongkynrih, B (2012) Private rural health providers in Haryana, India: profile and practices. Rural and Remote Health 12, 17.
Kanjilal, B, Mondal, S, Samanta, T, Mondal, A and Singh, S (2013) A parallel health care market: rural medical practitioners in West Bengal, India. Future Health Systems (FHS) Research Brief 2, 4.
Mahmood, SS, Iqbal, M, Hanifi, SM, Wahed, T and Bhuiya, A (2010) Are ‘Village Doctors’ in Bangladesh a curse or a blessing? BMC International Health and Human Rights 10, 18. Available at: http://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/1472-698X-10-18.
Mankar, M, Mehendale, AM, Garg, BS, Gupta, SS, Deshmukh, PR and Maliye, C (2012) Role of Community Health Worker in the treatment of minor ailments among children using IMCI guidelines. Indian Journal of Preventive Social Medicine 43, 325–31.
May, C, Roth, K and Panda, P (2014) Non-degree allopathic practitioners as first contact points for acute illness episodes: insights from a qualitative study in rural northern India. BMC Health Services Research 14, 111.
Nguyen, DT, Leung, KK, McIntyre, L, Ghali, WA and Sauve, R (2013) Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS One 8, e66030.
Pathak, D, Pathak, A, Marrone, G, Diwan, V and Lundborg, CS (2011) Adherence to treatment guidelines for acute diarrhoea in children up to 12 years in Ujjain, India--a cross-sectional prescription analysis. BMC Infectious Diseases 11, 32.
Pettigrew, LM, De Maeseneer, J, Anderson, MIP, Essuman, A, Kidd, MR and Haines, A (2015) Primary health care and the sustainable development goals. The Lancet 386, 2119–21.
Rosamund, A, Edwin, E, Abubakar, A and William, B (2012) Combating Antibiotic Resistance in Tropical Countries – Don’t ignore patent medicine vendors. The Internet Journal of Preventive Medicine 1, 2.
Sharma, C and Mukherjee, K (2014) Maternal healthcare providers in Uttar Pradesh, India: how to position informal practitioners within the system? Journal of Family & Reproductive Health 8, 183.
Sharma, DC (2015) India still struggles with rural doctor shortages. The Lancet 386, 2381–2.
Sudhinaraset, M, Ingram, M, Lofthouse, HK and Montagu, D (2013) What Is the role of informal healthcare providers in developing countries? A systematic review. PLoS One 8, e54978. Available at: http://dx.plos.org/10.1371/journal.pone.0054978.
Topp, SM and Abimbola, S (2018) Call for papers – the Alma Ata Declaration at 40: reflections on primary healthcare in a new era. BMJ Global Health 2, 1.
Walley, J, Lawn, JE, Tinker, A, De Francisco, A, Chopra, M, Rudan, I, Bhutta, ZA, Black, RE and Lancet Alma-Ata Working Group (2008) Primary health care: making Alma-Ata a reality. The Lancet 372, 1001–7.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed