Assessment of prescription pattern of under-five diarrhea cases in Western Odisha

Abstract

Introduction: Diarrhea is the second leading cause of death among under-five children. Prescription review by the authorities of the health facilities every month for the improvement of the quality of prescription writing of Medical practitioners is very essentials. With this background, the present study was conducted to assess the prescription patterns of healthcare providers for under-five diarrhea cases and to study the factors responsible for nonadherence to protocol of prescription patterns. Methodology: This cross-sectional study was conducted in the health facilities of two aspirational districts of Odisha. All secondary- and tertiary-level health institutions with 2–3 randomly selected PHCs of that blocks of the two districts were the study units. Mixed methods were used for data collection. Primary data were collected by in-depth interview of doctor and pharmacist. Secondary data were collected by review of records such as OPD ticket, IPD ticket, OPD register, dispensing register, and stock registers. Results: Of the 64 health facilities visited, a total of 516 prescriptions [217 (42%)] scanned/carbon copy of OPD ticket, 238 (46%) data from register on drug prescription, and 61 (11.8%) IPD record data were collected. Duration of diarrhea illness was not mentioned in any of the prescriptions which is important criteria for classifying the type of diarrhea and treatment. Signs of dehydration and degree of dehydration were mentioned in very few prescriptions of both the district. For the treatment of diarrhea cases, 2 to 4 medicines were prescribed in majority of 146 (67.3%), followed by more than four medicines in 38 (17.5%) prescriptions, and less than two medicines were prescribed in 33 (15.2%) cases. All prescriptions from MCH and SDH had ORS and zinc. Though all of them knew about the management protocol as per IMNCI, to be on the safe onside they used to prescribe more medicines to under-five diarrhea cases. None had the knowledge on five types of management plan. Conclusion: For under-five diarrhea cases, care should be taken to write the detail examination finding, weight of the child, associated comorbid condition, and advice on feeding in the prescription.