Management of acute diarrhea in children by community pharmacists in Lagos, Nigeria
Background: Acute diarrhea in children leads to dehydration and death if not appropriately managed. World Health Organization (WHO) recommends treating diarrhea with oral rehydration therapy (ORT), fluids and foods. Proper management is hinged on accurate assessment of patients to identify the acute watery diarrhea.
Objective: To compare the knowledge and attitude of community pharmacists in the management of acute diarrhea in children with their observed practice.
Methods: This study was carried out using two instruments: structured self-administered questionnaire to assess knowledge and attitude of community pharmacists in the management of acute diarrhea in children and simulated patient visits to evaluate assessment of patients, recommendation of products and instructions on feeding and fluid intake. The simulated patient visits were done in 186 pharmacies in the city of Lagos, Nigeria.
Results: The study reveals that the knowledge and attitude of community pharmacists in the management of acute diarrhea in children was different from their observed practice. The difference was statistically significant (p<0.05). During the simulations, 23% carried out appropriate assessment before recommending any products, and 15% recommended ORT alone. Although information to the pharmacists indicated non-dysentery, non-cholera, acute watery diarrhea, antibiotics and antidiarrheals were irrationally recommended and these were the mainstay of symptoms’ management in practice. Questionnaire data revealed that 24% of pharmacists knew the correct instructions to give on food and fluid intake during diarrhea, whereas 8% followed WHO guideline on food and fluid intake during the visits.
Conclusions: Assessment of patients to determine acute diarrhea was inadequate. Observed practice in managing acute diarrhea in children was inappropriate and significantly different from their claims in the questionnaire. The recommendation of ORT was scanty and advice on food and fluid intake was inadequate and sometimes inappropriate. This study shows that only 15% of community pharmacists managed acute diarrhea in children according to the WHO guidelines.
2. Boschi-Pinto C, Velebit L, Shibuya K. Estimating child mortality due to diarrhea in developing countries. Bull World Health Organ. 2008;86(9):710-717.
3. College of Paediatrics, Academy of Malaysia and Malaysia Paediatric Association. Guidelines on the management of acute diarrhea in children. Available from: http://www.acamed.org.my/ (Accessed August 17, 2013).
4. World Health Organization. The Treatment of Diarrhea: A manual for physicians and other senior health workers. 4th review of document. WHO/CDD/SER/80.2. Geneva: WHO; 2005
5. World Health Organization Diarrheal Disease Control Programme and Federation Internationale Pharmaceutique (FIP). The Treatment of Acute Diarrhea; Information for Pharmacists 1987. WHO CDD/SER/87 11
6. UNICEF/WHO. Diarrrhea-Why children are still dying and what can be done. Available from: http://www.7pointplan.org/global-childhooddiarrhea (Accessed October 8, 2013).
7. Santosham M, Keenan EM, Tulloch J, Broun D, Glass R. Oral Rehydration Therapy for diarrhea: an example of reverse transfer of technology. Pediatrics. 1997;100(5):E10. doi: 10.1542/peds.100.5.e10
8. World Health Organization. The role of the pharmacist in the health care system. WHO/PHARM/94.569 Geneve: WHO; 1994.
9. Saengcharoen W, Lerkiatbundit S. Practice and attitude regarding the management of childhood diarrhea among pharmacies in Thailand. Int J Pharm Pract. 2010;18(6):323-331. doi: 10.1111/j.2042-7174.2010.00066.x
10. Lapeyre-Mestre M, Pin M.Management of acute infantile diarrhea: A study on community pharmacy counseling in the Midi-Pyrénées region. Arch Pediatr. 2004;11(8):898-902.
11. Hussein A, Ibrahim MIM. Management of diarrhea cases by community pharmacists in 3 cities of Pakistan. East Mediterr Health J. 2012;18(6):635-640.
12. Okeke TA, Okafor HU, Amah AC, Onwuasigwe CN, Ndu AC. Knowledge, attitude, practice, and prescribing pattern of oral rehydration therapy among private practitioners in Nigeria. J Diarrhoeal Dis Res. 1996;14(1):33-36.
13. Igun U. Prescribing practices for diarrheal disease by formal and unlicensed pharmacies in Borno State Nigeria. Final report submitted to the ADDR project. 1991.
14. Karim R, Ramdahin P, Boodoo JR, Kochhar A, Pinto Pereira LM. Community pharmacists’ knowledge and dispensing recommendations for the treatment of acute diarrhea in Trinidad, West Indies. Int J Clin Pract. 2004;58(3):264-267.
15. Motala C, Hill ID, Mann MD, Bowie MD. Effect of loperamide on stool output and duration of acute infectious diarrhea in infants. J Pediatr. 1990;117(3):467-471.
16. Vanderhoof JA.. Short bowel syndrome. In: Leenthal E. (ed). Textbook of gastroenterology and nutrition in infancy. 2nd edn. New York: Raven Press Ltd, 1989.
17. Pickering LK. Therapy for acute infectious diarrhea in children. J Pediatr. 1991;118(4 Pt 2):S118-S128.
18. Rehydrationproject. New formulation of oral rehydration salts ORS with reduced osmolarity. 1996-2007. Available from: http://rehydrate.org/ors/low-osmolarity-ors.htm#reduced (Accessed October 8, 2013).