Summary:

Knowledge, attitude, practice, and prescribing pattern of oral rehydration therapy among private practitioners in Nigeria.

To determine the knowledge, attitude, and practice of oral rehydration therapy (ORT) among private medical practitioners in Enugu, Nigeria, 91 doctors were interviewed using a structured questionnaire. All the doctors had heard of ORT and believed in its efficacy. The commonest source of information on ORT was the medical school (44%). Fifty percent would recommend salt-sugar solution (SSS) rather than oral rehydration solution (ORS). The main reason is its cost-effectiveness and easy availability. Only 55% of the respondents knew how to prepare SSS correctly. The percentage of doctors who prescribe smooth muscle relaxant (spasmolytic use rate) was 41%, and the commonest reason for its use was to reduce bowel movement. The influence of year of medical graduation on spasmolytic use was found to be statistically significant (p < 0.05). Antibiotics were commonly used, although most (76%) doctors believed that viral infections were a common cause of childhood diarrhoea. All the respondents would recommend continued breastfeeding during diarrhoeal episodes. The study revealed a high rate of inappropriate drug use and a deficiency in the knowledge and practice of ORT.

PIP: In June 1994, in Enugu, Nigeria, interviews were conducted with 91 physicians (87% male, 13% female) working in 74 registered private hospitals/clinics to determine their knowledge, attitude, and practice of prescribing oral rehydration therapy (ORT) among private practitioners in Enugu. 53% had graduated from medical school after implementation of the ORT program in Nigeria. 42% had undergone specialist training. All 91 physicians had heard of ORT and believed in its efficacy. Yet 29% would prescribe intravenous fluids as the first line of treatment in cases of moderate dehydration. Knowledge sources included medical school (44%), medical journals (26%), and mass media (22%). 50% would use sugar-salt solution (SSS) while 18% would use oral rehydration salts (ORS). The leading reason for choosing SSS was cost-effectiveness and easy availability (81%). Only 4% would choose it because the World Health Organization recommends it. Only 55% of the physicians knew how to correctly prepare SSS. 58% prescribed antibiotics to treat diarrhea. Yet 76% knew that a virus is responsible for most cases of diarrhea. 40% would prescribe spasmolytics, largely to reduce bowel movement. Physicians who graduated before 1985 were more likely to use spasmolytics than those who graduated after 1985 (p 0.05). 92% would advise more fluid intake during a diarrhea episode. 40% would advise more food intake. 8% would advise no food intake. No physician would advise against fluid intake. All physicians advised continued breast feeding during a diarrhea episode. These findings show a need to expand ORT promotion among physicians through workshops, seminars, and other training programs. These training venues should focus on the limited usefulness of drugs in managing most cases of childhood diarrhea.

Authors: Okeke, T.  A.; Okafor, H.  U.; Amah, A.  C.; Onwuasigwe, C.  N.; Ndu, A.  C.

Journal: J Diarrhoeal Dis Res. 1996 Mar;14(1):33-6.