title: Management of childhood diarrhea among private providers in Uttar Pradesh, India.
abstract: BACKGROUND
  In Uttar Pradesh (UP), India, a new initiative to introduce zinc and reinvigorate ORS for diarrhea treatment in the public and private sectors was rolled out in selected districts. We conducted an external evaluation of the program that included assessing the knowledge and practices of private sector providers 6 months after the initial program rollout.
  
  
  METHODS
  We conducted interviews and direct observations among a randomly selected group of formal and informal private sector providers in 12 districts of UP. We calculated summary statistics for reported provider characteristics, diarrhea treatment knowledge and preferred treatments, as well as the treatments advised during consultation with a child with diarrhea.
  
  
  RESULTS
  We interviewed 232 providers, of whom 67% reported receiving a diarrhea treatment training/drug detailing visit. In the interview, 14% of providers reported prescribing zinc to all children with diarrhea and 36% reported prescribing zinc to more than half of diarrhea cases. During direct observation, ORS and zinc were prescribed by 77.3% and 29.9% of providers, respectively. Treatments other than zinc and ORS were also commonly prescribed, including antibiotics (61.9%) and antidiarrheals (17.5%).
  
  
  CONCLUSIONS
  Adequate treatment of childhood diarrhea with zinc and ORS remains a challenge among private sector providers in rural UP, India. Additional training and knowledge transfer activities are needed to curb the overprescription of antibiotics and antidiarrheals and to increase the confidence of private providers in advising zinc and ORS. In addition, policymakers and program implementers must ensure collaborative efforts to target and meaningfully engage informal private providers who play a major role in childhood diarrhea treatment in hard-to-reach areas.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors.forename: Christa L
authors.initials: CL
authors.lastname: Fisher Walker
authors.affiliation: Society for Applied Studies, New Delhi, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Lamberti
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors.forename: Amnesty
authors.initials: A
authors.lastname: Lefevre
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Black
authors.affiliation: Society for Applied Studies, New Delhi, India.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000930:Antidiarrheals / Q000627:therapeutic use; D002675:Child, Preschool; D003967:Diarrhea / Q000628:therapy*; D019468:Disease Management; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007194:India; D007223:Infant; D007407:Interviews as Topic; D010818:Practice Patterns, Physicians'; D017149:Private Sector; D012424:Rural Population; D015032:Zinc / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D000930:Antidiarrheals; D015032:Zinc