title: Management of childhood diarrhea by healthcare professionals in low income countries: An integrative review.
abstract: BACKGROUND
  The significant drop in child mortality due to diarrhea has been primarily attributed to the use of oral rehydration solutions, continuous feeding and zinc supplementation. Nevertheless uptake of these interventions have been slow in developing countries and many children suffering from diarrhea are not receiving adequate care according to the World Health Organization recommended guidelines for the clinical management of childhood diarrhea.
  
  
  OBJECTIVE
  The aim of this integrative review is to appraise healthcare professionals' management of childhood diarrhea in low-income countries.
  
  
  METHODS
  Whittemore and Knafl integrative review method was used, in conjunction with the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting observational cohort, case control and cross sectional studies.
  
  
  METHODS
  A comprehensive search performed from December 2014 to April 2015 used five databases and focused on observational studies of healthcare professional's management of childhood diarrhea in low-income countries.
  
  
  RESULTS
  A total of 21 studies were included in the review. Eight studies used a survey design while three used some type of simulated client survey referring to a fictitious case of a child with diarrhea. Retrospective chart reviews were used in one study. Only one study used direct observation of the healthcare professionals during practice and the remaining eight used a combination of research designs. Studies were completed in South East Asia (n=13), Sub-Saharan Africa (n=6) and South America (n=2).
  
  
  CONCLUSIONS
  Studies report that healthcare providers have adequate knowledge of the etiology of diarrhea and the severe signs of dehydration associated with diarrhea. More importantly, regardless of geographical settings and year of study publication, inconsistencies were noted in healthcare professionals' physical examination, prescription of oral rehydration solutions, antibiotics and other medications as well as education provided to the primary caregivers. Factors other than knowledge about diarrhea were shown to significantly influence prescriptive behaviors of healthcare professionals. This review demonstrates that "knowledge is not enough" to ensure the appropriate use of oral rehydration solutions, zinc and antibiotics by healthcare professionals in the management of childhood diarrhea.
authors.affiliation: University of Connecticut, School of Nursing, Storrs, CT, USA. Electronic address: ana.diallo@uconn.edu.
authors.forename: Ana F
authors.initials: AF
authors.lastname: Diallo
authors.affiliation: University of Connecticut, School of Nursing, Storrs, CT, USA.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Cong
authors.affiliation: National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Henderson
authors.affiliation: University of Connecticut, School of Nursing, Storrs, CT, USA; Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: McGrath
mesh_terms: D002675:Child, Preschool; D003906:Developing Countries; D003967:Diarrhea / Q000628:therapy*; D005440:Fluid Therapy; D006801:Humans; D007223:Infant
keywords: Antibiotics use; Childhood diarrhea; Clinical management of childhood diarrhea; Healthcare providers; Low income countries; Oral rehydration therapy; Prescribing behaviors; World Health Organization