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Indian Journal of Community Medicine

Pattern of Use of Drugs for Treatment of Acute Respiratory Infections in Childred by Female Health Workers in Rewa Division of Madhya Pradesh

Author(s): Nirmal Verma, S.S. Kushwah

Vol. 25, No. 3 (2000-07 - 2000-09)

Deptt. of Community Medicine, S.S. Medical College, Rewa (M.P.)

Abstract:

Research question: What are the drugs used by Female Health Workers for the treatment of pneumonia and common cold?

Objectives: 1. To study the pattern of use of drugs with doses and duration for treatment of ARI in children by Female Health Workers. 2. To compare the knowledge and practices related to treatment of ARI among trained and untrained (for CSSM) Female Health Workers.

Study design: Cross-sectional.

Setting and Participants: Female Health Workers from 5 CHCs and 1 Institutional Hospital of Rewa Division.

Study period: August 1998 to August 1999.

Sample size: 146 Female Health Workers of Rewa Division.

Statistical Analysis: Chi-Square test.

Results: Data analysis of 146 Female Health Workers interviewed revealed that 49.31% health workers advised co-trimoxazole for treatment of pneumonia, out of them only 34.72% mentioned proper doses and duration. 50.69% Female Health Workers prescribed unjustified combination of antibiotics. 45.89% of Female Health Workers prescribed steroid drugs and 11.64% cough syrups. 63.70% Female Health Workers advised antibiotics in common cold (viral infection).

Keywords: Acute respiratory infection (ARI), Drug use, Female health workers

Introduction:

In the world, more than eleven million children die from the effects of disease and inadequate nutrition each year. Acute respiratory infection is one of the major cause of deaths in children. It is estimated that about four million deaths occur among children under five years in developing world annually due to ARI1-6. They are also an important cause of morbidity in children7. An estimated 7,80,000 deaths under five annually are due to ARI in India. By using standard techniques 70% of lives currently being lost due to ARI could be saved7.

Our knowledge of the way in which the existing health personnel services and facilities are utilized is abysmal, still less is known about the knowledge and skill of those who make use of such facilities. The present study was carried out to find the pattern of use of drugs in the treatment of ARI by female health workers in Rewa division of M.P.

Material and Methods:

The criteria provided by World Health Organization and Govt. of India for the management of Acute Respiratory Infection was applied in this study7,8,9. This study was conducted among female health workers in Rewa division of Madhya Pradesh, which includes Rewa, Satna, Sidhi, Shahdol districts. Female health workers posted in five Community Health Centres and one Hospital were included in this study. Total 146 female health workers (10.14% of total female health workers of Rewa Division) were observed over one year from August 1998 to August 1999. The pre-tested questionnaire was used for assessment. The questions were asked in Hindi. The health workers were approached during their monthly meeting at their respective Community Health Centres. The aims, objectives and nature of study were properly explained to them. The secrecy of their identity was assured. Among these female health workers 125 were trained for national CSSM programme while 21 were not trained for it.

Results:

Table I: Drugs used by female health workers for the treatment of Pneumonia.

Drugs Trained for CSSM Untrained for CSSM Total
No. (%) No. (%) No. (%)
Co-trimoxazole 65 (52.00) 07 (33.33) 72 (49.31)
Unjustified combination of antibiotics 60 (48.00) 14 (66.67) 74 (50.69)
Paracetamol 93 (74.40) 12 (57.14) 105 (71.91)
Steroids 55 (44.00) 12 (57.14) 67 (45.89)
Cough syrups 14 (11.20) 04 (19.05) 18 (12.33)
Total 125 (100.00) 21 (100.00) 146 (100.00)

p<0.01

Only 49.31% (52% trained and 33.33% untrained) female health workers advised co-trimoxazole for treatment of pneumonia. 50.69% (48% trained and 66.67% untrained) female health workers advised unjustified combination of two or more antibiotics like co-trimoxazole, ampicillin, amoxycillin, gentamycine, erythromycine, ciprofloxacillin etc. 71.91% (74.4% trained and 57.14% untrained) female health workers advised paracetamol to treat the fever but only half of them advised correct doses. 45.89% (44% trained and 57.14% untrained) female health workers advised steroid drugs like dexamethasone and betamethasone. 12.33% (11.2% trained and 19.05% untrained) female health workers advised cough syrups.

Table II: Knowledge of dosage and duration of Paracetamol and Co-trimoxazole for treatment of ARI among female health workers.

Drugs Dosage
and
duration
Trained for CSSM Untrained for CSSM Total
No. (%) No. (%) No. (%)
Paracetamol Correct 46 (49.46) 05 (41.57) 51 (48.57)
Incorrect 47 (50.54) 07 (58.33) 54 (51.43)
Total 93 (100.00) 12 (100.00) 105 (100.00)
Co-trimoxazole Correct 25 (38.47) - - 25 (34.72)
Incorrect 40 (61.53) 07 (100.00) 47 (65.28)
Total 65 (100.00) 07 (100.00) 72 (100.00)

Only 34.72% (38.47% trained and no untrained) knew correct dosage and duration of co-trimoxazole.

Table III: Drugs used for treatment of No Pneumonia (Common cold) by female health workers.

Drugs Trained for CSSM
No.(%)
Untrained for CSSM
No.(%)
Total
No.(%)
Home remedies 50 (40.00) 03 (14.29) 53 (36.30)
Antibiotics 75 (60.00) 18 (85.71) 93 (63.70)
Total 125 (100.00) 21 (100.00) 146 (100.00)

p<0.02

In case of no pneumonia (common cold) only 36.3% (40% trained and 14.29% untrained) female health workers advised home remedies while 63.7% (60% trained and 85.71% untrained) advised antibiotics for the same.

Discussion:

All female health workers advised antibiotics for treatment of pneumonia but inappropriate treatment (type of antibiotic, dose and duration) was observed in 82%. In contrast to above observations, Hui L et al6 noted inappropriate antibiotics treatment in 63% of cases. In present study, inappropriate treatment was more observed among untrained group. Among female health workers antibiotics abuse (antibiotics for presumably viral infection) was observed in 63.7% and severe antibiotic abuse (such as advise of unjustified combination of 2 or more antibiotics) was detected in 50.69% which was significantly higher among untrained female health workers. In contrast to above observations, Hui L6 found antibiotics abuse in 97% cases and severe abuse in 37%. Majority of female health workers prescribed paracetamol for the treatment of fever. Steroids were advised by about half of female health workers and it was more among untrained female health workers. Cough syrup abuse was also more among untrained female health workers. It was also observed that knowledge of proper home remedies was deficient among female health workers.

Conclusion:

The observations of the present study indicate that female health workers who were exposed to CSSM training had significantly (p<0.05) better knowledge and practices related to treatment of ARI as compared to those who were not trained. Antibiotics abuse in treatment of ARI is a serious problem among female health workers in Rewa division of Madhya Pradesh, potentially may lead to widespread antibiotics resistance and wastage of the resources. Use of steroid drugs and cough syrups are also serious problems. These practices are harmful to the children. The impact of training was clearly seen in present study but some harmful practices were seen among trained female health workers also.

Recommendations:

  1. It is need of the hour as well as need of community to train untrained female health workers regarding ARI control.
  2. Refresher courses should be conducted for trained female health workers.
  3. The training should be on the job, more emphasis to be given on skill development rather than theory lectures.
  4. More attention to be given for rational drugs use in management of ARI during training programme.

References:

  1. Brewster DR et al: Evaluation of the ARI programme: a health facility survey in Simbu, Papua, New Guinea. PN J. 1993 Dec.; 36(4): 285-96.
  2. Fabbule et al: Case management of community health workers of children with Acute Respiratory Infection. Implications for National ARI control programme. J. Trop. Med. Hyg. 1995 Aug.; 98(4): 241-6.
  3. Farrow J et al: Management of children with ARI and diarrhoea in Addis Ababa, Ethiopia. Ethiop. Med. J. Oct. 1996; 34(4): 225-31.
  4. Govt. of India (1990): Acute Respiratory Infection in children. Ministry of Health and Family Welfare, Govt. of India.
  5. Govt. of India (1995): National Child Survival and Safe Motherhood Programme, book for health workers. M.C.H. Div., Ministry of Health and FAmily Welfare, Govt. of India.
  6. Hui L et al: Patterns and determinants of use of antibiotics for ARI in children in China. Pedia. Infect dis. J. June 1997; 16(6): 560-4.
  7. Improving Child Health: IMCI: The integrated approach, WHO/CHD/97, 12-Rev-1.
  8. Kapoor SK et al: Knowledge, attitude and practices regarding Acute Respiratory Infections. Indian J. Paedia. 1990 Aug; 57(4): 533-5.
  9. World Health Organization, (1995): The management of acute respiratory infections in children.
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