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Despite oral rehydration salts being a cost-effective treatment for diarrheal diseases, which are a significant cause of child mortality worldwide, health care providers in developing countries, especially in India, seldom prescribe it due to misperceptions about patient preferences, contributing to persistent low usage rates.
“Even when children seek care from a health care provider for their diarrhea, as most do, they often do not receive ORS, which costs only a few cents and has been recommended by the World Health Organization for decades,” said Neeraj Sood, senior author of the study, a senior fellow at theSchaeffer Center for Health Policy & Economics and a professor at the USC Price School of Public Policy.
To test these three hypotheses, Sood and his colleagues enrolled over 2,000 healthcare providers across 253 medium-size towns in the Indian states of Karnataka and Bihar. The researchers selected states with vastly different socioeconomic demographics and varied access to health care to ensure the results were representative of a broad population. Bihar is one of the poorest states in India with below-average ORS use, while Karnataka has above-average per capita income and above-average ORS use.
Providers were randomly assigned to patient visits where patients expressed a preference for ORS, a preference for antibiotics, or no treatment preference. During the visits, patients indicated their preference by showing the healthcare provider a photo of an ORS packet or antibiotics. The set of patients with no treatment preference simply asked the physician for a recommendation.
“Despite decades of widespread knowledge that ORS is a lifesaving intervention that can save lives of children suffering from diarrhea, the rates of ORS use remain stubbornly low in many countries such as India,” said Manoj Mohanan, co-author of the study and professor of public policy, economics, and global health at the Sanford School of Public Policy at Duke University. “Changing provider behavior about ORS prescription remains a huge challenge.
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