Assessment of the effect of training on management of acute diarrhoea in a primary health care setting.

Health care providers were trained to treat patients with acute diarrhoea using WHO-recommended oral rehydration therapy (ORT) in a rural area of Haryana, India. One year after the completion of the training programme, the diarrhoea management practices of these trainees were observed while they were treating 240 children with acute diarrhoea. The patients were treated by 12 Multipurpose Health Workers (MPHW), 12 Community Health Guides (CHG), and 11 childcare volunteers, called Anganwadi Workers (AWW), in 12 randomly selected villages. In addition, 9 doctors practising in Primary Health Centres and in a 50-bed hospital were also studied. The assessment of patients on the basis of the history of illness taken and the results of physical examinations varied significantly between the various health functionaries. Doctors assessed dehydration in 80% of patients, MPHWs in 65%, CHGs in 60% and AWWs in only 45% of patients (p less than 0.05). Oral rehydration solution (ORS) was given to every case. However, anti-microbial and anti-diarrhoeal drugs were used at a significantly higher rate by doctors than by other functionaries (p less than 0.05). The method of ORS preparation was explained to most (85-90%) of the parents by all types of functionaries but the quantity to be given to the child was told by doctors to 67%, MPHWs to 60%, CHGs to 63% and AWWs to only 43% of patients. Advice on feeding normal food during diarrhoea was either not given or restrictions to food intake were suggested by all types of functionaries. However, continuation of breast feeding during treatment was advised by all types of functionaries for the majority of patients.