The Know-Do Gap in Medical Management of Acute Diarrhea in Gaza City

Abstract

Programs aiming to reduce the burden of diarrhea among children in lower source settings typically raise awareness regarding evidence-based guidelines, however, studies have suggested that provider's knowledge are not necessarily translated into adequate practice. To compare between the medical management knowledge and practices of acute diarrhea regarding the WHO guidelines, a cross-sectional study was conducted in Gaza city (May to August 2016), in order to improve medical adherence to these guidelines. The interview-based questionnaires targeted all physicians working at AL-Nassr and Al-Durra pediatric hospitals (102 physicians) to identify their knowledge regarding the guidelines. The response rate was 93%. Also, a retrieval sheet was used to identify their actual practices, where 301 acute diarrhea cases' records were retrieved. Most of Acute Diarrhea danger signs (3 and 4 compatible signs) was 10.6% in the knowledge v/s 18.9% in the practice. Most of dehydration signs (2 and 3 correct signs) were 71.1% in the knowledge v/s 47.5% in the practice. The percentage of correct classification of dehydration was only 4.2% in the knowledge v/s 27% in the practice. Though the percentage of requesting serum electrolytes was 88.4% in the knowledge, 54.2% of the records contained them. The sharp differences between knowledge and practices were found in the correct indication of IV fluids and the use of zinc during management of acute diarrhea, where the percentages 85.3%, and 86.3% respectively were in knowledge, compared with 16.3%, and 24.3% in the practice. The opposite was found in the use of antiemetics (24.2% VS 65.1%), antimicrobials (18.9% VS 59.1%), and the correct indications of ORS (23.2% VS 65.4%). Regarding the use of antidiarrheal, the difference between knowledge (4.2%) and practice (5.6%) was very small. The pediatricians reported that the largest problem impeding application of the guidelines was workload (48.5%). The relations were highly statistically significant in all of the comparison aspects, except in the number of identified danger signs and in the use of antidiarrheal (P-value were 0.367 and 0.586, respectively). The researcher called for the importance of adoption and application of the WHO diarrheal disease management guidelines as well as the need for audit and regular feedback.