RATIONAL TREATMENT OF DIARRHOEA

Despite the national and international efforts, the inappropriate use of drugs for childhood diarrhoea, often without adequate rehydration therapy, remains a major impedement to the control of diarrhoeal diseases in developing countries. National surveys indicate that adoption of oral rehydration treatment (ORT) is very low and that the use of the pharmaceutical praparations is high for diarrhoea in under-fives. More than 60% of all the diarrhoeal episodes in under-five children were treated with some kind of drugs. The most frequently used drugs were antibiotics, such as Chloramphenicol, Tetracycline, Neomycin, Cotrimoxazole, and anti - motility agents such as Loperamide. Traditional remedies were widely used for diarrhoea. But modern pharmaceutical preparations, which can be easily bought in local shops were also used often in combination with traditional treatments.

The problem, however is not only of so-called "self-medication". Doctors also prescribe this type of drugs. A survey of pattern of drug prescribing found that majority of patients attending health facility or a private clinic for diarrhoea treatment recieved a prescription for anti-biotics and for an anti-diarrhoeal drug. One of the most important consequences, beside the potentially hazardous effect of the medicine, was the unnecessary high cost of the medicine and also its impact on the common people. It is clear that the drug use is a complex problem involving many vested interests.

Despite the fact that many mothers, pharmacists and doctors are aware of the advances in the correct management of diarrhoea, they have a variety of compelling reasons to use treatments that seem to them to be a more satisfactory option. There is still a lack of alternative, which would stop diarrhoea as soon as possible and calm the anxiety of the mothers. Fearful of losing the patients confidence in their prescriptions doctors look for a remedy which can offer a quick solution to the problem. However, there is little awareness of the possible hazardous effect and of the unnecessary cost especially for the poor families.

The ministry of health should organise a series of seminars throughout the country at which correct case management of diarrhoea and the undesirability of anti-diarrhoeals use are discussed with audience of doctors, nurses, internees/residents, pharmacists, and students. These messages should be reinforced through additional teaching sessions and through the mass media. The ministry of health should plan to devote special attention to the problem in the update of the Rational treatment guidelinaes. In addition, the local health activist groups in collabaration with the ministry of health should organize several forums on the subject for medical and pharmaceutical students, prepare popular information folders on anti-diarrhoeals, including the report of the working group and a WHO document on proper case management of diarrhoea.

Encouraging results could be obtained to rationalize the treatment of diarrhoea, only if there is willingness on the part of the scientific community, the ministry of health, international agencies and health activist groups to form a forum and work together to face this problem. In such an integrated approach in educating the practitioners and also the general public clearly lies our best hope for future rational therapy of childhood diarrhoea.