Treatment Gaps and Hospitalizations in Children Under Five with Diarrhea in India

A recent study investigated geographical variations in children under five for diarrhea-associated –prevalence, oral rehydration solution (ORS), and zinc supplementation treatment gaps, as well as hospitalization rates in India. Diarrhea is the third leading cause of under-five mortality in the country, with the potential to avert 93% of deaths through ORS and zinc usage. 

This cross-sectional retrospective secondary-data analysis aimed to measure district-wise treatment gaps, study health facility visits, and hospitalization rates, and analyze the association between treatment gaps and health outcomes across districts. The study used data from the National Family Health Survey (NFHS) 5 and the Health Management and Information System (HMIS) – for 2019-20.

The findings depicted that India ranks second in under-five diarrheal disease burden and mortality. ORS and zinc utilization rates for under-five diarrhea were 60.6% and 30.5%, respectively. The analysis underscored geographical disparities, with treatment gaps observed in western Maharashtra, Andhra Pradesh, and Gujarat.

While the Advanced Pediatric Life Support (APLS) formula effectively prevented bronchial intubation in Indian children aged 1 to 12 years, it tended to overestimate ET depth in approximately 50% of cases when considering the 'safe distance criteria.' The study emphasized the importance of verifying the ET tip's position through early post-intubation X-rays and making necessary adjustments.

In inference, the results highlight the need for targeted interventions to increase ORS and zinc uptake in low-utilization areas and allocate health system resources to districts with higher hospitalization rates. 

However, caution is advised in interpreting the results due to the lack of data for several districts. Further research with larger sample sizes is recommended to validate these findings and assess additional factors for a more comprehensive evaluation.

Source: Dubey S, Shrinivas D, Wadhwani V, Zadey S. Indian Pediatrics. 2023 Nov;60(11):955-7.