The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico

In Tlaxcala, Mexico, 80% of the children who died from diarrhoea or acute r espiratory infections (ARI) in 1992-1993 received medical care; in more tha n 70% of cases it was provided by a private general practitioner (GP). The present study evaluated the quality of case management by private and publi c GPs to children under Five years of age with diarrhoea and ARI. During th e clinical observation, the treatment and counselling given to the mother w ere assessed with the WHO guidelines as reference standard. A total of 41 p rivate and 40 public GPs were evaluated for the management of diarrhoea, an d 59 private and 40 public GPs for the management of ARI. For diarrhoea, ha lf of the private GPs gave inadequate rehydration therapy, 63% gave incorre ct advice on diet, 66% and 49% made an incorrect decision in the prescripti on of antimicrobial and symptomatic drugs, respectively. Public GPs general ly performed better in diarrhoea management: 7% gave inadequate rehydration therapy, 13% gave wrong advice on diet, 3% made a wrong decision in the pr escription of symptomatic drugs and 28% gave a wrong decision in antimicrob ial prescription. In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drug s, respectively, compared to 30% and 20% of public GPs, respectively. Couns elling to the mother given by both private and public GPs was considered in adequate in most cases of diarrhoea and ARI. These results clearly show tha t private doctors, as important providers of medical care, need to be inclu ded in the strategies to improve the quality of care of children with diarr hoea and ARI. Future research needs to address the determinants of the clin ical practice of private doctors in countries like Mexico.