PHYSICIANS PRESCRIBING BEHAVIOR FOR DIARRHEA IN CHILDREN - AN ETHNOEPIDEMIOLOGICAL STUDY IN SOUTHERN BRAZIL

With the aim of implementing an intervention program on physician's pr escribing behaviour for diarrhoea in children under five, an ethnoepid emiological study was conducted in Pelotas (Brazil), from February to April 1993. Information on prescription of drugs was obtained through record review of 381 cases of diarrhoea provided by 33 medical doctors From right health centres. Trained field workers observed a total of 54 clinical consultations due to diarrhoea. Brief exit interviews with the mothers were performed just after the observations. Twenty-seven open-ended home interviews were made with the mothers the day after th ey had been observed. After all observations had been completed, open- ended interviews were conducted with 21 physicians. The results showed that there is a misunderstanding of the role of ORS in the treatment of diarrhoea: mothers want something to ''cut'' diarrhoea and they not ice that ORS does not act in this way and doctors do not explain the a ction of ORS in diarrhoea management. Comparing with record reviews, d uring observations a child had a lower probability of receiving an ant ibiotic or antidiarrheal drug prescription. This finding indicates tha t other variables than technical skills are involved in doctor's presc ribing behaviour. A lack of ability or of motivation to deal with ''an xious or difficult mothers'' led some doctors to enhance antibiotic or other non-recommended drugs to manage diarrhoea. Therefore, efforts t o improve the quality of case management of diarrhoea, through interve ntion programmes in the government health sector. are needed in Pelota s. (C) 1998 Elsevier Science Ltd. All rights reserved.