Kumar V, Kumar R, Khurana J L
J Diarrhoeal Dis Res. 1989 Sep-Dec;7(3-4):70-6.
Health care providers were trained to treat patients with acute diarrhoea using WHO-recommended oral rehydration therapy (ORT) in a rural area of Haryana, India. One year after the completion of the training programme, the diarrhoea management practices of these trainees were observed while they were treating 240 children with acute diarrhoea. The patients were treated by 12 Multipurpose Health Workers (MPHW), 12 Community Health Guides (CHG), and 11 childcare volunteers, called Anganwadi Workers (AWW), in 12 randomly selected villages. In addition, 9 doctors practising in Primary Health Centres and in a 50-bed hospital were also studied. The assessment of patients on the basis of the history of illness taken and the results of physical examinations varied significantly between the various health functionaries. Doctors assessed dehydration in 80% of patients, MPHWs in 65%, CHGs in 60% and AWWs in only 45% of patients (p less than 0.05). Oral rehydration solution (ORS) was given to every case. However, anti-microbial and anti-diarrhoeal drugs were used at a significantly higher rate by doctors than by other functionaries (p less than 0.05). The method of ORS preparation was explained to most (85-90%) of the parents by all types of functionaries but the quantity to be given to the child was told by doctors to 67%, MPHWs to 60%, CHGs to 63% and AWWs to only 43% of patients. Advice on feeding normal food during diarrhoea was either not given or restrictions to food intake were suggested by all types of functionaries. However, continuation of breast feeding during treatment was advised by all types of functionaries for the majority of patients.
在印度哈里亚纳邦的一个农村地区，医疗保健提供者接受了培训，学习使用世界卫生组织推荐的口服补液疗法（ORT）治疗急性腹泻患者。培训项目结束一年后，观察了这些学员在治疗240名急性腹泻儿童时的腹泻管理实践。在12个随机选择的村庄中，由12名多功能卫生工作者（MPHW）、12名社区卫生指导（CHG）和11名儿童保育志愿者（称为安甘瓦迪工作者，AWW）对患者进行治疗。此外，还研究了在初级卫生中心和一家拥有50张床位医院执业的9名医生。不同卫生工作人员根据所采集的病史和体格检查结果对患者的评估差异很大。医生评估出80%的患者存在脱水，多功能卫生工作者评估出65%，社区卫生指导评估出60%，而安甘瓦迪工作者仅评估出45%的患者存在脱水（p小于0.05）。每个病例都给予了口服补液盐（ORS）。然而，医生使用抗菌和止泻药物的比例明显高于其他工作人员（p小于0.05）。所有类型的工作人员都向大多数（85 - 90%）的家长解释了口服补液盐的配制方法，但告知患儿服用量的比例为：医生67%，多功能卫生工作者60%，社区卫生指导63%，安甘瓦迪工作者仅43%。各类工作人员要么未就腹泻期间正常饮食提供建议，要么建议限制食物摄入量。不过，各类工作人员都建议大多数患者在治疗期间继续母乳喂养。
