University of Connecticut, School of Nursing, Storrs, CT, USA.
University of Connecticut, School of Nursing, Storrs, CT, USA.
Int J Nurs Stud. 2017 Jan;66:82-92. doi: 10.1016/j.ijnurstu.2016.08.014. Epub 2016 Sep 1.
The significant drop in child mortality due to diarrhea has been primarily attributed to the use of oral rehydration solutions, continuous feeding and zinc supplementation. Nevertheless uptake of these interventions have been slow in developing countries and many children suffering from diarrhea are not receiving adequate care according to the World Health Organization recommended guidelines for the clinical management of childhood diarrhea.
The aim of this integrative review is to appraise healthcare professionals' management of childhood diarrhea in low-income countries.
Whittemore and Knafl integrative review method was used, in conjunction with the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting observational cohort, case control and cross sectional studies.
A comprehensive search performed from December 2014 to April 2015 used five databases and focused on observational studies of healthcare professional's management of childhood diarrhea in low-income countries.
A total of 21 studies were included in the review. Eight studies used a survey design while three used some type of simulated client survey referring to a fictitious case of a child with diarrhea. Retrospective chart reviews were used in one study. Only one study used direct observation of the healthcare professionals during practice and the remaining eight used a combination of research designs. Studies were completed in South East Asia (n=13), Sub-Saharan Africa (n=6) and South America (n=2).
Studies report that healthcare providers have adequate knowledge of the etiology of diarrhea and the severe signs of dehydration associated with diarrhea. More importantly, regardless of geographical settings and year of study publication, inconsistencies were noted in healthcare professionals' physical examination, prescription of oral rehydration solutions, antibiotics and other medications as well as education provided to the primary caregivers. Factors other than knowledge about diarrhea were shown to significantly influence prescriptive behaviors of healthcare professionals. This review demonstrates that "knowledge is not enough" to ensure the appropriate use of oral rehydration solutions, zinc and antibiotics by healthcare professionals in the management of childhood diarrhea.
儿童死亡率的显著下降主要归因于口服补液溶液、持续喂养和补锌的使用。然而，这些干预措施在发展中国家的采用速度缓慢，许多患有腹泻的儿童没有按照世界卫生组织推荐的儿童腹泻临床管理指南接受充分的护理。
本综合评价旨在评估低收入国家医疗保健专业人员对儿童腹泻的管理。
采用 Whittemore 和 Knafl 综合评价方法，并结合观察性队列、病例对照和横断面研究的报告观察研究 (STROBE) 清单。
从 2014 年 12 月至 2015 年 4 月进行了全面搜索，使用了五个数据库，重点是关于低收入国家医疗保健专业人员管理儿童腹泻的观察性研究。
共有 21 项研究纳入了本综述。8 项研究采用了调查设计，3 项研究采用了某种形式的模拟患者调查，涉及虚构的腹泻儿童病例。一项研究使用了回顾性图表审查。只有一项研究直接观察了医疗保健专业人员的实践，其余八项研究则采用了多种研究设计。这些研究在东南亚（n=13）、撒哈拉以南非洲（n=6）和南美洲（n=2）完成。
研究报告称，医疗保健提供者对腹泻的病因和与腹泻相关的严重脱水体征有足够的了解。更重要的是，无论地理位置和研究发表年份如何，医疗保健专业人员在体格检查、口服补液溶液、抗生素和其他药物的处方以及向主要照顾者提供教育方面都存在不一致的情况。除了腹泻知识外，其他因素也被证明会显著影响医疗保健专业人员的处方行为。本综述表明，“知识是不够的”，无法确保医疗保健专业人员在管理儿童腹泻时正确使用口服补液溶液、锌和抗生素。
