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Private facilities less likely to provide rehydration therapy for diarrhea
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Oral rehydration therapy for diarrheal illness is less likely to be given to young children seeking treatment at private, for-profit clinics in sub-Saharan Africa compared with public facilities, according to recent study findings published in the American Journal of Tropical Medicine and Hygiene.
The differences in methods of care between private and public clinics could cost tens of thousands of lives each year from diarrheal disease, the researchers said.
“We estimate that reducing the gap in care between public and private clinics could save the lives of 20,000 children under 5 years old in sub-Saharan Africa each year,” Neeraj Sood, PhD, director of research at the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, said in a press release.
Sood and colleague, Zachary Wagner, a doctoral student of public health at the University of California-Berkeley, evaluated 19,059 children aged younger than 5 years from 29 countries in sub-Saharan Africa from 2003 to 2011 to determine the differences of care received at public vs. private clinics.
Most patients (71%) visited public facilities, followed by private facilities (24%) and non-governmental facilities (5%). In sub-Saharan Africa, the types of private facilities visited were most commonly hospitals/clinics and pharmacies; public facilities visited by patients were typically health centers and hospitals.
Oral rehydration therapy (ORT) and oral rehydration salts (ORS) were less likely to be given to patients who visited private, for-profit facilities. Patients who visited private, for-profit facilities were more likely to have mothers with more education, from wealthier households, and were less likely to be stunted compared with children who sought care at public facilities. Compared with the public facilities, private facilities were 14.6% less likely to give ORS and 15.1% less likely to give ORT. Pharmacies from the private, for-profit facilities were 13% less likely to give ORT compared with all other facility types (P<.01).
“Our findings are particularly significant because private health care providers are increasingly filling gaps in underserved areas of sub-Saharan Africa,” Wagner said in the release. “While this doesn’t apply to the entire private sector, we should be concerned that ORT is not being given, yet treatments that aren’t protocol, and could be harmful, are.”
Patients considered poor were less likely to receive ORT compared with wealthy patients. At private facilities, poor patients were 14% less likely to receive therapy compared with wealthy patients and 4% less likely to receive therapy at public facilities.
“If you look at the public-private disparities in health care for children living in poor and rural areas, you also find more operations being run by providers with less sophistication and less health care training,” Sood said. “Both of these findings are important as poor children or those living in rural areas are likely to be more vulnerable to dehydration and death due to diarrhea.”
Disclosure: The researchers report no relevant financial disclosures.
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