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Let us try academic detailing as a tool to reduce global mortality from childhood diarrhoea by 2015

Posted by plosmedicine on 01 Apr 2009 at 11:04 GMT

Authors of comment:

1. Saval Khanal, B. Pharm 1,4 - Tutor
2. Subish Palaian, M.Pharm 2 - Assistant Professor
3. Dr. P. Ravi Shankar, MD 3 - Associate Professor
4. Dr. Pranaya Mishra, PhD 2 - Associate Professor
5. Dr. Mohamed Izham Mohamed Ibrahim, PhD 4 - Professor

1 Department of Pharmacology, Nepalgunj Medical College, Chisapani, Banke, Nepal

2 Department of Hospital and Clinical Pharmacy/Department of Pharmacology Manipal Teaching Hospital/Manipal College of Medical Sciences Pokhara, Nepal

3 Department of Clinical Pharmacology and Therapeutics, KIST Medical College, Lalitpur, Nepal

4 Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia


This comment was emailed to the PLoS Medicine staff on 28 March 2009.

The article written by Fontaine et al. in PLoS Medicine (March 2009, volume 6, Issue 3, e100004) titled ‘Setting Research Priorities to Reduce Mortality from Childhood Diarrhoea by 2015’ summarized the top and bottom 15 research questions based overall priority score with average expert agreement related to each question. From the experts opinions it is clear that the majority of the top priority researches were related to health policy and system. Designing a locally adopted training program to orient health worker on Integrated Management of Childhood Illness (IMCI) was the research question obtaining 4th rank based on priority level. The authors plan to discuss the possibility of academic detailing as a locally adaptable training program to orient health workers about IMCI.

Acute diarrhea is one of the leading causes of child morbidity and mortality. Use of oral rehydration salts (ORS) and zinc is the first choice of treatment for acute diarrhoea in children.1 However, in many cases ORS and zinc is still underused in managing diarrhea in children. Instead of these simple remedies other agents like intravenous fluids, antimicrobials, antimotility agents, enzymes, etc have been the choice of treatment.2,.3 Along with other reasons, inadequate knowledge of prescribers may also be responsible. Prescribers may require educational and behavioral interventions to change their prescribing habits.

Academic detailing is a one on one educational outreach program provided usually by a trained pharmacist or clinician to practicing clinicians in their clinic. It has been shown to improve the prescribing behavior of clinicians and increase their adherence to guidelines.4, 5 Diarrhoea is the second major cause of mortality in Nepal.6 In Banke district of Nepal adjoining the Indian border we are carrying out a pilot study to find out the impact of academic detailing on knowledge, attitude and practice of clinicians towards diarrhoea and its management in children. Our module includes four different interventions covering different topics spread over a period of six months. These topics are
1. Clinical management of childhood diarrhoea (Based on WHO/UNICEF recommendations) 7, 8
2. Home based treatment in childhood diarrhoea. (Based on WHO/UNICEF recommendations) 7, 8
3. Evidence based medicine (Based on our scientific literature survey)
4. Summary of the above three interventions and positive reinforcement.

In Nepal, technical subjects are discussed in combination of Nepali and English. All the study tools have been written in a mixture of the two languages. We expect it to have good impact on knowledge, attitude and practice of prescribers toward diarrhea and its management in children in Banke. We hope the result of our pilot study will help people working in this area to design locally adoptable educational programs.


1. Centre for Health and Population Research, New Delhi India (2001) Meeting Report: Effect of Zinc Supplementation on Clinical Course of Acute Diarrhoea. J Health Popul Nutr 19 (4) : 338-46

2. Parekh P, Gandhi P, Nadkarni J (2004) Knowledge and perception of practicing doctors in the management of acute watery diarrhoea. Ind J Comm Med 2: 84-6

3. Reis EC, Goepp JG, Katz S, Santosham M (1994) Barriers to use of oral rehydration therapy. Pediatr 1994: 708-11

4. Boothby LA, Wang LJ, Mayhew S, Chestnutt L (2003) Academic Detailing of Meperidine at a Teaching Hospital. Hosp Pharm 38: 30–35

5. Ilett KF, Johnson S, Greenhill G, Mullen L, Brockis J, Golledge CL, Reid DB (2004) Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer).Br J Clin Pharmacol 49: 168-73.

6. Department of Health Services, Ministry of Health and Population, Nepal (2004) Annual Report 2003/2004. Kathmandu, Nepal: Department of Health Service

7. MOST- The USAID Micronutrient Program UNICEF and WHO (2005) Diarrhoea treatment guidelines including new recommendation for the use of ORS and zinc supplementation for clinic-based healthcare workers. Arlington VA, United States: MOST Headquarter

8. WHO, UNICEF, John Hopkins Bloomberg, School of Public Health and USAID (2006) Implementing the new recommendations on the clinical management of diarrhoea.. Geneva, Switzerland, WHO

No competing interests declared.