Improving Pharmacy Staff Knowledge and Practice on Childhood Diarrhea Management in Vietnam: Are Educational Interventions Effective?

Abstract

BackgroundIn many developing countries, private pharmacies play an important role in providing health information and services to local communities for common health issues. The aim of this study was to ascertain medium-term impact of educational interventions on knowledge and practice of pharmacy staff regarding management of childhood diarrhea in Vietnam.MethodsThis was a pre- and post-intervention study with 32 and 44 months difference from the time of the baseline survey to the conclusion of trainings and the time of the end-line survey, respectively. Interventions included in-class training for pharmacy staff, printed materials at the pharmacy, and supportive supervision. Knowledge/reported practice and actual practice of pharmacy staff were measured before and after interventions.ResultsAfter interventions, significant improvements (p<0.01) were observed for all indexes related to pharmacy staff's knowledge about childhood diarrhea; for instance, 31% and 60% of surveyed staff asked about weight of the child and accompanying symptoms of childhood diarrhea, respectively, an increase from 11% and 45% at the baseline. Oral rehydration solution (ORS) was the most frequently reported product recommended (97% to 99%), but probiotics and antidiarrheals were the products most frequently prescribed at pharmacies. Public health facilities remained the preferred choice for referrals from pharmacies, but the use of private clinics was increasing. Consultations and advice provided to caregivers also improved, but considerable gaps between knowledge and actual practice of staff in real pharmacy settings remained.ConclusionsEducational interventions were effective in improving pharmacy staff knowledge and practice regarding management of childhood diarrhea. Knowledge and actual practice of staff in real pharmacy settings did not always correlate; there is need for a stronger regulatory and law enforcement system. Interventions to improve pharmacy practice in developing countries should be focused, comprehensive, and evidence-based.

Treatment of pediatric diarrhea: a simulated client study at private pharmacies of Ujjain, Madhya Pradesh, India

“…In Vietnam, an average duration of 2.4-2.6 minutes for consultations regarding childhood diarrhea was reported by pharmacists. The study concluded that the time spent for consultation was insufficient to assess the condition of childhood diarrhea [13]. The number of questions asked regarding the condition of the child by the pharmacists was low.…”

“…Several studies in low-and middle-income countries have reported a lack of adherence to treatment guidelines for diarrhea as well as an overuse of antibiotics and antimotility drugs among qualified practitioners [9,13,18]. In these settings, it is possible that pharmacy staff is not even aware of such guidelines, given that 88% of staff manning pharmacies on a day-to-day basis is unqualified [17].…”

“…Education as well as stricter regulations for pharmacies are needed to improve the proper dispensing of medicines. The management of childhood diarrhea in private pharmacies was improved in Vietnam through an educational intervention [13]. Though the intervention had some positive outcomes in Vietnam, such interventions are difficult to implement in an unregulated private sector environment, in which staff who man pharmacies are not necessarily qualified or constant.…”

“…Childhood diarrhea is one of several illnesses that have been assessed in pharmacies by using SC [9,13,14]. There is limited information on how children are actually treated for diarrhea in private pharmacies, which are often the first point of contact and where such symptom-based consultations and treatments often take place.…”

Evaluation of the effectiveness of an Internet-based continuing education program on pharmacy-based minor ailment management: a randomized controlled clinical trial

“…Previous studies focused on CE programs for the management of major chronic illnesses, such as asthma, depression, and diabetes, used live media methods (e.g., workshops, lectures, and case studies), and were performed in developed countries (Rouleau, Beauchesne, Laurier, 2007;Saini et al, 2006;Chen et al, 2004;Pham et al, 2013). The differences between minor ailments and major chronic illness, between Internet-based and live media methods, and between pharmacy education curricula in developing and developed countries do not permit extrapolation of published data to our area of interest.…”