Although oral rehydration can mean the difference between life and death for children with diarrheal illnesses in sub-Saharan Africa, a new study suggests that for-profit clinics may be more likely than large public hospitals to prescribe expensive treatments instead.
Children younger than 5 years are at risk of death from diarrheal illnesses, which claim about 700 000 young lives each year. Most of the deaths result from dehydration and can be prevented by providing a solution of glucose and electrolytes. This simple and inexpensive intervention, which can cost less than 50 cents, is referred to as oral rehydration therapy (ORT). Unfortunately, this lifesaving tool is underused in sub-Saharan Africa.
To better understand why some children aren’t receiving ORT, Neeraj Sood, PhD, of the University of Southern California, and Zachary Wagner, of the University of California,Berkeley, analyzed survey data on 19 059 children from 29 countries in sub-Saharan Africa collected between 2003 and 2011. When they compared the care children with diarrhea received from for-profit vs public health providers, they found that for-profit providers were 15 percentage points less likely to provide ORT and about 12 percentage points more likely to provide treatments like antibiotics that may not be necessary and may cost more.
The for-profit facilities tended to be single-practitioner clinics or pharmacies compared with large public hospitals. The researchers found that pharmacies “were particularly likely to provide poor care.” Although wealthy parents were more likely to visit for-profit providers, underprivileged children from rural areas were disproportionately likely to receive poor care at for-profit facilities.
These findings are particularly concerning because for-profit facilities are becoming more common in sub-Saharan Africa as public health systems struggle to meet demand for care. Alan Magill, MD, president of the American Society of Tropical Medicine and Hygiene, said in a statement that the data suggest better coordination with the emerging private care sector in this region is needed to ensure the dissemination of evidence-based care.
“Given the important role that private health care providers are playing in Africa, this research shows that we need to be employing engagement strategies that we know have been successful in helping combat other diseases like HIV and malaria,” Magill said. “It is an illustration of the hand-in-hand relationship that research plays with clinical care.”