Management of acute childhood diarrhoea (10)

8 March, 2019

[Note from HIFA moderator (NPW): We are discussing this topic in parallel on CHIFA, our sister forum for child health and rights. I would like to encourage everyone to continue the discussion on CHIFA. You can join here: http://www.hifa.org/join/join-chifa-child-health-and-rights ]

Dear Neil and friends, Tony Waterston [Lead moderator, CHIFA] asked to me/to us a possible solution to curb overprescription of drugs, worldwide.

I kept waiting for the answers of my colleagues in Africa, in vain.

I think that WHO has suggested the way from long: *strict adherence to national clinical-therapeutic guidelines*. Let's see the example of HIV/AIDS or TB: treatment is fully in the hands of specific doctors, expert of these specific diseases, adopting specific guidelines for diagnose (!) and therapy. An ordinary doctor cannot prescribe anti-tb drugs just because he/she 'has the impression' of it; this has been done in order to minimize the risk of resistance to drugs.

Then...why all other pathologic conditions are left in the hands(and pen) of doctors, that feel free to prescribe whatever they like? To diagnose whatever crosses their mind? Just because they studied and therefore know medicine and drugs? No, mine is a convinced 'no' : doctors, we all (!) have abused of antibiotics prescribed without control, showing very little professional skill and ethic.

Therefore we must be disciplined, limited in our behaviour, forced to do so through the serious/systematic/controled adoption of guidelines. National or WHO clinical guidelines does not matter but the result must be one: diarrhoea be 'treated' the same in town or in a village, by a pediatrician or by a nurse in a missionary health centre.

What matters more, what remains as the competence of doctors is to make and express in writing (!) the *diagnose*. Therapy will follow the guidelines available.

As a pediatrician I assure you that this approach is always possible, maybe not pleasant but possible and due.

Conclusion: drugs in Africa (better to write 'in poor countries') are dealt in gross anarchy. Sold on the streets, in thousand illegal pharmacies, prescribed for profit: governments reluctantly intervene since people do want drugs to be cured and then vote. We health professionals cannot 'clean our room', we are too proud of us and of our art. We need guidance.

What depresses me is the fact that poor are cheated and then deprived of the little money they have, forced to buy nonsense/useless drugs that satisfy the greed of money and not certainly medicine.

Rich countries are not in better position, but at least people are not 'so poor'.

Thanks

Massimo

Afghanistan

HIFA profile: Massimo Serventi is a long-standing Pediatrician working in Africa since 1982. He currently works on a volunteer basis in an excellent missionary/credited hospital in north Uganda, St. Mary's Hospital-Lacor-GULU. He has worked for several NGOs in 6 African/2 Asian countries. His interests include clinical and community pediatrics, adherence to clinical guidelines and school education as the major determinant of good health. massimoser20 AT gmail.com