Study identifies treatment gap for children in Africa


Children affected by diarrheal diseases in sub-Saharan Africa are less likely to receive life-saving oral rehydration therapy if they seek treatment at private clinics, a new study published in the American Journal of Tropical Disease and Hygiene found. This treatment gap between public and private clinics could prevent thousands of lives being lost if closed.

“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, the study’s senior author and director of research at the Leonard D. Schaeffer Center for Health Policy & Economics at USC, said in a press release.

According to the World Health Organization, diarrheal disease is the second leading cause of death for children under 5, claiming 760,000 lives annually. ORT, which involves administering water mixed with sugar and salts, helps prevent dehydration and its resulting deaths. Since its implementation worldwide in 1980, ORT has reduced deaths from diarrheal diseases by two-thirds, and costs just fifty cents per treatment course, according to USC’s press release.

Despite its effectiveness and   low cost, providers at private health clinics, which have been moving in to fill the gap in health care services, are less likely to use ORT and more likely to prescribe pills, syrups, antibiotics, herbal or other treatments that are less effective or even harmful. By analyzing the types of treatment received at different facilities, researchers determined that children under 5 were 22 percent less likely to receive ORT and 61 percent more likely to receive alternate treatments at private clinics, the press release said.

The study looked at data spanning nearly a decade, from 2003 to 2011, and tracked patient data on 19,000 children across 29 African countries. About a quarter of patients received treatment from private clinics, with 71 percent utilizing public facilities and the remaining patients using nonprofit clinics run by NGOs.

“In most countries, there are several regulations governing private clinics, but in practice few of them are enforced, and there is very little government oversight of care provided in the private sector,” Sood said in a press release. “What’s more, governments are generally not involved in continuing medical education to improve the capacity of these private clinics to provide better care.”

Private health providers often include mobile clinics or small pharmacies and clinics staffed by a physician or pharmacist in sub-standard conditions. According to the study, pharmacies were 23 percent less likely to provide ORT compared to other private clinics.

The study also found that this treatment gap affected poorer children more significantly, since individuals in rural areas were 41 percent more likely to seek treatment at private clinics. Poorer children were also less likely to receive ORT at public clinics compared to wealthy children, but the effects were more pronounced at private clinics.

Given the rise of private, for-profit clinics in Africa, further collaboration between the government and private providers is necessary to ensure that proper standards of care are being followed, said Zachary Wagner, a co-author of the study and a doctoral student at UC Berkeley. The authors of the study hope that properly implementing existing treatment courses across the public and private sectors will lead to a decrease in preventable deaths from diarrhea.

“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,” Alan Magill, president of the American Society of Tropical Medicine and Hygiene, said in a press release. “It is an illustration of the hand-in-hand relationship that research plays with clinical care.”