Author(s): Sarah Dallas
Mentor(s): Melissa Watt, Daniel Leung
Institution U of U
Background: Globally, diarrheal diseases are the third leading cause of morbidity and mortality in children. In low- and middle- income countries like Bangladesh, antibiotics are often misused in the treatment of pediatric diarrhea. Improper prescription practices are influenced by various factors including pressure from the patients’ family. This study seeks to better understand the influence of parents’ expectations on the prescription of antibiotics for pediatric diarrhea in Bangladesh. Objective: To explore parents’ expectations when bringing their child with diarrhea to the formal healthcare setting in Bangladesh and to understand how physicians manage these expectations. Methods: Using qualitative data methods, we conducted in-depth interviews (IDIs) with 18 licensed healthcare providers and 36 patient caregivers in three patient care centers in Bangladesh. Data was analyzed using an applied thematic analysis framework. Coding was completed using NVivo (version 14 Pro) and then synthesized into analytic memos. Results: When seeking care in a hospital setting, parents generally expect a higher quality of care than they expect to receive from informal healthcare providers which is a significant driver to visit a licensed provider. Many parents expect increased availability and accessibility to resources such as diagnostic testing, medication, and psychosocial support. Additionally, parents carry complex views concerning antibiotics. The majority of parents do not expect antibiotics as a primary treatment method and many even expressed apprehensions to use antibiotics to treat diarrhea. However, many of the parents, including those who did not expect them to be used, expressed a belief that antibiotics are superior to other medications. Many physicians correctly identified parents’ understanding of antibiotics as superior but misinterpreted parents’ expectation of receiving antibiotics. Physicians stated that the most common form of managing parents’ various expectations is via counseling and education. Discussion: The misinterpretation of parents’ expectations by physicians is a notable source of inappropriate antibiotic prescription as well as general frustration for both parties. Fulfilling or moderating parent expectations has important consequences in caregivers continued utilization of the formal healthcare system and in implementing antibiotic stewardship strategies.