دورية أكاديمية
أعرض في EDS

An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions.

التفاصيل البيبلوغرافية
العنوان: An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions.
المؤلفون: Biswas D; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Hossin R; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Rahman M; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Bardosh KL; Center for One Health Research, School of Public Health, University of Washington, USA; Department of Anthropology, University of Florida, USA., Watt MH; Population Health Sciences, University of Utah, USA., Zion MI; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Sujon H; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA., Rashid MM; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Salimuzzaman M; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA., Flora MS; Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA., Qadri F; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Khan AI; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh., Nelson EJ; Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, USA. Electronic address: eric.nelson@ufl.edu.
المصدر: Social science & medicine (1982) [Soc Sci Med] 2020 Sep; Vol. 260, pp. 113185. Date of Electronic Publication: 2020 Jul 10.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Pergamon Country of Publication: England NLM ID: 8303205 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-5347 (Electronic) Linking ISSN: 02779536 NLM ISO Abbreviation: Soc Sci Med Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Oxford ; New York : Pergamon, c1982-
مواضيع طبية MeSH: Diarrhea*/epidemiology , Diarrhea*/therapy , Sanitation*, Bangladesh/epidemiology ; Disease Management ; Hospitals, Public ; Humans
مستخلص: Introduction: Diarrheal disease is one of the most common causes of hospital admission globally. The barriers that influence guideline-adherent care at resource limited hospitals are poorly defined, especially during diarrheal disease outbreaks. The objective of this study was to characterize challenges faced in diarrheal disease management in resource-limited hospitals and identify opportunities to improve care.
Methods: The study was conducted during a diarrheal disease outbreak period at ten public district hospitals distributed across Bangladesh. A rapid ethnographic approach included observations and informal interviews with clinicians, staff nurses and patients. In the first phase, observations identified common and unique challenges in diarrheal management at the ten sites. In the second phase, four hospitals were purposively selected for additional ethnographic study. Systematic observations over 420 total hours were collected from patient-clinician interactions (n = 76) and informal interviews (n = 138). Applied thematic analysis identified factors that influenced hospitalbased diarrhea management.
Results: Normalization of guideline deviation was observed at all ten sites, including prescription of non-indicated antibiotics and intravenous (IV) fluids. Conflict between 'what should be done' and 'what can be done' was the most common challenge identified. Clinical assessments and patient treatment plans were established at admission in a median of 2 minutes (n = 76), often without a physical examination (57%; n=43/76). Factors that prevented adherence to clinical guidelines included human resource constraints, conflicts of interests, overcrowding, and inadequate hygiene and sanitation in the emergency department and wards.
Conclusion: This study identified challenges in hospital-based management of diarrheal disease and opportunities to improve care in seemingly change-resilient hospital settings. The results reveal important areas for intervention and policy engagement that may have additive benefit for both hospitals and their patients. These interventions include targeting barriers to clean-water, sanitation and hygiene that prevent clinicians from adopting guidelines out of concern for hospital acquired infections.
(Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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معلومات مُعتمدة: DP5 OD019893 United States OD NIH HHS; R21 TW010182 United States TW FIC NIH HHS
فهرسة مساهمة: Keywords: Antibiotic stewardship; Bangladesh; Cholera; Decision-making; Decision-support; Diarrhea; Diarrhoea; Ethnography; Public hospital; Vibrio cholerae
تواريخ الأحداث: Date Created: 20200727 Date Completed: 20210427 Latest Revision: 20231112
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC7502197
DOI: 10.1016/j.socscimed.2020.113185
PMID: 32712557
قاعدة البيانات: MEDLINE
الوصف
تدمد:1873-5347
DOI:10.1016/j.socscimed.2020.113185