- Press Release Distribution

Care for life-threatening child diarrhea limited by health providers’ views

Ineffective treatments often prescribed because providers misperceive caregivers’ wishes

( Young children in India who suffer from life-threatening diarrhea frequently are given ineffective treatments because health providers misperceive the wishes of a child’s caregiver, according to a novel new study.


Using actors posing as child caregivers to examine the behavior of health providers in two divergent regions in India, researchers found that the perceived preferences of a child’s caregiver was a more important factor in the way a child was treated than the views of the health care provider about the best course of action.


The findings offer possible new pathways to address an illness that annually kills more than 500,000 children under age 5 around the world, even though most could be successfully treated with inexpensive oral rehydration salts.


The study is published by the journal Science.


“We found that providers avoided prescribing oral rehydration salts because they thought caregivers wanted something different for their child,” said Zachary Wagner, the study’s lead author and an economist at RAND, a nonprofit research organization. “But oral rehydration salts were the most preferred treatment when we asked caregivers directly about their preferences.


“Interventions to change providers’ perceptions of patients’ preferences about oral rehydration therapy have the potential to increase its use and reduce child mortality from diarrhea.”


Diarrhea is the second leading cause of death for children in low- and middle-income

countries, despite the fact nearly all such deaths could be prevented with oral rehydration salts -- a small package of electrolytes that is mixed with water before drinking.


Although it has been lauded as one of the most important medical advances of the 20th century, use of oral rehydration salts has been underutilized for decades. At present,

nearly half of diarrhea cases around the world do not receive the treatment.



Researchers from RAND, the University of Southern California, Duke University and the Indian Institute of Management used a unique approach to estimate the extent to which the underprescription of oral rehydration salts is driven by perceptions that patients do not want oral rehydration salts, providers’ financial incentives for prescribing other medications, and oral rehydration salts being out of supply.


Researchers trained 25 actors to pose as child caregivers so they could visit health providers to seek help for children in distress with diarrhea. The extensive two-week training included memorizing both a script and responses to common questions, as well as practice visits with real health care providers.


The actors visited 2,282 private health providers across 253 medium-sized towns in the Indian states of Bihar and Karnataka, presenting a case of a 2-year-old child who had been having uncomplicated diarrhea for two days. Half the actors presented a moderate case and the other half a severe case, with both types of cases being severe enough to require oral rehydration salts.


The research team also surveyed the providers, both when they agreed to participate in the study and shortly after they were visited by an actor caregiver. In addition, about 1,200 child caretakers were surveyed, answering questions about their treatment preferences, treatment-seeking behavior, and provider interactions for caretakers among those whose children had a recent case of diarrhea.


The study found that when patients expressed a preference for oral rehydration salts, prescribing of the treatment increased by 27 percentage points. Assuring that oral rehydration salts were in stock increased prescribing of the treatment by 7 percentage points.


Removing financial incentives for health providers to prescribe higher-profit medicines did not affect prescribing of oral rehydration salts on average, but did increase oral rehydration salts prescribing at pharmacies.


Researchers estimate that perceptions that patients did not want oral rehydration salts explained 42% of underprescribing, whereas being out of stock and financial incentives explain only 6% and 5%, respectively.


Prior to this study, researchers did not know why health practitioners do not routinely prescribe oral rehydration salts. There was anecdotal evidence that it was because the treatment does not provide a good profit margin or because patients prefer other treatments because of its poor taste. In addition, practitioners may believe that caregivers do not like oral rehydration salts because of a lack of observable symptom relief (it treats and prevents dehydration rather than diarrhea symptoms), and a perception that the treatment is not “real” medicine as compared to a pill or a shot.


“A long-standing puzzle in global health has been that providers do not prescribe oral rehydration salts for child diarrhea, even though they know it is the standard of care,” said Neeraj Sood, coauthor of the study and a professor at the USC Price School of Public Policy. “This study provides new insights that now allow us to pursue interventions that can address this problem.” 


Support for the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases. Other authors of the study are Manoj Mohanan of Duke University, Rushil Zutshi1 of RAND, and Arnab Mukherji of the Indian Institute of Management Bangalore.


RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.



ANU scientists debunk role of ‘junk cells’ in fight against malaria

ANU scientists debunk role of ‘junk cells’ in fight against malaria
Researchers from The Australian National University (ANU) have discovered a previously unknown ability of a group of immune system cells, known as Atypical B cells (ABCs), to fight infectious diseases such as malaria.    The discovery provides new insight into how the immune system fights infections and brings scientists a step closer to harnessing the body’s natural defences to combat malaria.  The scientists say ABCs could also be key to developing new treatments for chronic autoimmune conditions such as lupus.  According to the researchers, ABCs have long been associated with malaria, ...

Fibroblasts in the penis are more important for erectile function than previously thought

Regular erections could be important for maintaining erectile function, according to a new study on mice published in Science by researchers at Karolinska Institutet. “We discovered that an increased frequency of erections leads to more fibroblasts that enable erection and vice versa, that a decreased frequency results in fewer of these cells,” says principal investigator Christian Göritz. In a new study on mice, researchers at Karolinska Institutet and Uppsala University in Sweden ...

MIT physicists capture the first sounds of heat “sloshing” in a superfluid

In most materials, heat prefers to scatter. If left alone, a hotspot will gradually fade as it warms its surroundings. But in rare states of matter, heat can behave as a wave, moving back and forth somewhat like a sound wave that bounces from one end of a room to the other. In fact, this wave-like heat is what physicists call “second sound.”  Signs of second sound have been observed in only a handful of materials. Now MIT physicists have captured direct images of second sound for the first time.  The new images reveal how heat can move like a wave, ...

How emotions affect word retrieval in people with aphasia

COLUMBUS, Ohio – People with aphasia have more trouble coming up with words they want to use when they’re prompted by images and words that carry negative emotional meaning, new research suggests. The study involved individuals whose language limitations resulted from damage to the brain caused by a stroke – the most common cause of aphasia, affecting at least one-third of stroke survivors. The disorder impairs the expression and understanding of language as well as reading and writing. Researchers from The Ohio State University who led the study said the findings – suggesting that prompts ...

Pregnant women living in states with limited access to abortion face higher levels of intimate partner homicide

Key Takeaways  Young women under the age of 30, Black women, and women with lower education levels are disproportionately affected by intimate partner homicide during pregnancy, reflecting the need to better serve and protect these vulnerable populations.  Particularly by firearms, increasing rates of intimate partner homicide of women who are pregnant or recently pregnant are occurring in states that have limited access to abortion.  Researchers describe a ‘dire ...

Researchers uncover genetic factors for severe Lassa fever

While combing through the human genome in 2007, computational geneticist Pardis Sabeti made a discovery that would transform her research career. As a then postdoctoral fellow at the Broad Institute of MIT and Harvard, Sabeti discovered potential evidence that some unknown mutation in a gene called LARGE1 had a beneficial effect in the Nigerian population. Other scientists had discovered that this gene was critical for the Lassa virus to enter cells. Sabeti wondered whether a mutation in LARGE1 ...

Leader in robotics at U-M and beyond elected to National Academy of Engineering

Feb. 8, 2024 Contact: Katherine McAlpine, 734-647-7087,    Image Leader in robotics at U-M and beyond elected to National Academy of Engineering Dawn Tilbury is recognized for advances in manufacturing network control and human-robot interaction, as well as engineering leadership ANN ARBOR—Dawn Tilbury, the Ronald D. and Regina C. McNeil Department Chair of Robotics at the University of Michigan, has been recognized with one of engineering's greatest honors—election to the National Academy of Engineering.  NAE members are outstanding researchers, ...

16 UTA scholars receive McNair federal research award

16 UTA scholars receive McNair federal research award
A competitive U.S. Department of Education program that prepares undergraduate students interested in careers in academic research has selected 16 undergraduate students from The University of Texas at Arlington to join. The McNair Scholars Program was named for physicist and astronaut Ronald E. McNair, the second Black astronaut in U.S. history and one of several crew members killed when the space shuttle Challenger exploded on Jan. 28, 1986. The program assists qualified first-generation ...

Nanofiber bandages fight infection, speed healing

ITHACA, N.Y. – Cornell University researchers have identified a new way to harness the antioxidant and antibacterial properties of a botanical compound to make nanofiber-coated cotton bandages that fight infection and help wounds heal more quickly. The findings are especially important given the increasing prevalence of multidrug-resistant bacteria. Cotton gauze is one of the most common wound dressings; it’s inexpensive, readily available, comfortable and biocompatible. However, it doesn’t promote healing or fight infection. “Cotton alone cannot provide an answer for these ...

Newly discovered genetic malfunction causes rare lung disease

Newly discovered genetic malfunction causes rare lung disease
The macrophage is one of the body’s most important inhabitants. Meaning “big eater” in Greek, this immune cell consumes and digests problematic elements from microbes and cancer cells to dust and debris. Macrophages are especially important in the lungs, where they both fight bacterial infection and clear the lungs of excess surfactant, a protein- and lipid-rich layer that’s essential to healthy function but can create a sticky buildup if not controlled. In a recent study, investigators from Rockefeller University ...


Drug limits dangerous reactions to allergy-triggering foods, Stanford Medicine-led study of kids finds

Measuring the properties of light: Scientists realise new method for determining quantum states

For faster access to gene and cell therapies in Europe

Scientists deliver portable total chemical analysis without pumps and tubes

A very long, winding road: Developing novel therapeutics for metastatic tumors

Unlocking health: How In Our DNA SC is pioneering genetic screening for South Carolinians

Down Under Demo: ONR touts additive manufacturing tech at Australian event

Study shows benralizumab is effective as a treatment for eosinophilic granulomatosis with polyangiitis, a rare form of vasculitis

Researchers identify new choice of therapy for rare autoimmune disease EGPA

Powering nitrogenases

NJIT marketing experts measure brain waves and skin current to predict emotions

Babies use immune system differently, but efficiently

Cloud clustering causes more extreme rain

Mindfulness at work protects against stress and burnout

Scientists closer to solving mysteries of universe after measuring gravity in quantum world

Revolutionary brain stimulation technique shows promise for treating brain disorders

Global warming increases the diversity of active soil bacteria

Patient mindset training helps care teams

Dual-energy harvesting device could power future wireless medical implants

Study: ‘Hexaplex’ vaccine aims to boost flu protection

New structural insights could lead to mechanical enhancement in alloys

New research challenges conventional picture of Parkinson's disease

Dairy cows fed botanicals-supplemented diets use energy more efficiently

Aston University receives nearly half a million pounds to create safer and greener batteries

New study shows glycan sugar coating of IgG immunoglobulin can predict cardiovascular health

Sir Peter Rigby appointed as honorary chair of Aston University’s new Digital Futures Institute

Yale School of Medicine receives a $575,000 grant from PolyBio Research Foundation to fund long COVID research

Common plant could help reduce food insecurity, researchers find

Innovative chemotherapy approach shows promise against lung cancer

Encoding computers of the future

[] Care for life-threatening child diarrhea limited by health providers’ views
Ineffective treatments often prescribed because providers misperceive caregivers’ wishes