Qualitative study of healthcare providers’current practice patterns and barriersto successful rehydration for pediatricdiarrheal illnesses in Kenya

Abstract

Background. For children worldwide, diarrhea is the second leading cause of death.These deaths are preventable by fluid resuscitation. Nasogastric tubes (NGs) have beenshown to be equivalent to intravenous fluids for rehydration and recommended by theWorld Health Organization (WHO) for use in severe dehydration. Despite this, NGs arerarely used for rehydration in Kenya. Our objective was to evaluate clinicians’ adherenceto rehydration guidelines and to identify barriers to the use of NGs for resuscitatingdehydrated children.Methods. A case-based structured survey was administered to pediatric care providersin western Kenya to determine their choices for alternative rehydration therapieswhen oral rehydration and intravenous fluids fail. Providers then participated in aqualitative, semi-structured interview to identify barriers to using nasogastric tubes forrehydration. Analysis included manual, progressive coding of interview transcripts toidentify emerging central themes.Results. Of 44 participants, only four (9%) followed WHO guidelines that recommendquickly switching to NG for rehydration in their case responses. Participants identifiedthat placing intravenous lines in dehydrated children is a challenge. However, whendiscussing NG use, many believed NGs are not effective for rehydration. Otherparticipants’ concerns surrounded knowledge and training regarding guidelines as wellas not having NGs available.Discussion. Healthcare providers in western Kenya do not report using NGs forrehydration in accordance with WHO guidelines for diarrheal illness with severedehydration. Barriers to the use of NG tubes were lack of knowledge and availability.Education and implementation of guidelines using NG tubes for rehydration mayimprove outcomes of children suffering from diarrheal illness with severe dehydration.