Background In the densely populated slums of Kolkata, informal healthcare providers’ (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance. Methods A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation. Results Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved. Conclusions Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up.

中文翻译：

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干预以改善加尔各答贫民窟非正规医疗保健提供者的腹泻相关知识和实践

背景 在加尔各答人口稠密的贫民窟，应提高非正式医疗保健提供者 (IHP) 的腹泻相关知识和实践的合理性，以降低不良结果、支出和抗菌素耐药性的风险。方法 在加尔各答 8 个区的贫民窟中，对 140 名具有代表性的 IHP 进行了多因素干预，以评估其对他们腹泻相关知识和实践的影响。提供了六个当地语言的干预模块（每月 1 个）以及基线（N = 140）和干预后（N = 124）评估。结果 病因/传播（5.4 至 8.1；P < .0001）、管理（6.4 至 7.2；P < .0001）和口服补液溶液（[ORS] 5.7 至 6.5；P < .0001）显着增加（在 α = 0. 05) 干预后保留良好。对病因学/传播知识的影响（调整优势比 [aOR] = 5.6；P < .0001）、霍乱（aOR = 2.0；P = .0041）、管理（aOR = 3.1；P < .0001）、ORS （aOR = 2.3；P = .0008）和总体（aOR = 4.3；P < .0001）是显着的。干预对实践 ≥ 10 年的 IHP（aOR = 3.2；P < .0001）、未经培训的 IHP（aOR = 4.8；P < .0001）和药剂师（aOR = 8.3；P < .0001）效果更好. 每个霍乱病例的经验性抗生素使用 (aOR = 0.3; P < .0001) 和每个腹泻病例的调查 (aOR = 0.4; P = .0003) 等不合理做法都减少了。检测的合理性 (aOR = 4.2; P < .0001) 和抗生素使用 (aOR = 1.8; P = .0487) 得到改善。结论 多元教育干预导致加尔各答贫民窟 IHP 腹泻相关知识和实践的可持续改善。应在实施和扩大规模的同时宣传政策影响。