Improving diarrhea management in mobile medical clinics serving tribal populations in North Bengal: a best practice implementation project.

BACKGROUND: Diarrheal disease remains the third leading cause of death among children under 5 globally, with 90% of deaths occurring in low- and middle-income countries. In India's tribal communities, this burden is compounded by poor sanitation, unsafe water, and limited access to health care. Mobile medical clinics (MMCs) are the primary health care contact for many indigenous populations, yet evidence-based diarrhea management is not consistently implemented in those clinics. AIM: This project aimed to improve the management of childhood diarrheal disease in MMCs serving tribal populations of North Bengal, India through the implementation of evidence-based practices. METHODS: The project followed the JBI Evidence Implementation Framework, which is grounded in an audit and feedback process. A baseline audit was conducted of 60 treatment encounters using seven evidence-based audit criteria. This was followed by the identification of barriers to non-compliance, the implementation of targeted strategies, and a post-implementation audit to measure improvements. Health worker knowledge, attitudes, and behaviors were assessed via surveys. RESULTS: Baseline compliance ranged from 0% to 59.71%; however, this improved across all domains after the implementation of strategies, including structured training, multilingual visual aids, emphasis on record-keeping, and demonstrations of best practice. Thus, promotion of rotavirus vaccination increased from 0% to 50.62%, advice on administering oral rehydration solution increased from 0% to 60.26%, maintaining distribution records and clinical data increased from 50% to 78.28%, and water, sanitation, hygiene (WASH) counseling in multiple local languages increased from 59.71% to 67.29%. CONCLUSIONS: Evidence-based diarrhea management can be meaningfully improved in resource-limited MMCs through multi-modal strategies incorporating education, locally relevant materials, and supported practice change. Sustaining improvements will require embedded supervision and supply chain support. SPANISH ABSTRACT: https://links.lww.com/IJEBH/A699.