In Guatemala, as is the case in many of the other Central American countries, the pharmacy is often the only health resource used outside the household. This paper analyzes knowledge, attitudes and practices of the personnel from seven pharmacies located in marginal-urban areas of Guatemala. It also studies their interaction with 3,277 users related to all diseases, specifically those related to diarrheal disease and its treatment. Findings revealed that the pharmacies' personnel handle diarrheal disease in an empirical way, using medicines to treat the cause of the diarrhea, instead of trying to prevent dehydration. There are limitations and deficiencies of knowledge and practices related to the use and abuse of non-indicative medicines, insofar as the pharmacies' personnel and users are concerned. Findings also revealed that the Oral Rehydration Salts (ORS) are not used, and prepared oral serum is used in very small amounts, because these do not fit in popular expectations of a medicine that reduces diarrheic evacuations.
PIP: Knowledge and practices regarding diarrheal disease and its treatment were assessed among workers in 7 pharmacies located in marginal urban areas of Guatemala City. In Guatemala, as in many developing countries, the pharmacy is often the only health resource utilized outside the home. Intensive observation of interactions between pharmacy personnel and interviews with 18 of the 20 owners and workers allowed evaluation of knowledge of diarrhea among the workers and consistency between theoretical knowledge and actual treatment practices. Home visits were made 5 days after observation in the pharmacy to all households containing children under 5 for whom diarrhea remedies were sought. The observations and interviews occurred between January-June 1987. The 7 pharmacies were the only ones in the area they served. 2 covered a population of approximately 64,688 and the other 5 served approximately 106,955 residents. The pharmacy owners had worked and average of 19 years and the workers an average of 4.9 years in pharmacies. 15 of the 18 stated they had learned their trade through daily practice. Few had any formal pharmacy training. The principal sources of information on drugs were visits made to introduce new drugs. The pharmacists also used the literature accompanying the medications and the reference work "dictionary of Pharmaceutical Specifications". 14 stated that their recommendation for treatment of diarrhea depended on the signs and symptoms described to them. A wide variety of possible treatments were mentioned, but in practice the antidiarrheals were most often prescribed. Only 4 of the 18 routinely explained to the mother the type of diarrhea, why the specific drug was chosen, and how to administer it. 9 provided instructions for administration only, and the other 5 provided no information. 16 of the 18 cited nutritional signs of dehydration, and lower proportions mentioned other signs. 11 of the 18 stated that oral rehydration solution should be given to prevent dehydration, 3 stated that oral or injectable solution should be given, and 4 said that the cause of dehydration should be combatted. None appeared to know how to prepare homemade oral rehydration solution. 6 pharmacies sold oral rehydration salts, but only at the customer's request. A total of 3277 contacts between pharmacy workers and users were observed in 97 hours of observation, for an average of 34 contacts per hour. 80.3% of clients requested a self-prescribed medication, 4.6% had medical prescriptions, and 7.8% followed the advice of the pharmacist. 26.4% of clients were unable to obtain their 1st choice, 15.1% because it was not available and 11.3% because they lacked sufficient funds. 112 cases of diarrhea were observed in children 12 and under and 440 in adults.