Antibiotic use for acute respiratory infections among under-5 children in Bangladesh: a population-based survey

Abstract

IntroductionDespite acute respiratory infections (ARIs) being the single largest reason for antibiotic use in under-5 children in Bangladesh, the prevalence of antibiotic use in the community for an ARI episode and factors associated with antibiotic use in this age group are unknown.MethodsWe analysed nationally representative, population-based, household survey data from the Bangladesh Demographic and Health Survey 2014 to determine the prevalence of antibiotic use in the community for ARI in under-5 children. Using a causal graph and multivariable logistical regression, we then identified and determined the sociodemographic and antibiotic source factors significantly associated with the use of antibiotics for an episode of ARI.ResultsWe analysed data for 2 144 children aged <5 years with symptoms of ARI from 17 300 households. In our sample, 829 children (39%) received antibiotics for their ARI episode (95% CI 35.4% to 42.0%). Under-5 children from rural households were 60% (adjusted OR (aOR): 1.6; 95% CI 1.2 to 2.1) more likely to receive antibiotics compared with those from urban households, largely driven by prescriptions from unqualified or traditional practitioners. Private health facilities were 50% (aOR: 0.5; 95% CI 0.3 to 0.7) less likely to be sources of antibiotics compared with public health facilities and non-governmental organisations. Age of children, sex of children or household wealth had no impact on use of antibiotics.ConclusionIn this first nationally representative analysis of antibiotic use in under-5 children in Bangladesh, we found almost 40% of children received antibiotics for an ARI episode. The significant prevalence of antibiotic exposure in under-5 children supports the need for coordinated policy interventions and implementation of clinical practice guidelines at point of care to minimise the adverse effects attributed to antibiotic overuse.

Bifidobacterium Species Colonization in Infancy: A Global Cross-Sectional Comparison by Population History of Breastfeeding

“…Also supporting the concept that antibiotic use did not drive the disappearance of B. longum subsp. infantis , antibiotic use is prevalent in Bangladesh, where approximately 40% of children under the age of 5 with acute respiratory infection receive antibiotics [ 64 ]. Despite the high rate of antibiotic use, our work shows that colonization with B. longum subsp.…”

Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic

“…We reported output as the unadjusted odds ratio (OR) with 95% CI and p -value. We utilized the conceptual framework technique, which displayed the potential causal pathway and link between antibiotic use after admission and explanatory variables, including patient age, sex, comorbid conditions, smoking status, disease severity, and antibiotic use before hospital admission to delineate the causal relationship ( Figure 2 ) [ 46 ]. Technical details of the conceptual framework technique have been explained in Jewell et al [ 47 ].…”

Antibiotic Use for Febrile Illness among Under-5 Children in Bangladesh: A Nationally Representative Sample Survey

“…This is alarming since most pharmacies in Bangladesh are run by unqualified practitioners who provide antibiotics without a prescription [27]. Several studies have reported the overuse of antibiotics obtained from unqualified providers and drug shops in Bangladesh, and 80-90% of drug shops and medicine vendors operate without a license [8,13,19,28]. Additionally, the adequate supervision and inspection of drug outlets are complicated by the limited availability of drug inspectors (i.e., one drug inspector supervises 2236 pharmacy shops) [6].…”

“…We investigated seven associated factors with antibiotic usage in children with febrile illnesses based on existing literature [13,26,31,32,[36][37][38][39][40][41][42][43][44]. Explanatory variables utilised in this study are defined in Table 3.…”

“…Bangladesh is a LMIC where more than half of the antibiotics used in children are thought to be inappropriately prescribed, dispensed, or sold [11][12][13]. This inappropriate antibiotic usage can be attributed to several factors within Bangladesh's pluralistic healthcare system, which disparate actors govern: government, private sectors, non-governmental organisations (NGOs), and informal sectors, including unqualified providers and pharmacies [14].…”