Pre-hospital exposures to antibiotics among children presenting with fever in northern Uganda: a facility-based cross-sectional study

Abstract

Background The rise in the indiscriminate use of antibiotics has become a major global public health problem and presents the biggest global health challenge in the twenty-first century. In developing countries, caregivers initiate treatment with antibiotics at home before presentation to a health facility. However, there is a paucity of evolving data towards surveillance of this trend in low-income countries. We investigated antibiotic use among febrile children presenting to a tertiary health facility in northern Uganda. Methods We conducted a cross-sectional study in a tertiary health facility in northern Uganda between March and September 2021. Children aged 6–59 months with fever were selected using systematic random sampling. A pre-tested interviewer-administered questionnaire was used the collect clinical data from the caregivers. Data were analyzed using SPSS version 23. Descriptive statistics and multiple logistic regression models were applied. P-value < 0.05 was considered for statistical significance. Results Eighty-three (39.5%) of the 210 children with fever in this study used antibiotics prior to the hospital visit, 55.4% of which were on a self-medication basis, while 44.6% were empiric prescriptions. The most commonly used antibiotics were amoxicillin 33/83 (39.8%), erythromycin 18 (21.7%), metronidazole 14 (16.9%), ciprofloxacin 13 (15.7%) and ampicillin 6 (7.2%). The main sources of the antibiotics included buying from drug shops 30/83 (36.1%), issuance from clinics (33.7%), remnants at home (12.0%), picking from a neighbour (7.2%) and others (10.8%). The factors associated with antibiotic use among the febrile children were residence (p < 0.001); distance from the nearest health facility (p = 0.005); caregivers’ gender (p = 0.043); cough (p = 0.012); diarrhoea (p = 0.007); duration of fever (p = 0.002); perceived convulsion complicating fever (p = 0.026), and caregivers’ perception that fever (p = 0.001), cough (p = 0.003), diarrhoea (p < 0.001) and any infection (p < 0.001) are indications for antibiotics. Conclusions Inappropriate use of antibiotics for childhood febrile illnesses is prevalent in the study setting, facilitated by the ease of access and use of leftover antibiotics. There is a need to address communities’ health-seeking behaviour and the health providers’ practice alike.

Antibiotics Self Medication among Children: A Systematic Review

“…For example both in a Brazilian study and in a Chinese study, high-school degree significantly reduced the risk of ASM [ 57 , 64 ]. The same result was observed in a Jordan study were parents who have attended university had a reduced risk of antibiotic self-medication [ 47 ]. Moreover, a high level of instruction turned out to be a risk factor for ASM only for mothers in a Chinese study [ 27 ] and in a German study (OR 1.37, IC 1.19–1.57) that considered both children and adolescents [ 69 ].…”

“…A box plot was created to analyze the distribution of ASM in the world region from which the studies were conducted ( Figure 2 ). A higher prevalence was found in Middle East (34%), Africa (22%), Asia (20%), and South America (17%), while the lowest prevalence was found in Europe (8%) [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ,…”

“…Two studies discovered that the risk of ASM was significantly higher for mothers than fathers [ 40 , 46 ], but other three studies found that the risk of self-medication was higher in fathers than in mothers [ 47 , 57 , 63 ].…”

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

“…It was moderate (i.e., some concerns) and high levels in 11 [22,43,50,53,55,56,58,60,64,65,70] and two [49,68] of the remaining studies, respectively. Most studies had a low or moderate risk of participant selection bias, while this was of a high level in nine studies [20, 21, 23, 49, 52, 58, 62, [53,55,56,60,64,68,69,71]. However, 22 studies had a high risk of data collection bias [22, 38, 41-50, 58-61, 63-68].…”

“…The risk of bias was judged as of low level for the 26 studies we included [20, 21, 23-25, 38-42, 44-48, 51, 52, 54, 57, 59, 61-63, 66, 67, 69]. It was moderate (i.e., some concerns) and high levels in 11 [22,43,50,53,55,56,58,60,64,65,70] and two [49,68] of the remaining studies, respectively. Most studies had a low or moderate risk of participant selection bias, while this was of a high level in nine studies [20, 21, 23, 49, 52, 58, 62, [53,55,56,60,64,68,69,71].…”