Quantifying antimicrobial access and practices for paediatric diarrheal disease in an urban community setting in Southeast Asia

Abstract

30Antimicrobial-resistant infections are increasing across Asia. Aiming to evaluate antimicrobial access 31 and practices in Ho Chi Minh City (HCMC) of Vietnam, we mapped pharmacy locations and used a 32 simulated client method to calculate antimicrobial sales for paediatric diarrheal disease. We 33 additionally evaluated healthcare choices for parents and caregivers when their children experienced 34 diarrhoea. District 8 (population 396,175) of HCMC had 301 pharmacies (one for every 1,316 people), 35 with a density of 15.8 pharmacies/km 2 . A wide range of different treatments (n=57) were sold for 36 paediatric diarrheal disease, with 8% (3/37) and 22% (8/37) of the sampled pharmacies selling 37 antimicrobials for watery and mucoid diarrhoea, respectively. Despite the apparent abundance of 38 pharmacies, the majority of caregivers chose to take their child to a specialized hospital, with 81% 39 (319/396) and 88% (347/396) of responders selecting this as their first, second, or third choice for 40 watery and mucoid diarrhoea, respectively. Lastly, by combining denominators derived from 41 caregiver interviews and diarrheal incidence figures, we calculated that 16% (2,359/14,427) of watery 42 or mucoid diarrhoea episodes of the District 8 population aged 1 to <5 years would receive an 43 antimicrobial for diarrhoea annually, but antimicrobial prescribing was almost ten times greater in 44 hospitals than in the community. Our novel mixed-methods approach found that, whilst antimicrobials 45 are commonly available for paediatric diarrhoea in the community of HCMC, usage is greater in 46 hospitals. The observed non-standardized approach to diarrheal treatments is indicative of poor 47 recommendations. We advocate better guidelines, training and dissemination of information regarding 48 antimicrobials and their use in this location. 49 50 51 52 53 54 55 56 57 Committee (OxTREC approval 5110-16) and the local Institutional Review Board (IRB) of the 102 University of Medicine and Pharmacy at HCMC (No. 220/DHYD-HD). Written informed consent 103 was obtained from all participants over 18 years of age, or from parents and guardians if participant 104 was under 18 years. 105 106 Study setting and design 107With an estimated population of >8 million people, HCMC is the largest city in southern Vietnam 17 . 108

Excess body weight and age associated with the carriage of fluoroquinolone and third-generation cephalosporin resistance genes in commensal Escherichia coli from a cohort of urban Vietnamese children

“…Between March and August 2016, we collected rectal swabs from 498 children without diarrhoea attending a routine health check at the designated healthcare facility. All children were from a single district (eight) in HCMC (the same study area assessed for access to pharmacies in this age group [1]) and enrolled in a longitudinal cohort study of 748 individuals. This population was considered to be generally representative of the child population in HCMC.…”

“…Antimicrobial resistance (AMR) has become an increasingly recognized global health problem. The social complexities associated with AMR are multifaceted; however, a major driver of AMR is thought to be non-prescribed use of antimicrobials in the community, which is particularly common in many low-and middle-income countries (LMICs) [1]. Multiple studies have demonstrated a recent dramatic rise in pathogenic bacteria exhibiting resistance against fluoroquinolones and third-generation cephalosporins [2][3][4], which are two of the most commonly used classes of antimicrobials globally [5].…”

“…Multiple studies have demonstrated a recent dramatic rise in pathogenic bacteria exhibiting resistance against fluoroquinolones and third-generation cephalosporins [2][3][4], which are two of the most commonly used classes of antimicrobials globally [5]. Consistently, cephalosporins and fluoroquinolones are most consumed classes of antimicrobial classes in Vietnam, with prescribed consumption from hospitals equalling consumption from retail pharmacies [1,6].…”