Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study

Lanyero, Hindum; Ocan, Moses; Obua, Celestino; Lundborg, Cecilia Stålsby; Nanzigu, Sarah; Katureebe, Agaba; Kalyango, Joan N.; Eriksen, Jaran

doi:10.1186/s12889-021-11254-1

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…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].…”

Section: Risk Of Bias Of the Included Studiesmentioning

confidence: 99%

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

Edessa

Assefa

Dessie

et al. 2022

J of Pharm Policy and Pract

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Background Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries. Methods A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage. Results In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40–50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49–62%) than those studies with community surveys (40%; 95% CI: 34–46%) (P = 0.001). It was also varied by the recall period of antibiotics use—56% (95% CI: 50–62%) for instantly observed practice, 36% (95% CI: 22–50%) for within two week recall, 35% (95% CI: 26–45%) for 1–6 months recall, and 46% (95% CI: 37–54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets. Conclusions We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries. Trial registration number: CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971.

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Section: Risk Of Bias Of the Included Studiesmentioning

confidence: 99%

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

Edessa

Assefa

Dessie

et al. 2022

J of Pharm Policy and Pract

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“…Recent efforts to measure antibiotic use in sub-Saharan African hospitals have been documented [ 19 , 20 , 21 , 22 ]. However, there are limited studies that utilize the standardized WHO PPS methodology for resource-limited settings, such as Ugandan hospitals [ 23 , 24 , 25 ]. This paper presents data from 13 hospitals in the context of a global health security agenda project for strengthening antimicrobial stewardship programs in low- and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Kiggundu¹,

Wittenauer

Waswa³

et al. 2022

Antibiotics

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Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.

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“… 28–30 Studies have shown that diarrhea is a major concern in sub-Saharan Africa and Uganda in particular. 31 , 32 …”

Section: Discussionmentioning

confidence: 99%

Management of children with danger signs in integrated community case management care in rural southwestern Uganda (2014–2018)

Matte

Ntaro

Kenney

et al. 2023

International Health

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Background In integrated community case management (iCCM) care, community health workers (CHWs) provide home-based management of fever, diarrhea and fast breathing for children aged <5 y. The iCCM protocol recommends that children with danger signs for severe illness are referred by CHWs to health facilities within their catchment area. This study examines the management of danger signs by CHWs implementing iCCM in a rural context. Methods A retrospective observational study that examined clinical records for all patients with danger signs evaluated by CHWs from March 2014 to December 2018 was conducted. Results In total, 229 children aged <5 y had been recorded as having a danger sign during 2014–2018. Of these children, 56% were males with a mean age of 25 (SD 16.9) mo, among whom 78% were referred by the CHWs as per the iCCM protocol. The age category of 12 to 35 mo had the highest numbers of prereferred and referred cases (54% and 46%, respectively). Conclusions CHWs play a key role in early symptomatic detection, prereferral treatment and early referral of children aged <5 y. Danger signs among children aged <5 y, if left untreated, can result in death. A high proportion of the children with danger signs were referred as per the iCCM protocol. Continuous CHW training is emphasized to reduce the number of referral cases that are missed. More studies need to focus on children aged 12–35 mo and why they are the most referred category. Policymakers should occasionally revise iCCM guidelines to detail the types of danger signs and how CHWs can address these.

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Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study

Cited by 9 publications

References 24 publications

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

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

Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda

Management of children with danger signs in integrated community case management care in rural southwestern Uganda (2014–2018)

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