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

Abstract

Fever in children under five years of age is a common and predominantly self-limiting sign of illness. However, in low- and middle-income countries, antibiotics are frequently used in febrile children, although these children may not benefit from antibiotics. In this study, we explored the prevalence of, and factors associated with, antibiotic use in children under five years old with febrile illness in Bangladesh. We analysed data from the 2017–2018 Bangladesh Demographic and Health Survey to determine the prevalence of antibiotic use in children under five years of age with a febrile illness. We used a causal graph and performed a multivariable logistical regression to identify the factors associated with antibiotic use in children under five years old with febrile illness in Bangladesh. Of the 2784 children aged less than five years with fever included in our analysis, 478 (17%, 95% CI 15% to 19%) received antibiotics. Unqualified sources, including unqualified providers and pharmacies, contributed to 60% of antibiotic prescriptions in children with fever, followed by the private medical sector (29%) and the public sector (23%). The highest use of antibiotics was found in children under six months of age (25%). Children with parents who completed secondary or higher education were more likely to receive antibiotics (adjusted OR (aOR): 2.61 (95% CI 1.63 to 4.16)) than children whose parents did not complete primary education. Educational interventions promoting rational use of antibiotics and improved regulations governing over the counter purchase of antibiotics in Bangladesh may improve antibiotic dispensing practices.

Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh

“…Pharmacy is often the first and only source of healthcare outside home for a majority of population in LMICs [ 10 ]. However, most antibiotics in pharmacies are sold without a registered physicians’ prescription, resulting in irrational use and overuse of antibiotics [ 14 , 15 , 16 ]. According to the National Drug Policy in Bangladesh, there should be a ”Grade C pharmacist” in the pharmacy for dispensing drugs and drug sellers are prohibited from dispensing any antibiotics without a registered physician’s prescription [ 17 ].…”

Factors contributing to antibiotic misuse among parents of school-going children in Dhaka City, Bangladesh

“…To our knowledge, this is the first broad-range KAP-based study in Bangladesh on the misuse of antibiotics by parents of school-going children. Though, there are several studies conducted regarding antibiotic uses and misuses in Bangladesh 33 , 58 – 61 .…”

Incidence, pattern and determinants of self-medication for fevers in children: A survey of caregivers in an emergency unit in Benin City, Nigeria

“…9,27 Muoneke et al 27 discovered that more than one-fifth of their participants in Enugu, south-east Nigeria, self-medicate febrile under-five children with antibiotics. In addition, Samir et al 28 discovered that approximately 17% of under-five children with febrile illnesses received antibiotics in a recent national survey in Bangladesh. Given the high risk of misdiagnosis, suboptimal dosages, and adverse drug reactions, self-medication is dangerous, especially in children.…”