Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones

Ingelbeen, Brecht; Phanzu, Delphin Mavinga; Phoba, Marie-France; Budiongo, Mi YN.; Berhe, Neamin M.; Kamba, Frédéric K.; Kalonji, Lisette Mbuyi; Mbangi, Bijou; Hardy, Liselotte; Tack, Bieke; Im, Justin; Heyerdahl, Leonardo W.; Luz, Raquel Inocencio Da; Bonten, Marc J. M.; Lunguya, Octavie; Jacobs, Jan; Mbala, Placide; Sande, Marianne AB. van der

doi:10.1016/j.cmi.2022.04.002

Cited by 13 publications

(11 citation statements)

References 18 publications

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“…Our findings largely align with findings from other studies in sub-Saharan Africa [32,38,39], and will be used to tailor community-based antibiotic stewardship interventions to tackle uncontrolled and likely inappropriate dispensing and (over) use. We found a strong association between financial limitations and healthcare seeking outside healthcare facilities sustained by both qualitative and quantitative data.…”

Section: Discussionsupporting

confidence: 85%

Healthcare seeking outside healthcare facilities and antibiotic dispensing patterns in rural Burkina Faso: A mixed methods study

Valia

Kouanda

Ingelbeen

et al. 2023

Tropical Med Int Health

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Objective Optimising antibiotic use is important to limit increasing antibiotic resistance. In rural Burkina Faso, over‐the‐counter dispensing of antibiotics in community pharmacies and non‐licensed medicine retail outlets facilitates self‐medication. We investigated its extent, reasons and dispensing patterns. Methods In an exploratory mixed‐method design conducted between October 2020 and December 2021, this study first explored illness perceptions, the range of healthcare providers in communities, antibiotics knowledge and reasons for seeking healthcare outside healthcare facilities. Second, frequencies of illness and healthcare utilisation in the last 3 months were quantitatively measured. Results Participants distinguished between natural and magico‐religious illnesses, according to origins. For illnesses considered to be ‘natural’, healthcare was mainly sought at healthcare facilities, private pharmacies and informal drug outlets. For illnesses considered as magico‐religious, traditional healers were mainly visited. Antibiotics were perceived in the community as medicines similar to painkillers. Healthcare‐seeking outside healthcare facilities was reported by 660/1973 (33.5%) participants reporting symptoms, including 315 (47.7%) to informal vendors. Healthcare seeking outside facilities was less common for 0–4‐year‐olds (58/534, 10.9% vs. 379/850, 44.1% for ≥5‐year‐olds) and decreased with improving socio‐economic status (108/237, 45.6% in the lowest quintile; 96/418, 23.0% in the highest). Reported reasons included financial limitation, and also proximity to informal drug vendors, long waiting times at healthcare facilities, and health professionals' non‐empathetic attitudes towards their patients. Conclusion This study highlights the need to facilitate and promote access to healthcare facilities through universal health insurance and patient‐centred care including reducing patients' waiting time. Furthermore, community‐level antibiotic stewardship programmes should include community pharmacies and informal vendors.

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Section: Discussionsupporting

confidence: 85%

Healthcare seeking outside healthcare facilities and antibiotic dispensing patterns in rural Burkina Faso: A mixed methods study

Valia

Kouanda

Ingelbeen

et al. 2023

Tropical Med Int Health

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“…As in this study, a long duration of health itinerary in a large proportion of children was observed in other health facility-based febrile illness studies in sub-Saharan Africa [11,[33][34][35][36]. Furthermore, previous verbal and social autopsy studies also revealed long health itineraries in deceased children, e.g.…”

Section: Long Health Itinerary and High Case Fatality In Children Wit...supporting

confidence: 86%

“…The high share of the private healthcare sector in DR Congo carries a public health risk [10,29]. In addition to the higher total antibiotic consumption in private health centres, more Watch group and intravenous antibiotics were consumed in private centres in the current study and in a previous survey in Kisantu [36]. Caretakers often demand "strong" medication, i.e.…”

Section: Delayed Appropriate Treatment Due To Prehospital Antibiotics...mentioning

confidence: 47%

“…Long health itinerary: hospital admission > 3 days after fever onset [64] Home care: administration of medicines that were still available at home, either remaining from prior illness or bought and stored at home in advance to illness [10] Healthcare seeking: any care sought from an external healthcare provider (briefly referred to as provider) [9] Delayed first healthcare seeking: first healthcare seeking > 1 day after fever onset [7,8,41,65] Formal healthcare seeking: healthcare seeking at registered health posts, health centres or hospital. These providers were grouped as formal healthcare providers [9,10,36,37].…”

Section: Study Populationmentioning

confidence: 99%

“…Remote or large health centres are often run by medical doctors and nurses, others by nurses only [15,56,57] ➢ Health posts offer a limited package of curative and preventive healthcare services compared to health centres and are run by nurses or health workers [14,15] Informal healthcare seeking: healthcare seeking from private pharmacists or drug vendors (further referred to as pharmacy), traditional healthcare providers (religious practitioners/institutions also considered as traditional), private practitioners or private health centres. These providers were considered as informal healthcare providers [9,10,36,37].…”

Section: Study Populationmentioning

confidence: 99%

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Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Tack

Vita²,

Nketo³

et al. 2023

PLoS Negl Trop Dis

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Background Prompt appropriate treatment reduces mortality of severe febrile illness in sub-Saharan Africa. We studied the health itinerary of children under-five admitted to the hospital with severe febrile illness in a setting endemic for Plasmodium falciparum (Pf) malaria and invasive non-typhoidal Salmonella infections, identified delaying factors and assessed their associations with in-hospital death. Methodology Health itinerary data of this cohort study were collected during 6 months by interviewing caretakers of children (>28 days − <5 years) admitted with suspected bloodstream infection to Kisantu district hospital, DR Congo. The cohort was followed until discharge to assess in-hospital death. Principal findings From 784 enrolled children, 36.1% were admitted >3 days after fever onset. This long health itinerary was more frequent in children with bacterial bloodstream infection (52.9% (63/119)) than in children with severe Pf malaria (31.0% (97/313)). Long health itinerary was associated with in-hospital death (OR = 2.1, p = 0.007) and two thirds of deaths occurred during the first 3 days of admission. Case fatality was higher in bloodstream infection (22.8% (26/114)) compared to severe Pf malaria (2.6%, 8/309). Bloodstream infections were mainly (74.8% (89/119)) caused by non-typhoidal Salmonella. Bloodstream infections occurred in 20/43 children who died in-hospital before possible enrolment and non-typhoidal Salmonella caused 16 out of these 20 bloodstream infections. Delaying factors associated with in-hospital death were consulting traditional, private and/or multiple providers, rural residence, prehospital intravenous therapy, and prehospital overnight stays. Use of antibiotics reserved for hospital use, intravenous therapy and prehospital overnight stays were most frequent in the private sector. Conclusions Long health itineraries delayed appropriate treatment of bloodstream infections in children under-five and were associated with increased in-hospital mortality. Non-typhoidal Salmonella were the main cause of bloodstream infection and had high case fatality. Trial registration NCT04289688

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Setting a realistic AWaRe target for primary care antibiotic use in LMICs

Ingelbeen

Valia²,

Phanzu³

et al. 2023

The Lancet Infectious Diseases

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Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones

Cited by 13 publications

References 18 publications

Healthcare seeking outside healthcare facilities and antibiotic dispensing patterns in rural Burkina Faso: A mixed methods study

Healthcare seeking outside healthcare facilities and antibiotic dispensing patterns in rural Burkina Faso: A mixed methods study

Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo

Setting a realistic AWaRe target for primary care antibiotic use in LMICs

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