Determinants and patterns of antibiotic consumption for children under five in Nepal: analysis and modelling of Demographic Health Survey data from 2006 to 2016

Abstract

Objectives Our aims were to examine AMR‐specific and AMR‐sensitive factors associated with antibiotic consumption in Nepal between 2006 and 2016, to explore health care‐seeking patterns and the source of antibiotics. Methods Cross‐sectional data from children under five in households in Nepal were extracted from the 2006, 2011 and 2016 Demographic Health Surveys (DHS). Bivariable and multivariable analyses were carried out to assess the association of disease prevalence and antibiotic use with age, sex, ecological location, urban/rural location, wealth index, household size, maternal smoking, use of clean fuel, sanitation, nutritional status, access to health care and vaccinations. Results Prevalence of fever, acute respiratory infection (ARI) and diarrhoea decreased between 2006 and 2016, whilst the proportion of children under five receiving antibiotics increased. Measles vaccination, basic vaccinations, nutritional status, sanitation and access to health care were associated with antibiotic use. Those in the highest wealth index use less antibiotics and antibiotic consumption in rural areas surpassed urban regions over time. Health seeking from the private sector has overtaken government facilities since 2006 with antibiotics mainly originating from pharmacies and private hospitals. Adherence to WHO‐recommended antibiotics has fallen over time. Conclusions With rising wealth, there has been a decline in disease prevalence but an increase in antibiotic use and more access to unregulated sources. Understanding factors associated with antibiotic use will help to inform interventions to reduce inappropriate antibiotic use whilst ensuring access to those who need them.

Faringoamigdalitis Bacteriana en Preescolares: Factores Involucrados y Uso de Antibióticos

“…Adicionalmente, se encontró que el 47.36% de los padres considera que administrar antibióticos es la mejor solución cuando su hijo padece una afección de garganta, mientras que el 52% opina que la preocupación por la resistencia a los antibióticos está exagerada. Estos hallazgos son consistentes con los presentados por Zheng et al (2021), quienes observaron que en Nepal, el incremento en el nivel económico se traduce en una menor incidencia de enfermedades, pero a su vez en un aumento en el uso de antibióticos y una mayor disponibilidad de fuentes no reguladas. Asimismo, vale la pena mencionar el estudio de Ojeda y Martínez (2018), realizado en Yucatán, donde se analizó el impacto de las normas sociales y culturales en la prescripción y consumo de antibióticos.…”

Antibiotics Prescription, Dispensing Practices and Antibiotic Resistance Pattern in Common Pathogens in Nepal: A Narrative Review

“…45 Study conducted in 2020 revealed that antibiotic consumption rate increased from 24% in 2006 to 40% in 2016 for acute respiratory infections, 25% to 35% in fever and 8.2% to 26.2% in diarrhea cases. 45 Therefore, irrational use of antimicrobials is one of the important factors attributing to the development of antimicrobial resistance. 37,46 Self-medication Self-medication (SM) is the practice of consuming medication without the consultation of physicians.…”

“…37 However, study conducted in Nepal between 2006, Nepal between 2016 among children under 5 years of age shows decline in disease prevalence but increase in irrational use of antibiotics. 45 Study conducted in 2020 revealed that antibiotic consumption rate increased from 24% in 2006 to 40% in 2016 for acute respiratory infections, 25% to 35% in fever and 8.2% to 26.2% in diarrhea cases. 45 Therefore, irrational use of antimicrobials is one of the important factors attributing to the development of antimicrobial resistance.…”

Point prevalence surveys of antibiotic prescribing in children at a tertiary hospital in a resource constraint, low-income sub-Saharan African country—the impact of an antimicrobial stewardship program

“…Resistance to multiple antibiotics, including carbapenems, by various organisms, has been documented in children, and these drug-resistant strains are the cause of morbidity, prolonged hospital stays, and mortality [11][12][13][14][15][16][17][18][19]. Studies have demonstrated patients, caregivers and prescribers are responsible for the misuse of antibiotics in children [6,[20][21][22][23][24][25]. It is therefore imperative to monitor and control antibiotic prescribing to ensure judicious use, prevent resistance, and reduce the cost of healthcare.…”