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Sources of antibiotics for acute respiratory infection in children aged <5 years children in South Asia: A multicountry study
- Md Abdullah Al Jubayer Biswas, Mohammad Riashad Monjur, South Eastern Sydney Local Health District, Md. Zakiul Hassan, Nusrat Homaira
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s29
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Background: In South Asia, a region of almost 2 billion people across 8 countries, acute respiratory infections (ARIs) are associated with significant morbidity and mortality in children aged <5 years. Although ~80% of ARIs are due to viral etiology and are often self-limiting, they remain the single largest reason for antibiotic use in children aged <5 years in South Asia. We investigated the sources and dispensing pattern of antibiotics for ARIs in children aged <5 years in South Asia. Methods: We analyzed nationally representative, population-based, publicly available household survey data from 6 South Asian countries’ Demographic and Health Surveys (DHS): Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. The outcome of interest was the source of antibiotics for children aged <5 years who reportedly had symptoms compatible with ARI (cough, fever, and runny nose) and had received antibiotics for the ARI episode in the 2 weeks preceding the survey. We used a generalized estimating equation with an exchangeable correlation structure to account for country-specific cluster-level correlation to estimate the odds of sources of antibiotics usage. Models were adjusted for age, sex, type of place of residence, wealth index, and parents’ education. To analyze the data, we used the sample weight supplied by the DHS to ensure that our results appropriately reflect the target population in each of the countries studied. Results: In total, across the 6 South Asian countries, 24,104 children aged <5 years had symptoms of ARI, 7,587 (31%; 95% CI, 30–33) from received antibiotics. A higher proportion of antibiotic usage for ARIs episodes occurred in Afghanistan (66%), followed by Maldives (53%), Pakistan (45%), and Nepal (43%). Regarding the source of antibiotics, a higher proportion of antibiotics was obtained from the private medical sector in India, followed by unqualified sources in Bangladesh, and the public sector in Afghanistan. Our adjusted multivariable analysis revealed that, in comparison to the public sector, participants were 2.6 times (aOR, 2.6; 95% CI, 1.6–4.3) more likely to receive antibiotics from private medical sector drug sources in Nepal and 1.3 times more likely (aOR, 1.3; 95% CI, 1.1–1.5) in Afghanistan. Conclusions: In South Asian countries, the private medical sector was the most common primary source of antibiotics for children with ARIs. Targeted efforts to create awareness around antibiotic dispensing and guidelines to improve practices may curtail the use of antibiotics for ARIs in children aged <5 years in South Asia.
Disclosures: None
Antibiotic use among SARI patients according to the AWaRe classification before and during the COVID-19 pandemic in Bangladesh
- Md Ariful Islam, Md. Zakiul Hassan, Mohammad Abdul Aleem, Zubair Akhtar, Tanzir Ahmed Shuvo, Md Kaousar Ahmmed, Syeda Mah-E-Muneer, Md Abdullah Al Jubayer Biswas, Ayesha Afrin, Probir Kumar Ghosh, Fahmida Chowdhury
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, p. s28
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Background: Irrational antibiotic use among hospitalized patients can lead to antibiotic resistance. For rational use, the WHO introduced the Access, Watch, and Reserve (AWaRe) classification of antibiotics. We explored antibiotic use according to the AWaRe classification among patients hospitalized with severe acute respiratory infection (SARI) between the prepandemic and COVID-19 pandemic periods in Bangladesh. Methods: From June 2017 to November 2022, we analyzed SARI inpatient data from the hospital-based influenza surveillance platform at 9 tertiary-level hospitals in Bangladesh. We defined June 2017–February 2020 as the prepandemic period and March 2020–November 2022 as the pandemic period. Physicians identified inpatients meeting the WHO SARI case definition and recorded patient demographics, clinical characteristics, and antibiotics received during hospitalization. We used descriptive statistics to summarize the data. Results: We enrolled 20,640 SARI patients (median age, 20 years; IQR, 1.6–50; 63% male); and among them, 18,197 (88%) received antibiotics (26% of those received >1 different course of antibiotics). Compared to the prepandemic period, the proportion of antibiotic use among SARI patients was higher during the pandemic: 93% (9,887 of 10,655) versus 83% (8,310 of 9,985) (P < .001). According to AWaRe classification, Access, Watch, and Reserve groups accounted for 32% (n = 2,623), 86% (n = 7,158), and 0.05% (n = 4), respectively, before the pandemic and 32% (n = 3,194), 90% (n = 8,850), and 0.08% (n = 8), respectively, during the pandemic (Fig.). The most common antibiotic prescribed for children aged <5 years during the prepandemic was ceftriaxone (n = 1,940, 74%), followed by amikacin (n = 325, 13%) and flucloxacillin (n = 300, 12%); similarly, during the pandemic, most common antibiotic prescribed was ceftriaxone (n = 3,097, 79%), followed by amikacin (n = 723, 18%) and flucloxacillin (n = 348, 9%). The most common antibiotic prescribed for patients aged ≥5 years during the prepandemic period was ceftriaxone (n = 3,174, 54%), followed by amoxicillin-clavulanic acid (n = 1,304, 22%) and azithromycin (n = 1,038, 18%). During the pandemic, the most common antibiotic prescribed for patients aged ≥5 years was ceftriaxone (n = 3,793, 64%), followed by amoxicillin-clavulanic acid (n = 1,327, 22%) and clarithromycin (n = 797, 13%). Among children aged <5 years, use of the Watch group of antibiotics during the prepandemic and pandemic periods was similar: 94% (n = 3,688) versus 95% (n = 2,347) (P = .099). However, among patients aged ≥5 years, the use of Watch antibiotics was higher during the pandemic compared to the prepandemic period: 87% (n = 5,163) versus 82% (n = 4,811) (P < .001). Conclusions: Use of antibiotics in the Watch group was predominant among SARI patients both before and during the COVID-19 pandemic, and it increased among SARI patients aged ≥5 years during the pandemic period in Bangladesh. Promoting antibiotic stewardship programs for physicians, including in-service training on antibiotic use, could reduce irrational antibiotic use, which might contribute to mitigating antibiotic resistance in the country.
Financial support: This study was funded by the CDC.
Disclosures: None
Assessment of standard precaution related to infection prevention readiness of healthcare facilities in Bangladesh: Findings from a national cross-sectional survey
- Md Abdullah Al Jubayer Biswas, Md Zakiul Hassan, Mohammad Riashad Monjur, Md Saiful Islam, Aninda Rahman, Zubair Akhtar, Fahmida Chowdhury, Sayera Banu, Nusrat Homaira
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 09 December 2021, e52
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Background:
Baseline assessment of standard precaution relating to infection prevention and control (IPC) preparedness to fight health crisis within healthcare facilities at different levels and its associated factors in Bangladesh remains unknown.
Methods:We analyzed the nationally representative Bangladesh health facility survey (BHFS) data conducted by the Ministry of Health and Family Welfare (MoHFW) during July–October 2017. We used the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) manual to determine the standard precautions related to the IPC readiness index. Using a conceptual framework and multivariable linear regression, we identified the factors associated with the readiness index.
Results:We analyzed data for 1,524 surveyed healthcare facilities. On average, only 44% of the standard precaution elements were available in all facilities. Essential elements, such as guidelines for standard precautions (30%), hand-washing soap (29%), and pedal bins (38%), were not readily available in all facilities. The tuberculosis service area was least prepared, with 85% of elements required for standard precaution deficient in all facilities. Significantly lower readiness indexes were observed in the rural healthcare facilities (mean difference, −13.2), healthcare facilities administered by the MoHFW (mean difference, −7.8), and private facilities (mean difference, −10.1) compared to corresponding reference categories.
Conclusions:Our study revealed a severe lack of standard precaution elements in most healthcare facilities, particularly in rural health centers. These data can provide a baseline from which to measure improvement in infection prevention and control (IPC) in these facilities and to identify areas of gaps for targeted interventions to improve IPC strategies that can improve the Bangladesh health system.