Unnecessary antibiotic use for mild ARI in 28-day follow-up of 823 children under five in rural...

Unnecessary antibiotic use for mild ARI in 28-day follow-up of 823

children under five in rural Vietnam

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Nguyen Quynh HoaNguyen Thi Kim ChucHo Dang PhucMattias LarssonBo ErikssonCecilia Stalsby Lundborg

Introduction

Aim of the study

Study method

Results and discussion

Conclusions

Recommendations

Outline

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Acute respiratory infections (ARI)

Leading cause of mortality and morbidity

Antibiotic treatment

IMCI guidelines: don’t need antibiotic for mild ARI

Irrational antibiotic use resistance

Role of caregivers

Primary diagnosis, assess the severity

Make the decisions to treat the sick child

Introduction

Antibiotic use and AB resistance in Vietnam

A dramatic increase of private health facilities

Availability of antibiotics: easily obtain increase the Irrational Use of Antibiotics : self-medication, incorrect dose

High resistance and multidrug resistance

Weak regulatory implementation and enforcement

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Introduction

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Aim of the study To assess knowledge and practice

among caregivers about antibiotic use

for mild ARIs in children and the

association with demographic, social

and economic characteristics

Study settingBavi district

410410 km2; km2;476476 person/km2 person/km2262,000 262,000 personspersons

Methods

BAVI DISTRICT: 32 communes

50.000 HHs; 232.400 persons

FILABAVI: 69 clusters, 12.000 HHs

51.000 persons; 4.000 children under 5

Lowland area: 19 clusters899 children 6-60 months

Highland area: 33 clusters1998 children 6-60 months

Mountainous area: 17 clusters1048 children 6-60 months

4 clusters/3 communes

284 children/284 HHs





Sample of the study 847 HHs - 847 children 6-60 months

(13 clusters/9 communes)

SamplingMethods

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Interview using questionnaire

Knowledge, reported practice: 828

Antibiotic use

Symptoms in the most recent

illness

Health seeking behavior

Antibiotic use survey: 823 children

Symptoms, health-care, drug use

28 days follow-up: daily self-

report, prescription, drug

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Methods

Nov 20, 2009Nguyen Quynh Hoa 9

Data management and data analysis

Illness classification: IMCI guidelines

Mild ARI: cough, runny nose, sore throat, without fast breathing

Severe ARI: fast breathing, chest in-drawing, stridor

Others: watery feces, vomit, ear ache, injury, pain, skin rash…

28-day follow up period:

Episode of illness: period of having continuous symptoms

Course of antibiotic: period of using continuous antibiotic

Multiple logistic regression: knowledge and reported

practice

Methods

Data management and quality control

Instruments: developed in consultancy with relevant professionals

Pre-tested and piloted before conducting each sub-study.

Training of interviewers: theory and field practice.

One week recall period of drug use based on households’ daily

self-reported forms: reduce recall bias.

Re-interviewed 5% of study population, checked 5% entered data

against questionnaires.

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Methods

Nguyen Quynh Hoa

Caregivers‘knowledge of AB use for ARIs

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Results

• 85% would not require for non-febrile cough

• 45% would require for febrile cough

• 47% would need antibiotics for pneumonia symptoms

• 42% would not need antibiotics in any case

• 37% would need in all the cases

• 13% caregivers had correct overall knowledge

Nguyen Quynh Hoa

Child illness & caregivers’ health-care seeking behaviour

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Results

Antibiotic use for children in the most recent illness

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71%

Seeking care at health facilities: higher antibiotic use

Nguyen Quynh Hoa

Results

Illness and antibiotic use in 28-day follow up

Results

Duration of antibiotic course

Results

Pattern of antibiotics use for 823 children in 28 days

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Results

82% of antibiotics for mild ARI were recommended by HCPs

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Most of children had unnecessarily used

antibiotics putting a constant selective pressure

on bacterial resistance.

It’s likely health facilities used more unnecessary

antibiotic use for mild ARI

Conclusions

Policy implications

Need to improve caregivers’ knowledge about cause of cold and appropriate AB indications

Need to have regular training and monitoring for Health Care Providers in both public and private sectors

Controlling and enforcing the regulations of

prescribed-drugs, GPP and registering of

antibiotics

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Nguyen Quynh Hoa

Unnecessary antibiotic use for mild ARI in 28-day follow-up of 823 children under five in rural...

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