unnecessary antibiotic use for mild ari in 28-day follow-up of 823 children under five in rural...
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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
4 clusters/3 communes
284 children/284 HHs
5 clusters/3 communes
282 children/282 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
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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
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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
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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