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University of Basel

14 December 2019

Excessive rates of antibiotic prescriptions for children in low- and middle-income countries

(Photo: Danielle Powell, Swiss TPH)
(Photo: Danielle Powell, Swiss TPH)

Children in low- and middle-income countries are receiving an average of 25 antibiotic prescriptions during their first five years of life. This excessive amount could harm the children’s ability to fight pathogens as well as increase antibiotic resistance worldwide, according to researchers from the Swiss Tropical and Public Health Institute (Swiss TPH) and Harvard T.H. Chan School of Public Health. Their study has been published in in the journal The Lancet Infectious Diseases.

“We knew children in low- and middle-income countries are sick more often, and we knew antibiotic prescription rates are high in many countries. What we did not know was how these elements translate into actual antibiotic exposure—and the results are rather alarming,” said Günther Fink, lead author of the study and Professor of Epidemiology and Household Economics at the University of Basel.

Global health threat

Antimicrobial resistance is one of today’s biggest threats to global health and development, according to the World Health Organization. One factor contributing to this global health threat is the excessive use of antibiotics worldwide.

Previous studies have shown that antibiotics are overprescribed to children in many countries. In Tanzania, for instance, several studies have shown that over 90% of children who visit a health facility receive an antibiotic, although only in about 20% of the cases the infection was due to a bacterial infection.

“Remarkable” estimate

The research team from Swiss TPH and Harvard Chan School analyzed data from 2007–2017 from health facilities and household surveys from eight countries: Haiti, Kenya, Malawi, Namibia, Nepal, Senegal, Tanzania, and Uganda. The study found that, on average, children received 5 antibiotic prescriptions per year through age five—a “remarkable” estimate, the authors wrote, given that two antibiotic prescriptions per year is considered excessive in many high-income settings. Results showed that antibiotics were administered in 81% of cases for children with a respiratory illness, in 50% for children with diarrhoea, and in 28% for children with malaria.

The researchers found that the number of antibiotic prescriptions in early childhood varied from country to country: While a child in Senegal received approximately one antibiotic prescription per year in the first five years of life, a child in Uganda was prescribed up to 12. In comparison, a prior study showed that children under five in Europe receive less than one antibiotic prescription per year on average. “Even that number is still high given that the vast majority of infections in this age group are of viral origin,” said study co-author Valérie D’Acremont, a group leader at Swiss TPH.

“What is unique about this study is that it provides a much more comprehensive picture of pediatric antibiotic exposure in LMICs than what has been reported previously. It combines both household data on where and when children are brought for care with data from direct observations of health care workers caring for sick children,” said Jessica Cohen, at Harvard Chan School and senior author of the study.

Impact on children

“The consequences of antibiotic overprescription not only pose a huge threat to global health, but can also result in a concrete health impact for these children,” said Valérie D’Acremont. “Excess antibiotic use destroys the natural gut flora which is essential to fighting pathogens and building immunity defences.”

A research project is underway to better comprehend the health impact of overusing antibiotics on children. “Understanding the concrete impact on individual children is crucial to achieve a policy change,” said Fink. His research team is currently comparing policies at a country level to identify best practices that lead to lower antibiotic prescription rates.

Tackling resistance with digital health tools

The most decisive factor, however, are the health workers. “Training and supervision have the biggest effect on reducing unnecessary antibiotic prescriptions,” said Valérie D’Acremont. To that end, her research team at Swiss TPH and Unisanté in Lausanne developed an electronic Point of Care Tool (ePOCT), which guides health workers through diagnosing and treating sick children.

Introducing ePOCT in health facilities resulted in improved clinical outcomes and a drastic reduction in the prescription of antibiotics from 95% to 11%. The tool is being further enhanced to include artificial intelligence-based algorithms.

Original source

Günther Fink, Valérie D’Acremont, Hannah H Leslie, Jessica Cohen
Antibiotic exposure among children younger than 5 years in low-income and middle-income countries: a cross-sectional study of nationally representative facility-based and household-based surveys
The Lancet Infectious Diseases (2019), doi: 10.1016/S1473-3099(19)30572-9

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