Frequent unregulated use of antibiotics in rural Cambodian infants.

Asuka Miyazaki,Azusa Iwamoto,Bunsreng Taing,Mitsuaki Matsui,Rathavy Tung,Sharon E Cox

doi:10.1093/trstmh/traa020

Abstract

BackgroundDespite a high prevalence of antibiotic resistance in Cambodia, few studies have assessed health-seeking behaviour and the use of antibiotics by caregivers of young children in Cambodia.MethodsWe conducted a cross-sectional survey of infants <12 months of age and their caregivers, assessing the frequency of reported illness, common symptoms and associated health-seeking behaviour through structured questionnaires administered by trained fieldworkers at a home visit. In a subset of these participants, ages 4–8 months with no acute malnutrition, we conducted a 3-month surveillance with fortnightly home visits.ResultsOf 149 infants (ages 1–11 months, 54.4% male) enrolled in the cross-sectional study, 76 (51.4%) reported symptoms of diarrhoea, fever or cough in the previous 14 d, with associated use of antibiotics reported in 22 (14.8%) infants. In 47 infants enrolled in the longitudinal surveillance, there were 141 reported episodes of illness in 44 (94%) infants with 21 infants (45%) reported to have received antibiotics in 32/141 (22.7%) episodes. Amoxicillin was the most commonly reported antibiotic in both surveys (68% [40/59 episodes reporting the use of antibiotics]).ConclusionsAntibiotic usage is high in this population and appears to be occurring largely outside of the formal healthcare system.

Highlights

Inappropriate antibiotic use can lead to the development of antimicrobial resistance (AMR)
During a cross-sectional study and 3-month surveillance of a subgroup we aimed to describe the incidence of episodes of diarrhoea, fever and cough as reported by mothers and describe associated health-seeking behaviour and the proportion of episodes associated with reported antibiotic use or other medications
We demonstrate a high incidence of symptoms of illness in young rural Cambodian infants resulting in health-seeking behaviour outside of the home and frequent use of antibiotics

Summary

Introduction

Inappropriate antibiotic use can lead to the development of antimicrobial resistance (AMR). This is a global problem, but one likely to have the most impact on the poorest populations where infectious diseases are still highly endemic. The western border area of Cambodia is known to be a hotspot for the development of new resistancecausing mutations for antimalarial drugs and there is increasing research on health provider and community use of antimalarials, but much less for antibiotics, within the community. Despite a high prevalence of antibiotic resistance in Cambodia, few studies have assessed healthseeking behaviour and the use of antibiotics by caregivers of young children in Cambodia

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