Urban-Rural Differentials in Using Antimicrobials at Home among Under-5 Children with Diarrhea

Abstract

Due to self-limiting course of disease, use of antimicrobials in childhood diarrhea should be limited; however, irrational use is widely reported and is considered as a potential challenge for controlling its rational use. Thus, the present study aimed to describe urban-rural differentials with regard to socio-demographic characteristics, clinical features, and etiologic distribution in antimicrobial use and identify predictors of its use at home before coming to the hospital. From the database (January, 2010 to December, 2012) of Diarrheal Disease Surveillance System (DDSS) of urban Dhaka Hospital and rural Matlab Hospital of icddr,b, we extracted relevant information of 4,245 under-5 children from Dhaka Hospital and 2,161 children from Matlab Hospital. In multivariate analysis, children from urban area were 1.53 times, children aged under 2 years were 1.31 times, better socio-economic status (monthly income >100 US$) were 1.34 times, distance to health facility >5 miles from home 1.63 times, use of oral rehydration solution at home 2.95 times, duration of diarrhea >24 hours 4.25 times, frequency of stool >10 times/24 hrs. 1.47 times, abdominal pain 1.30 times and rotavirus infection were 1.54 times more likely to use antimicrobials at home before coming to the hospital (all p<0.05). On the other hand, maternal illiteracy (OR-0.74), cough (0.83) and Vibrio cholerae infection (0.70) were less likely to influence antimicrobials use at home in study children (all p<0.05). Socio-economic characteristics, clinical features, and etiologic agents of under-5 children determine use of antimicrobials at home before presenting to health facility.