Abstract
Inappropriate use of antibacterials is a major public health challenge as it can promote emergence of resistance, wastage of financial resources, morbidity and mortality. In this study, we determined the prevalence and factors associated with antibacterial use in managing symptoms of acute respiratory tract infections (ARIs) in households in rural communities of Gulu district, northern Uganda. A cross-sectional study was conducted among households selected using multi-stage sampling. Data were collected through interviews with care-givers of children under five years, using a structured interviewer administered questionnaire. Out of the 856 children who had symptoms of ARIs, 515 (60.2%; CI: 54.5%-65.6%) were treated with antibacterials. The most commonly used antibacterials were amoxicillin (55.2%, n = 358), cotrimoxazole (15.4%, n = 100) and metronidazole (11.4%, n = 74). The determinants of antibacterial use included; getting treatment from a health facility (AOR: 1.85, CI: 1.34–2.56, P < 0.001), households located in peri-urban area (AOR: 2.54, CI: 1.34–4.84, P = 0.005), and a child having cough (AOR: 7.02, CI: 4.36–11.31, P < 0.001). The prevalence of antibacterial use among children under five years with symptoms of ARIs is high in communities of Gulu district, northern Uganda. Getting treatment from a health facility, if a household was located in a peri-urban area and having a cough are positive predictors of antibacterial use. There is need for targeted education on appropriate antibacterial use in rural communities and hospital settings where over prescription is most likely especially in treating symptoms of ARIs among children under five years.
Highlights
Antibacterials are a valuable resource, the benefit of their use should be weighed against the potential risk both to the society and the patient [1, 2]
In uni-variable analysis, we found that children in the age group 37–59 months (P = 0.039), households in peri-urban areas (P = 0.017), getting treatment from a health facility (P < 0.001), cough (P < 0.001), runny nose (P = 0.003) and fast breathing (P = 0.002) were significantly associated with antibacterial use (Table 2)
The inadequate enforcement of regulation of access to antibacterials especially in the private sector coupled with nonfunctional microbiology laboratories in most health facilities could be responsible for the high antibacterial use in children with symptoms of acute respiratory tract infections (ARIs) observed in this study
Summary
Antibacterials are a valuable resource, the benefit of their use should be weighed against the potential risk both to the society and the patient [1, 2]. A number of factors need to be considered when deciding to use antibacterials in managing acute respiratory tract infections (ARIs) [3]. Acute respiratory tract infections (ARIs) are usually viral, especially in children under five years, and do not require use of antibacterials [6]. A study in Kampala, Uganda reported a 43% prevalence of antibacterial use in treating children under five years with symptoms of ARIs [7]. This high prevalence of antibacterial use is a major public health concern, since it potentially promotes emergence of bacterial resistance, poor clinical outcomes, increased mortality and wastage of financial resources [10]
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