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Nguyen Quynh Hoa Nguyen Thi Kim Chuc Ho Dang Phuc Mattias Larsson Bo Eriksson

Unnecessary antibiotic use for mild ARI in 28-day follow-up of 823 children under five in rural Vietnam. Nguyen Quynh Hoa Nguyen Thi Kim Chuc Ho Dang Phuc Mattias Larsson Bo Eriksson Cecilia Stalsby Lundborg. Outline. Introduction Aim of the study Study method

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Nguyen Quynh Hoa Nguyen Thi Kim Chuc Ho Dang Phuc Mattias Larsson Bo Eriksson

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  1. Unnecessary antibiotic use for mild ARI in 28-day follow-up of 823 children under five in rural Vietnam Nguyen Quynh Hoa Nguyen Thi Kim Chuc Ho Dang Phuc Mattias Larsson Bo Eriksson Cecilia Stalsby Lundborg

  2. Outline • Introduction • Aim of the study • Study method • Results and discussion • Conclusions • Recommendations

  3. Introduction 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 3

  4. 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

  5. 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 4

  6. Methods Study setting Bavi district 410 km2; 476 person/km2 262,000 persons

  7. 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 clusters 899 children 6-60 months Mountainous area: 17 clusters 1048 children 6-60 months Highland area: 33 clusters 1998 children 6-60 months 4 clusters/3 communes 284 children/284 HHs 5 clusters/3 communes 282 children/282 HHs 4 clusters/3 communes 284 children/284 HHs Sample of the study 847 HHs - 847 children 6-60 months (13 clusters/9 communes) Sampling

  8. Methods 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 container 8

  9. Methods 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 Nguyen Quynh Hoa Nov 20, 2009 9

  10. 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.

  11. Results Caregivers‘knowledge of AB use for ARIs • 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 Nguyen Quynh Hoa

  12. Results Child illness & caregivers’ health-care seeking behaviour • The most recent child illness: 79% mild ARIs • Health seeking behavior: Drugstores 38%; public clinics 34%, private clinics 27%, self-treatment 19% • Higher-educated caregivers more likely to self-treat • In the 28-day followed-up period: • Mild ARIs: 623 children (73%), in 1,048 episodes • 286 children (35%) had ≥ 2 mild ARI episodes • Health seeking behavior: Drugstores 34%, public clinic 27%, self treatment 25%, private clinics 21% Nguyen Quynh Hoa

  13. Results Antibiotic use for children in the most recent illness 71% Seeking care at health facilities: higher antibiotic use Nguyen Quynh Hoa

  14. Results Illness and antibiotic use in 28-day follow up • Antibiotic use: inappropriate use • 62% children (513/823), 843 courses, in 1,790 days • 63% AB courses for mild ARI • Mild ARIs: most common • 73% children (623/823), 1048 episodes, in 4,077 days • Half of episodes were treated with antibiotics

  15. Results Duration of antibiotic course

  16. Results Pattern of antibiotics use for 823 children in 28 days 82% of antibiotics for mild ARI were recommended by HCPs

  17. Conclusions • 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 18

  18. 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 Nguyen Quynh Hoa

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