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Measuring antibiotic availability and use in 20 low- and middle-income countries

Knowles, R; Sharland, M; Hsia, Y; Magrini, N; Moja, L; Siyam, A; Tayler, E (2020) Measuring antibiotic availability and use in 20 low- and middle-income countries. BULLETIN OF THE WORLD HEALTH ORGANIZATION, 98 (3). ISSN 0042-9686 https://doi.org/10.2471/BLT.19.241349
SGUL Authors: Hsia, Yingfen Sharland, Michael Roy

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Abstract

Objective To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization’s AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities.

Item Type: Article
Additional Information: Knowles, R; Sharland, M; Hsia, Y; Magrini, N; Moja, L; Siyam, A; Tayler, E. Measuring antibiotic availability and use in 20 low- and middle-income countries. Bull World Health Organ. 2020; 98 (3). 10.2471/BLT.19.241349. Licence: Creative Commons BY 3.0 IGO
Keywords: Tropical Medicine, 11 Medical and Health Sciences
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: BULLETIN OF THE WORLD HEALTH ORGANIZATION
ISSN: 0042-9686
Dates:
DateEvent
March 2020Published
31 January 2020Published Online
10 December 2019Accepted
Publisher License: Creative Commons: Attribution 3.0 IGO
URI: http://openaccess.sgul.ac.uk/id/eprint/111621
Publisher's version: https://doi.org/10.2471/BLT.19.241349

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