Trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing across low-income and middle-income countries in 2005-17: a systematic analysis of 132 national surveys from 73 countries
Trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing across low-income and middle-income countries in 2005-17: a systematic analysis of 132 national surveys from 73 countries
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DOI：
10.1016/s2214-109x(20)30079-6
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发表时间：
2020-06-01
影响因子：
34.3
通讯作者：
Johansson, Emily White
中科院分区：
文献类型：
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作者：
Allwell-Brown, Gbemisola;Hussain-Alkhateeb, Laith;Johansson, Emily White
对抗生素消费的全球评估依赖于药品销售数据，这些数据不衡量个人层面的使用情况，对于低收入和中等收入国家来说往往是不可靠的或无法获得的。为了帮助填补这一证据空白，我们汇编了2005- 2017年低收入和中等收入国家调查的数据，报告了5岁以下患病儿童使用抗生素的情况。方法基于来自73个中低收入国家的132项人口与健康调查和多指标聚类调查，我们分析了按世卫组织地区、世界银行收入分类和症状主诉报告的发热、腹泻或咳嗽伴呼吸急促或困难的5岁以下儿童抗生素使用趋势。使用线性贝叶斯回归模型进行logit变换来估计结果。该模型包括国家层面的社会经济、疾病发病率和卫生系统协变量，以产生缺失值的国家-年份估计。在中低收入国家，报告的5岁以下患病儿童抗生素使用情况从2005年的36.8%（不确定区间[UI] 28.8-44.7）增加到2017年的43.1%（33.2-50.5）。低收入国家的相对增幅最大；在这些国家，报告的5岁以下患病儿童使用抗生素的比例在研究期间上升了34%，从2005年的29.6%（21.2-41.1）上升到2017年的39.5%(32.9- 47.6%)，尽管在整个研究期间，它仍然是所有收入群体中最低的。我们发现2005- 2017年中低收入国家报告的5岁以下患病儿童抗生素使用有限但稳定增长，尽管重叠的美国使解释复杂化。这一增长主要是由低收入国家的收益推动的。我们的研究扩大了来自中低收入国家的证据基础，在这些国家，加强抗生素消费和耐药性监测是全球卫生重点。版权所有(C) 2020作者。Elsevier Ltd.出版。
Background Global assessments of antibiotic consumption have relied on pharmaceutical sales data that do not measure individual-level use, and are often unreliable or unavailable for low-income and middle-income countries (LMICs). To help fill this evidence gap, we compiled data from national surveys in LMICs in 2005-17 reporting antibiotic use for sick children under the age of 5 years.Methods Based on 132 Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 73 LMICs, we analysed trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing by WHO region, World Bank income classification, and symptom complaint. A logit transformation was used to estimate the outcome using a linear Bayesian regression model. The model included country-level socioeconomic, disease incidence, and health system covariates to generate estimates for country-years with missing values.Findings Across LMICs, reported antibiotic use among sick children under 5 years of age increased from 36.8% (uncertainty interval [UI] 28.8-44.7) in 2005 to 43.1% (33.2-50.5) in 2017. Low-income countries had the greatest relative increase; in these countries, reported antibiotic use for sick children under 5 years of age rose 34% during the study period, from 29.6% (21.2-41.1) in 2005 to 39.5% (32.9-47.6) in 2017, although it remained the lowest of any income group throughout the study period.Interpretation We found a limited but steady increase in reported antibiotic use for sick children under 5 years of age across LMICs in 2005-17, although overlapping UIs complicate interpretation. The increase was largely driven by gains in low-income countries. Our study expands the evidence base from LMICs, where strengthening antibiotic consumption and resistance surveillance is a global health priority. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.