Measuring antibiotic availability and use in 20 low- and middle-income countries
Measuring antibiotic availability and use in 20 low- and middle-income countries
复制标题
DOI：
10.2471/blt.19.241349
复制
发表时间：
2020-03-01
影响因子：
11.1
通讯作者：
Tayler, Elizabeth
中科院分区：
文献类型：
--
作者：
Knowles, Rebecca;Sharland, Mike;Tayler, Elizabeth
目的通过服务提供评估和服务可得性及准备程度评估调查，评估低收入和中等收入国家卫生机构抗生素的可得性和使用情况。方法通过13项服务提供评估和8项服务可得性和准备度评估调查，获得13 561家卫生机构的抗生素可得性数据。在10项服务提供评估调查中，观察了儿童与卫生保健提供者的咨询情况，提供了22 699名儿童使用抗生素的数据。根据世界卫生组织的AWaRe分类，抗生素被分为获取、观察和储备。估计了各国提供特定抗生素的卫生保健设施的百分比以及接受抗生素治疗主要临床综合征的儿童的比例。调查评估了27种抗生素的可获得性（19种可获得，7种观察，1种未分类）。复方新诺明和甲硝唑的供应最为广泛，分别占卫生设施库存的89.5%（四分位数间距，IQR: 11.6%）和87.1% （IQR: 15.9%）。相比之下，其他17种获取和观察抗生素的库存低于50%的中位数。在观察的22 699名儿童中，60.1%（13 638名）开具了抗生素（主要是复方新诺明或阿莫西林）。呼吸道疾病儿童最常使用抗生素（76.1%;8972/11 796），其次是未分化发热（50.1%;760/1518）、腹泻（45.7%;1293/2832）和疟疾（30.3%;352/1160）。结论：常规卫生机构调查提供了低收入和中等收入国家抗生素可得性和使用情况的宝贵数据来源。大多数卫生保健机构无法获得许多可获得的抗生素。
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.