Inappropriate use of antibiotics in the management of common childhood illness in Nepal

Funder

Wellcome Trust (Core grant scientific fund from OUCRU Vietnam)

Principal Investigator

Dr Suchita Shrestha

Co-Investigator

Associate Professor Abhilasha Karkey

Researchers

Manish Duwal

Sushmita Pathak

Antibiotics are one of the greatest inventions in the history of medicine which has helped in battling common bacterial infections and saving countless lives. However, today’s world is not only using them in an alarming rate but also in viral illnesses where no antibiotic treatment is required. Various reports suggest irrational use of antibiotics in the form of unnecessary antibiotic use for self-limiting viral infections (treatment or prophylaxis), self-medication with antibiotics by consumers and unnecessary antibiotic prescriptions for self-limiting viral infections by providers in developing countries. This inappropriate and irrational use of antibiotics has resulted to loss of its effectiveness against common bacterial infections and has brought the world on the verge of a deadly public health problem known as antibiotic resistance. Nepal has no adequate surveillance system for tracking antibiotic resistance rates or documenting antibiotic use. Various reports have suggested presence of drug resistant/multidrug resistance bacteria in Nepal. If the problem of antibiotic resistance continues, most children may have no effective treatment in the future. Children are vulnerable to infections and are dependent on their parents for treatment. Hence, the decision that they make directly impacts their children. This is a hospital based cross sectional study which will take place in the inpatient department of Kanti Children’s Hospital involving 450 parents/guardians of children of age 1 month – 14 years. The present study aims to investigate inappropriate use of antibiotics in children affected with common childhood illnesses using a structured questionnaire and in-depth interviews. A structured validated questionnaire, the Parental Perceptions on Antibiotics (PAPA) instrument, will be used for data collection tool via face to face interview which will involve 450 parents/ guardian. The questionnaire will include items related to demographic characteristics of parents and their children, use of antibiotics without doctor’s prescription for current illness, any health issues within the last 1 year, use of antibiotics without doctor’s prescription in the past 1 year, accessibility to services, source of antibiotics and psychosocial domains of antibiotic use. Alongside a structured questionnaire, a purposive selection of parents/guardians for in-depth interviews (IDIs) will also be conducted. The interviews will be designed to explore the perception of parents/guardians regarding antibiotic use in general, which will further aid in identifying factors influencing antibiotic misuse in children. Information sheet will be provided to each participant and they will be included in the study on voluntary basis after written informed consent is taken. The findings of this study will be useful in giving baseline information on self-medication of antibiotics in children and help to explain the determinants of inappropriate use of antibiotics by parents/guardians. This study will also help with the development of targeted and pertinent public health messaging and help create activities that will promote rational use of antibiotics in the wider community.

Background

Antibiotics are one of the greatest inventions in the history of medicine which has helped in battling common bacterial infections and saving countless lives. They are designed to kill or inhibit the growth of bacteria, but today’s world is not only using them in an alarming rate but also in viral illnesses for which no antibiotic treatment is required. Globally, antibiotic consumption has increased by 46% between the years 2000 to 2018 and antibiotics are now the most regularly sold drugs in developing countries (1). Various reports suggest irrational use of antibiotics in the form of unnecessary antibiotic use for self-limiting viral infections (treatment or prophylaxis), self-medication with antibiotics by consumers and unnecessary antibiotic prescriptions for self-limiting viral infections by providers in developing countries (1–3). This inappropriate and irrational use of antibiotics has resulted to loss of its effectiveness against common bacterial infections and has brought the world on the verge of a deadly public health problem known as antibiotic resistance. In Nepal, high burden of drug resistant/multidrug resistant bacteria have been reported through various reports (4-6). If the problem of antibiotic resistance continues, most children may have no effective treatment in the future.

Rational/Justification

Children are vulnerable to infections and are dependent on their parents for treatment. Hence, the decision that they make directly impacts their children. Nepal has no adequate surveillance system for tracking antibiotic resistance rates or documenting antibiotic use. Hence, the present study aims to study inappropriate use of antibiotics in children affected with common childhood illnesses. Children need appropriate treatment to limit the development of antibiotic resistance and hence, it is essential to understand parents’ administration of treatment to their children.

Key Milestones / Activities

PELAJARI SELENGKAPNYA

Related

OUCRU

Kanti Children’s Hospital

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