A community survey of antibiotic consumption among children in Madagascar and Senegal: The importance of healthcare access and care quality

Background: Antibiotic resistance is growing in low-income countries (LICs). Children in LICs are particularly at risk. Information on antibiotic consumption is needed to control the development and spread of resistant bacteria. Methods: To measure antibiotic consumption and related factors, a community surveywas undertaken in two sites in Madagascar (Antananarivo and Moramanga) and in Senegal (Guediawaye) among children under 2. Face-toface interviews were conducted with parents or caregivers of eligible children. Regression analysis was used to determine variables associated with reported antibiotic consumption. Availability of health structures and health policies were also investigated. Results: Populationestimates forantibiotic consumptionin the last3 monthswere37.2%(95%CI 33.4%-41.2%)in Guediawaye, 29.3%(95%CI 25.0%-34.1%) in Antananarivo and 24.6%(95%CI 20.6%-29.1%) inMoramanga. In all sites, the largemajority of antibioticswere takenwith a prescription (92.2%, 87.0%and 92.0%for Antananarivo, Moramanga and Guediawaye, respectively) and purchased in pharmacies (89.4%, 73.5%and 78.5%, respectively). Living in houseswithout flushing toilets and baby agewere significantly associatedwith any antibiotic consumption afteradjusting for site. Ahigher density of public health structureswas associatedwith lowerantibiotic consumption levels, while a higher density of private pharmacies was associated with higher levels across sites. Conclusions: These data are crucial for the implementation of local programmes aimed at optimizing antibiotic consumption. Factors such as density of healthcare facilities, prescriber training and national policy must be taken into account when developing strategies to optimize antibiotic consumption in LICs.