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Determinants and Patterns of Antibiotic Use in Children Under Five in Cambodia: Analysis of Demographic and Health
Eunseo Han1, Jeongho Suh2, Young Hwa Lee1
1Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
Insights
Antibiotic use in Cambodian children under five remains high despite declining illness rates. Overuse is concentrated in urban and wealthier households, highlighting a need for targeted antimicrobial stewardship.
Area of Science:
- Global Health
- Pediatrics
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Antimicrobial resistance is a significant global health threat, exacerbated by inappropriate antibiotic use.
- In Cambodia, young children often receive antibiotics for common illnesses, contributing to resistance concerns.
Purpose of the Study:
- To analyze trends and determinants of antibiotic use for acute respiratory infection (ARI), fever, and diarrhea in Cambodian children under five.
- To identify factors associated with antibiotic administration in this population.
Main Methods:
- Secondary analysis of Cambodia Demographic and Health Surveys (2010, 2014, 2021-2022).
- Examined caregiver-reported illnesses (ARI, fever, diarrhea) and antibiotic use in children under 60 months.
- Used multivariable logistic regression to identify associations between antibiotic receipt and demographic/socioeconomic factors.
Main Results:
- Fever and diarrhea prevalence declined significantly between 2010 and 2021-2022.
- Despite declining illness, antibiotic use remained high, with 53% of fever and 29% of diarrhea episodes treated in 2021-2022.
- Urban residence and higher household wealth quintiles were associated with increased odds of antibiotic use, particularly for fever and diarrhea.
Conclusions:
- Childhood illness rates have decreased in Cambodia, but antibiotic overuse persists, especially in urban and affluent households.
- Antimicrobial stewardship programs should prioritize reducing unnecessary antibiotic prescriptions in privileged populations.
- Ensuring equitable access to appropriate care in underserved areas is crucial for effective antimicrobial stewardship.
Background:
Antimicrobial resistance is driven by inappropriate antibiotic use. In Cambodia, young children frequently receive antibiotics despite declining rates of common illnesses. We analyzed nationally representative data to describe trends and determinants of antibiotic use for acute respiratory infection (ARI), fever, and diarrhea among under-five children.
Materials And Methods:
We performed a secondary analysis of the Cambodia Demographic and Health Surveys from 2010, 2014, and 2021-2022. Caregivers reported whether children (<60 months) experienced ARI, fever, or diarrhea in the two weeks preceding the survey and whether antibiotics were administered. We calculated weighted prevalence estimates of each illness and the proportion of episodes treated with antibiotics. For fever and diarrhea separately, we fitted multivariable logistic regression models-stratified by survey year-to identify associations between antibiotic receipt and child age, sex, urban vs. rural residence, household wealth quintile, and maternal education, accounting for sampling weights and clustering.
Results:
Between 2010 and 2021-2022, the two-week prevalence of fever declined from 26.8% to 13.2% (P<0.001) and diarrhea from 14.5% to 6.9% (P<0.001), yet antibiotic use remained high. In 2021-2022, 53% of fever episodes and 29% of diarrheal episodes were treated with antibiotics. Urban residence was associated with higher odds of antibiotic use for fever (adjusted odds ratio [aOR], 1.85; 95% confidence interval [CI], 1.05-3.25) and diarrhea (aOR, 2.38; 95% CI, 1.02-5.54) vs. rural residence. In 2010, children in the richest quintile had greater odds of antibiotic use for fever (aOR, 2.10; 95% CI, 0.89-4.97) and diarrhea (aOR, 3.39; 95% CI, 1.61-7.11) compared to those in the poorest quintile; these disparities persisted, though attenuated, in later surveys.
Conclusion:
Despite substantial declines in childhood illness, antibiotic use among Cambodian children under five remains disproportionately high-especially in urban and wealthier households. Antimicrobial stewardship initiatives should focus on reducing overuse in privileged populations while ensuring equitable access in underserved areas.
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