Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones
Ingelbeen, Brecht; Phanzu, Delphin M; Phoba, Marie-France; Budiongo, Mi Yn; Berhe, Neamin M; Kamba, Frédéric K; Kalonji, Lisette; Mbangi, Bijou; Hardy, Liselotte; Tack, Bieke; Im, Justin; Heyerdahl, Leonardo W; Da Luz, Raquel Inocencio; Bonten, Marc Jm; Lunguya, Octavie; Jacobs, Jan; Mbala, Placide; van der Sande, Marianne Ab
(2022) Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, volume 28, issue 9, pp. 1272 - 1277
(Article)
Abstract
Objective: In the Democratic Republic of Congo and other low-resource countries, community-acquired pathogens are increasingly resistant to most locally available antibiotics. To guide efforts to optimize antibiotic use to limit antibiotic resistance, we quantified healthcare provider–specific and community-wide antibiotic use. Methods: From household surveys, we estimated monthly healthcare visit rates
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by provider. From healthcare visit exit surveys, we estimated prevalence, defined daily doses, and access/watch/reserve distribution of antibiotic use by provider. Combining both, we estimated community-wide antibiotic use rates. Results: Of 88.7 (95% CI 81.9–95.4) healthcare visits per 1000 person-months (n = 31221), visits to private clinics (31.0, 95% CI 30.0–32.0) and primary health centres (25.5, 95% CI 24.6–26.4) were most frequent. Antibiotics were used during 64.3% (95% CI 55.2–73.5%, 162/224) of visits to private clinics, 51.1% (95% CI 45.1–57.2%, 245/469) to health centres, and 48.8% (95% CI 44.4–53.2%, 344/454) to medicine stores. Antibiotic defined daily doses per 1000 inhabitants per day varied between 1.75 (95% CI 1.02–2.39) in rural Kimpese and 10.2 (95% CI 6.00–15.4) in (peri) urban Kisantu, mostly explained by differences in healthcare utilisation (respectively 27.8 versus 105 visits per 1000 person-months), in particular of private clinics (1.23 versus 38.6 visits) where antibiotic use is more frequent. The fraction of Watch antibiotics was 30.3% (95% CI 24.6–35.9%) in private clinics, 25.6% (95% CI 20.2–31.1%) in medicine stores, and 25.1% (95% CI 19.0–31.2%) in health centres. Treatment durations <3 days were more frequent at private clinics (5.3%, 9/169) and medicine stores (4.1%, 14/338) than at primary health centres (1.8%, 5/277). Discussion: Private healthcare providers, ubiquitous in peri-urban settings, contributed most to community-wide antibiotic use and more frequently dispensed Watch antibiotics and shortened antibiotic courses. Efforts to optimize antibiotic use should include private providers at community level.
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Keywords: Anti-bacterial agents/therapeutic use/Antibiotic use, Antibiotic resistance, Antimicrobial resistance, Antimicrobial stewardship, Cross-sectional studies, Democratic Republic of the Congo, Developing countries, Healthcare utilization, Microbiology (medical), Infectious Diseases, Journal Article
ISSN: 1198-743X
Publisher: Elsevier Limited
Note: Funding Information: All authors declare no competing interests. This work was part of the Bacterial Infections in the Tropics research cluster at the Institute of Tropical Medicine, funded by the InBev-Baillet-Latour Fund. Kimpese Health Research Center, Kimpese and Institut National de Recherche Biomédicale, Democratic Republic of Congo, received funding by the Belgian Directorate of Development Cooperation for Antimicrobial Resistance projects. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Pseudonymized individual data collected for the study, study protocol, questionnaires, and analysis scripts are available on https://github.com/ingelbeen/cabu . Publisher Copyright: © 2022 The Author(s)
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