Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones

Brecht Ingelbeen, Delphin M Phanzu, Marie-France Phoba, Mi Yn Budiongo, Neamin M Berhe, Frédéric K Kamba, Lisette Kalonji, Bijou Mbangi, Liselotte Hardy, Bieke Tack, Justin Im, Leonardo W Heyerdahl, Raquel Inocencio Da Luz, Marc Jm Bonten, Octavie Lunguya, Jan Jacobs, Placide Mbala, Marianne A B van der Sande

Research output: Contribution to journalA1: Web of Science-articlepeer-review

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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 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.

Original languageEnglish
JournalClinical Microbiology and Infection
Issue number9
Pages (from-to)1272-1277
Number of pages6
Publication statusPublished - 2022


  • Anti-Bacterial Agents/therapeutic use
  • Democratic Republic of the Congo/epidemiology
  • Drug Resistance, Microbial
  • Health Personnel
  • Humans
  • Rural Population


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