TY - JOUR
T1 - Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones
AU - Ingelbeen, Brecht
AU - Phanzu, Delphin M
AU - Phoba, Marie-France
AU - Budiongo, Mi Yn
AU - Berhe, Neamin M
AU - Kamba, Frédéric K
AU - Kalonji, Lisette
AU - Mbangi, Bijou
AU - Hardy, Liselotte
AU - Tack, Bieke
AU - Im, Justin
AU - Heyerdahl, Leonardo W
AU - Da Luz, Raquel Inocencio
AU - Bonten, Marc Jm
AU - Lunguya, Octavie
AU - Jacobs, Jan
AU - Mbala, Placide
AU - van der Sande, Marianne A B
N1 - NPP; Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.
PY - 2022
Y1 - 2022
N2 - OBJECTIVES: 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 (DDD), and Access/Watch/Reserve distribution of antibiotic use by provider. Combining both, we estimated community-wide antibiotic use rates.RESULTS: Of 88.7 (95%CI81.9-95.4, 1588/31221 person-months) healthcare visits per 1000 person-months, visits to private clinics (31.0, 95%CI 30.0-32.0, 418/31221) and primary health centres (25.5, 95%CI 24.6-26.4, 641/31221) 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 DDD 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).CONCLUSIONS: 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.
AB - OBJECTIVES: 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 (DDD), and Access/Watch/Reserve distribution of antibiotic use by provider. Combining both, we estimated community-wide antibiotic use rates.RESULTS: Of 88.7 (95%CI81.9-95.4, 1588/31221 person-months) healthcare visits per 1000 person-months, visits to private clinics (31.0, 95%CI 30.0-32.0, 418/31221) and primary health centres (25.5, 95%CI 24.6-26.4, 641/31221) 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 DDD 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).CONCLUSIONS: 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.
U2 - 10.1016/j.cmi.2022.04.002
DO - 10.1016/j.cmi.2022.04.002
M3 - A1: Web of Science-article
C2 - 35447342
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
SN - 1198-743X
ER -