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

doi:10.1016/j.cmi.2022.04.002

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 journal › A1: Web of Science-article › peer-review

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 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 language	English
Journal	Clinical Microbiology and Infection
Volume	28
Issue number	9
Pages (from-to)	1272-1277
Number of pages	6
ISSN	1198-743X
DOIs	https://doi.org/10.1016/j.cmi.2022.04.002
Publication status	Published - 2022

Keywords

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

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10.1016/j.cmi.2022.04.002

Cite this

Ingelbeen, B., Phanzu, D. M., Phoba, M-F., Budiongo, M. Y., Berhe, N. M., Kamba, F. K., Kalonji, L., Mbangi, B., Hardy, L., Tack, B., Im, J., Heyerdahl, L. W., Da Luz, R. I., Bonten, M. J., Lunguya, O., Jacobs, J., Mbala, P., & van der Sande, M. A. B. (2022). Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones. Clinical Microbiology and Infection, 28(9), 1272-1277. https://doi.org/10.1016/j.cmi.2022.04.002

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 A B. / Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones. In: Clinical Microbiology and Infection. 2022 ; Vol. 28, No. 9. pp. 1272-1277.

@article{7b84aa8796dd42fa86c5decc4f6f4a3b,

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

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 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.",

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

author = "Brecht Ingelbeen and Phanzu, {Delphin M} and Marie-France Phoba and Budiongo, {Mi Yn} and Berhe, {Neamin M} and Kamba, {Fr{\'e}d{\'e}ric K} and Lisette Kalonji and Bijou Mbangi and Liselotte Hardy and Bieke Tack and Justin Im and Heyerdahl, {Leonardo W} and {Da Luz}, {Raquel Inocencio} and Bonten, {Marc Jm} and Octavie Lunguya and Jan Jacobs and Placide Mbala and {van der Sande}, {Marianne A B}",

year = "2022",

doi = "10.1016/j.cmi.2022.04.002",

language = "English",

volume = "28",

pages = "1272--1277",

journal = "Clinical Microbiology and Infection",

issn = "1198-743X",

publisher = "Elsevier Science",

number = "9",

}

Ingelbeen, B, Phanzu, DM, Phoba, M-F, Budiongo, MY, Berhe, NM, Kamba, FK, Kalonji, L, Mbangi, B, Hardy, L , Tack, B, Im, J, Heyerdahl, LW, Da Luz, RI, Bonten, MJ, Lunguya, O, Jacobs, J, Mbala, P & van der Sande, MAB 2022, 'Antibiotic use from formal and informal healthcare providers in the Democratic Republic of Congo: a population-based study in two health zones', Clinical Microbiology and Infection, vol. 28, no. 9, pp. 1272-1277. https://doi.org/10.1016/j.cmi.2022.04.002

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 A B.

In: Clinical Microbiology and Infection, Vol. 28, No. 9, 2022, p. 1272-1277.

Research output: Contribution to journal › A1: Web of Science-article › peer-review

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

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

KW - Anti-Bacterial Agents/therapeutic use

KW - Democratic Republic of the Congo/epidemiology

KW - Drug Resistance, Microbial

KW - Health Personnel

KW - Humans

KW - Rural Population

U2 - 10.1016/j.cmi.2022.04.002

DO - 10.1016/j.cmi.2022.04.002

M3 - A1: Web of Science-article

C2 - 35447342

VL - 28

SP - 1272

EP - 1277

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

SN - 1198-743X

IS - 9

ER -

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

Abstract

Keywords

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