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The Journal of antimicrobial chemotherapy v.72 no.2, 2017년, pp.564 - 573   SCI SCIE
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A community survey of antibiotic consumption among children in Madagascar and Senegal: the importance of healthcare access and care quality

Padget, Michael (INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France ); Tamarelle, Jeanne (INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France ); Herindrainy, Perlinot (Epidemiology and Infectious Disease Unit, Institut Pasteur, Antananarivo, Madagascar ); Ndir, Awa (Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal ); Diene Sarr, Fatoumata (Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal ); Richard, Vincent (Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal ); Piola, Patrice (Epidemiology and Infectious Disease Unit, Institut Pasteur, Antananarivo, Madagascar ); Guillemot, Didier (INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France ); Delarocque-Astagneau, Elisabeth (INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France ); Seguy, Maud ( ); Cherblanc, Fanny ( ); Watier, Laurence ( ); Nadimpalli, Maya ( ); Le Fouler, Lenaig ( ); Garin, Benoit ( ); Huynh, Bich-Tram ( ); Collard, Jean-Marc ( ); Raheliarivao, Bodonirina Tanjona ( ); Rakotoarimanana, Feno Manitra Jacob ( ); Randrianirina, Frééédéééérique ( ); Vray, Muriel ( ); Seck, Abdoulaye ( ); Bercion, Raymond ( ); Sow, Amy Gassama ( ); Diouf, Jean Baptiste ( ); Dieye, Pape Samba ( ); Sy, Balla ( ); Ndao, Bouya ( ); Borand, Laurence ( ); Chon, Thida ( ); de Lauzanne, Agathe ( ); Goyet, Sophie ( ); Kerleguer, Alexandra ( ); Lach, Siyin ( ); Ngo, Veronique ( ); Tarantola, Arnaud ( ); Touch, Sok ( ); Kermorvant-Duchemin, Elsa ( );
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    Background Antibiotic resistance is growing in low-income countries (LICs). Children in LICs are particularly at risk. Information on antibiotic consumption is needed to control the development and spread of resistant bacteria. Methods To measure antibiotic consumption and related factors, a community survey was undertaken in two sites in Madagascar (Antananarivo and Moramanga) and in Senegal (Guediawaye) among children under 2. Face-to-face interviews were conducted with parents or caregivers of eligible children. Regression analysis was used to determine variables associated with reported antibiotic consumption. Availability of health structures and health policies were also investigated. Results Population estimates for antibiotic consumption in the last 3 months were 37.2% (95% CI 33.4%–41.2%) in Guediawaye, 29.3% (95% CI 25.0%–34.1%) in Antananarivo and 24.6% (95% CI 20.6%–29.1%) in Moramanga. In all sites, the large majority of antibiotics were taken with a prescription (92.2%, 87.0% and 92.0% for Antananarivo, Moramanga and Guediawaye, respectively) and purchased in pharmacies (89.4%, 73.5% and 78.5%, respectively). Living in houses without flushing toilets and baby age were significantly associated with any antibiotic consumption after adjusting for site. A higher density of public health structures was associated with lower antibiotic consumption levels, while a higher density of private pharmacies was associated with higher levels across sites. Conclusions These data are crucial for the implementation of local programmes aimed at optimizing antibiotic consumption. Factors such as density of healthcare facilities, prescriber training and national policy must be taken into account when developing strategies to optimize antibiotic consumption in LICs.


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