Antibiotic use without prescription among children aged under 5 years in low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND

Antimicrobial resistance as a result of inappropriate use of antibiotics is one of the top global public health threats. This systematic review and meta-analysis aimed to assess the prevalence of antibiotic use without prescription among children aged under 5 years in low- and middle-income countries (LMICs).

METHODS

To identify primary studies a comprehensive search of databases was conducted from PubMed, Scopus and HINARI. Observational studies conducted among children ≤5 years old and published in the English language were included. After screening, data were extracted using a checklist. Heterogeneity was assessed using forest plots, Cochran's test and . The random effects meta-analysis model was employed to pool the prevalence of antibiotic use without prescription among under-5 children in LMICs. Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test.

FINDINGS

The review was conducted of 12 cross-sectional studies with a combined sample size of 8773 participants. The pooled prevalence of antibiotic use without prescription among under-5 children in LMICs was 33.27% (95% CI, 27.37%-39.18%;  < 0.0001) with high heterogeneity (  = 97.21%,   0.001). The pooled estimates were higher among studies from Africa (39.85%; 95% CI, 35.61%-44.09%) compared with studies from South America (28.59%; 95% CI, 24.17%-33.01%).

CONCLUSIONS

The pooled prevalence of antibiotic use without prescription among under-5 children in LMICs is high. This implies that the WHO in collaboration with the nations should develop different strategies to improve the regulatory system in LMICs and prevent the use of antibiotics without prescription among under-5 children.