title: A community survey of antibiotic consumption among children in Madagascar and Senegal: the importance of healthcare access and care quality.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France mjpadget@gmail.com.|Institut Pasteur, B2PHI, F-75015, Paris, France.|Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Padget
authors.affiliation: INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France.|Institut Pasteur, B2PHI, F-75015, Paris, France.|Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Tamarelle
authors.affiliation: Epidemiology and Infectious Disease Unit, Institut Pasteur, Antananarivo, Madagascar.
authors.forename: Perlinot
authors.initials: P
authors.lastname: Herindrainy
authors.affiliation: Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal.
authors.forename: Awa
authors.initials: A
authors.lastname: Ndir
authors.affiliation: Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal.
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Diene Sarr
authors.affiliation: Epidemiology and Infectious Disease Unit, Institut Pasteur, Dakar, Senegal.
authors.forename: Vincent
authors.initials: V
authors.lastname: Richard
authors.affiliation: Epidemiology and Infectious Disease Unit, Institut Pasteur, Antananarivo, Madagascar.
authors.forename: Patrice
authors.initials: P
authors.lastname: Piola
authors.affiliation: INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France.|Institut Pasteur, B2PHI, F-75015, Paris, France.|Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France.|AP-HP, Raymond-Poincaré Hospital, F-92380, Garches, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Guillemot
authors.affiliation: INSERM 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), F-75015, Paris, France.|Institut Pasteur, B2PHI, F-75015, Paris, France.|Université de Versailles Saint-Quentin, UMR 1181, B2PHI, F-78180, Montigny-le-Bretonneux, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Delarocque-Astagneau
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003906:Developing Countries / Q000706:statistics & numerical data*; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008270:Madagascar; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012675:Senegal; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents