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  • Khare, ShwetaKarolinska Inst, Dept Global Publ Hlth, Hlth Syst & Policy HSP Med Focusing Antibiot, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India. (author)

Determinants and pathways of healthcare-seeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing : a cohort study in rural India

  • Article/chapterEnglish2021

Publisher, publication year, extent ...

  • 2021-12-03
  • BMJ Publishing Group Ltd,2021
  • electronicrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-462228
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-462228URI
  • https://doi.org/10.1136/bmjopen-2021-052435DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:148279974URI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • Objectives To explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India.Study design Prospective cohort study.Study setting and study sample The cohort included 270 U-5 children from selected six villages in rural demographic surveillance site, of the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. A community-based cohort was visited two times weekly for over 113 weeks (August 2014 to October 2016) to record the HSB of caregivers using HSB diaries. Sociodemographic information was also solicited.Primary and secondary outcome measures Primary outcomes: first point of care, healthcare-seeking pathway and quantify antibiotic prescribing for the common acute illnesses.Secondary outcome HSB risk factors were determined using mixed-effects multinomial logistic regression.Results A total of 60 228 HSB follow-up time points for 270 children were recorded with a total of 2161 acute illness episodes. The most common illnesses found were respiratory tract infections (RTI) (69%) and gastrointestinal tract infections (8%). No healthcare was sought in 33% of illness episodes, mostly for RTIs. The most common healthcare-seeking pathway was to informal healthcare providers (IHCPs, 49% of illness episodes). The adjusted relative risk for obtaining no treatment, home treatment and treatment by IHCPs was higher for RTIs (aRR=11.54, 1.82 and 1.29, respectively), illiterate mothers (aRR=2.86, 2.38 and 1.93, respectively), and mothers who were homemakers (aRR=2.90, 4.17 and 2.10, respectively). Socioeconomic status was associated with HSB, with the highest aRR for no treatment in the lowest two socioeconomic quintiles (aRR=6.59 and 6.39, respectively). Antibiotics were prescribed in 46% (n=670/1450) illness episodes and the majority (85%, n=572/670) were broad spectrum.Conclusion In our rural cohort for many acute episodes of illnesses, no treatment or home treatment was done, which resulted in overall reduced antibiotic prescribing. The most common healthcare-seeking pathway was to visit IHCPs, which indicates that they are major healthcare providers in rural areas. Most of the antibiotics were prescribed by IHCPs and were commonly prescribed for illnesses where they were not indicated.

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  • Pathak, Ashish,1973-Karolinska Institutet,Uppsala universitet,Internationell barnhälsa och nutrition,Karolinska Inst, Dept Global Publ Hlth, Hlth Syst & Policy HSP Med Focusing Antibiot, S-17177 Stockholm, Sweden; Ruxmaniben Deepchand Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India(Swepub:uu)ashpa703 (author)
  • Purohit, Manju RajKarolinska Inst, Dept Global Publ Hlth, Hlth Syst & Policy HSP Med Focusing Antibiot, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Pathol, Ujjain 456006, Madhya Pradesh, India. (author)
  • Sharma, MeghaKarolinska Institutet (author)
  • Marrone, GaetanoKarolinska Institutet (author)
  • Tamhankar, Ashok J.Karolinska Inst, Dept Global Publ Hlth, Hlth Syst & Policy HSP Med Focusing Antibiot, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Environm Med, Indian Initiat Management Antibiot Resistance, Ujjain 456006, Madhya Pradesh, India. (author)
  • Stålsby Lundborg, CeciliaKarolinska Institutet (author)
  • Diwan, VishalKarolinska Institutet (author)
  • Karolinska Inst, Dept Global Publ Hlth, Hlth Syst & Policy HSP Med Focusing Antibiot, S-17177 Stockholm, Sweden.;Ruxmaniben Deepchand Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India.Internationell barnhälsa och nutrition (creator_code:org_t)

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  • In:BMJ Open: BMJ Publishing Group Ltd11:122044-6055

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