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Antibiotic use amon...
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Allwell-Brown, GbemisolaUppsala universitet,Internationell barnhälsa och nutrition
(author)
Antibiotic use among children in low- and middle-income countries : Studies on global trends, and contextual determinants of antibiotic prescribing in Eastern Uganda
Publisher, publication year, extent ...
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Uppsala :Acta Universitatis Upsaliensis,2022
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79 s.
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electronicrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-470913
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ISBN:9789151314662
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-470913URI
Supplementary language notes
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Language:English
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Summary in:English
Part of subdatabase
Classification
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Subject category:vet swepub-contenttype
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Subject category:dok swepub-publicationtype
Series
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Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine,1651-6206 ;1830
Notes
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This thesis aimed to systematically map trends in reported antibiotic use (RAU) among sick under-five children across low- and middle-income countries (LMICs) in 2005-2017, and, to understand the contextual determinants of antibiotic prescribing in Eastern Uganda. Based on 132 national surveys from 73 LMICs, and using Bayesian linear regression models, trends in RAU among sick under-five children (with symptoms of fever, diarrhoea or cough with fast/difficult breathing) across LMICs in 2005-2017 were mapped by WHO region, World Bank country income group, symptom complaint (Study-I), and by the following user characteristics: rural/urban residence, maternal education, household wealth and source of care (Study-II). To provide context, Study-III investigated patterns and contextual determinants of antibiotic prescribing for febrile under-five outpatients (FUO) attending 37 primary and secondary healthcare facilities across Bugisu, a sub-region in Eastern Uganda, based on a healthcare facility survey, and a two-year retrospective review of outpatient registers from January 2019-December 2020. To further strengthen the understanding of contextual determinants of antibiotic prescribing, in Study-IV, 10 focus group discussions and 10 in-depth interviews were conducted with 85 healthcare providers across primary and secondary healthcare facilities in Bugisu, and analysed using thematic analysis.A modest (17%) relative increase in RAU for sick under-five children across LMICs in 2005-2017 was found, with about 43% of the children reportedly receiving antibiotics for their illness in 2017. Low-income, African, and South-East Asian countries consistently recorded the lowest RAU for sick under-five children. Within LMICs, RAU for sick under-five children increased across all user groups in 2005-2017 but remained lowest among the poorest children, those living in rural areas, and having mothers with the lowest education levels. In Bugisu, 62.2% of FUO in surveyed healthcare facilities received antibiotic prescriptions. Amoxicillin and co-trimoxazole accounted for two-thirds of all antibiotic prescriptions. Cotrimoxazole and ampicillin/cloxacillin were prescribed, despite not being indicated in any of the reported conditions in Study-III. Among other interrelated factors across multiple levels of the health system, availability of antibiotics and diagnostics within healthcare facilities, caregiver demands, and governance at national and sub-national levels were important health worker considerations in antibiotic prescribing for febrile under-five patients.These studies suggest that inequitable access to antibiotics remains a challenge between and within LMICs. Yet, misuse and wastage of antibiotics persists in the same populations with the greatest lack of access to antibiotics and formal healthcare services. A health systems strengthening approach is required to improve antibiotic stewardship and overall quality of care in LMICs.
Subject headings and genre
Added entries (persons, corporate bodies, meetings, titles ...)
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White Johansson, Emily,1976-Uppsala universitet,Internationell barnhälsa och nutrition(Swepub:uu)emijo337
(thesis advisor)
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Mårtensson, Andreas,1963-Uppsala universitet,Centrum för klinisk forskning i Sörmland (CKFD),Internationell barnhälsa och nutrition(Swepub:uu)andma331
(thesis advisor)
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Kitutu, FreddyUppsala universitet,Internationell barnhälsa och nutrition(Swepub:uu)freki150
(thesis advisor)
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Hussain-Alkhateeb, Laith,Dr.Gothenburg University
(thesis advisor)
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Strömdahl, SusanneUppsala universitet,Infektionsmedicin,Infektionssjukdomar(Swepub:uu)susst222
(thesis advisor)
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English, Mike,ProfessorUniversity of Oxford
(opponent)
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Uppsala universitetInternationell barnhälsa och nutrition
(creator_code:org_t)
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