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Valia D, Ingelbeen B, Nassa GJW, Kaboré B, Kiemdé F, Rouamba T, Compaoré A, Kouanda JS, Robert A, Rodriguez-Villalobos H, Van Der Sande MAB, Tinto H. Antibiotic use by clinical presentation across all healthcare providers in rural Burkina Faso: a healthcare visit exit survey. J Antimicrob Chemother 2024; 79:2534-2542. [PMID: 39051704 PMCID: PMC11441991 DOI: 10.1093/jac/dkae252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND To guide antibiotic stewardship interventions, understanding for what indications antibiotics are used is essential. METHODS In rural Burkina Faso, we measured antibiotic dispensing across all healthcare providers. From October 2021 to February 2022, we surveyed patients in Nanoro district, Burkina Faso, following visits to health centres (3), pharmacies (2), informal medicine vendors (5) and inpatients in health centres. We estimated prevalence of antibiotic use and the proportion of Watch group antibiotics by provider type and by clinical presentation, assessing compliance with WHO's AWaRe Antibiotic Book. We estimated per capita antibiotic use by multiplying prevalence of antibiotic use, mean DDD per adult treatment course, and the rate of healthcare visits per 1000 inhabitants per day, estimated from a prior household survey. RESULTS Outpatient antibiotic use was more frequent after health centre visits (54.8%, of which 16.5% Watch, n = 1249) than after visits to pharmacies (26.2%, 16.3% Watch, n = 328) and informal medicine vendors (26.9%, 50.0% Watch, n = 349). The frequency of antibiotic use was highest for bronchitis (79.9% antibiotic use, of which 12.6% Watch), malaria (31.9%, 23.1% Watch), gastroenteritis (76.0%, 31.7% Watch), rhinopharyngitis (40.4%, 8.3% Watch) and undifferentiated fever (77.0%, 44.8% Watch). Compliance with WHO AWaRe guidance could have averted at least 68.4% of all Watch antibiotic use in outpatients at health centres. Community-wide, 2.9 DDD (95% CI 1.9-3.9) were used per 1000 adult inhabitants per day. CONCLUSIONS Most Watch antibiotic use at community level or primary care deviated from WHO guidance. Antibiotic stewardship should focus on key clinical presentations and include primary care and self-medication.
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Affiliation(s)
- Daniel Valia
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Guétawendé Job Wilfried Nassa
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Bérenger Kaboré
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - François Kiemdé
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Adélaïde Compaoré
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Juste Stéphane Kouanda
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
| | - Annie Robert
- Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Hector Rodriguez-Villalobos
- Microbiology unit, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marianne A B Van Der Sande
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé, Direction Régionale du Centre-Ouest/Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
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van der Sande M, Ingelbeen B, Meudec M, van Kleef E, Campbell L, Wouters E, Marien J, van Vredendaal R, Leirs H, Valia D, Yougbare S, Kouanda Juste S, Welgo A, Tinto H, Mpanzu D, Mbangi B, Khoso Muaka CA, Kiabanza O, Melanda A, Makuaya R, Ndomba D, Diagne PM, Heyerdahl L, Giles-Vernick T, Van Puyvelde S, Cooper B. Evaluating the effect of a behavioural intervention bundle on antibiotic use, quality of care, and household transmission of resistant Enterobacteriaceae in intervention versus control clusters in rural Burkina Faso and DR Congo (CABU-EICO). Trials 2024; 25:91. [PMID: 38281023 PMCID: PMC10821568 DOI: 10.1186/s13063-023-07856-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a rising threat in low-resource settings, largely driven by transmission in the community, outside health facilities. Inappropriate antibiotic use is one of the main modifiable drivers of AMR. Its risk is especially high in poor resource settings, with limited diagnostic and surveillance capacities, and many informal medicine vendors determining community use. We hypothesise that to optimise community antibiotic use, especially Watch antibiotics (recommended only as first-choice for more severe clinical presentations or for causative pathogens likely to be resistant to Access antibiotics), both the supply side (medicine vendors) and the demand side (communities) should be pro-actively involved in any intervention. METHODS In two existing demographic health surveillance sites (HDSS) in Burkina Faso and in the Democratic Republic of Congo, behavioural intervention bundles were co-created in a participatory approach, aiming to rationalise (Watch) antibiotic use and improve hygiene and sanitation practices. Bundles consisted of interactive interventions, including theatre, posters, discussions, etc. To evaluate impact, 11 of 22 clusters (a HDSS community with at least one (in)formal medicine vendor) were randomly assigned to this intervention, which will run over a year. The effect of the intervention will be evaluated by comparing outcomes before and after in intervention and control villages from a) exit interviews of clients from vendors, b) mystery patients presenting to vendors with a set of predefined symptoms, c) household interviews to assess behavioural changes related to antibiotic use, health literacy and water-sanitation-hygiene indicators. Long-term impact on AMR will be estimated by modelling changes in resistant Enterobacteriaceae carriage from repeated household surveys before, during and after the intervention in both arms. DISCUSSION Most existing interventions aimed at improving antibiotic use focus on health care use, but in resource-limited settings, community use is highly prevalent. Previous studies targeting only providers failed to show an effect on antibiotic use. Evaluation will be done with before-after epidemiological measurements of actual prescriptions and use. If effective in reducing (Watch) antibiotic use, this would be an empowering methodology for communities, which has significant promise for long-term impact. TRIAL REGISTRATION ClinicalTrials.gov NCT05378880 . 13 May 2022.
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