Systematic mapping of antibiotic usage patterns among sick children across low- and middle-income countries from 2005–2017 and its health system, policy and epidemiology drivers

There is a critical need to achieve balance between access to and excess use of antibiotic medicines in order to combat resistance, one of today’s top global health challenges. While high-income countries must limit excess antibiotic use, millions of people worldwide lack access to life-saving medicines. Yet, it is increasingly recognized that the access-excess divide in antibiotic consumption is more complicated than simply between rich and poor countries. There are also important geographic and socioeconomic differentials in antibiotic usage across low- and middle-income countries that need to be identified and addressed to reduce access disparities. Previous global antibiotic consumption assessments have primarily relied on pharmaceutical sales data, which were to a large extent from high-income and upper-middle-income countries, with little representation of low-income and lower-middle-income countries. Pharmaceutical sales data also do not directly measure population antibiotic usage or its variations across socioeconomic groups. To fill this evidence gap, this project aims to analyze national population-based surveys comparably conducted across low- and middle-income countries in 2005–2017 to identify global trends, regional variations and socio-economic differentials. These large-scale analyses will be complemented by an in-depth field study on antibiotic stewardship practices in Uganda, a low-income country with high antibiotic use and rising resistance rates. Taken together, project findings will provide new and important evidence of changing antibiotic use patterns for sick children in low- and middle-income countries including key health system, policy or epidemiological drivers.