Social and Health Seeking Determinants of Antibiotic Use in Vietnamese Children Under 5: Analysis of National Household Survey Data

BackgroundAntibiotic resistance is an important global public health issue, perpetuated by increases in antibiotic use. In low- and middle-income countries (LMICs), tackling antibiotic resistance bacteria is especially challenging. Due to high rates of infectious disease and continuing high mortality from untreated bacterial infections, policy must balance tackling both antibiotic access and antibiotic overuse. This paper investigates the social and health-seeking determinants that impact appropriate and inappropriate antibiotic use in Vietnamese children under 5 for Acute Respiratory Illness (ARI). MethodsDescriptive analyses and logistic regression models were performed on country-wide household data from UNICEF Multiple Indicator Cluster Surveys in 2006, 2011, 2014. ResultsResults show that antibiotic overuse is higher in those who sought care from a healthcare provider than those who self-treated. In 2014, children who sought care at private facilities and government facilities were more likely to overuse antibiotics for mild respiratory infections (OR 6.1 and OR 3.8 respectively) than those who did not seek care at private and government facilities respectively. Furthermore, higher socioeconomic level was associated with both appropriate antibiotic use for pneumonia and inappropriate for mild ARI. Children in the poorest households in 2011 and 2014 were less likely to appropriately use antibiotics than those from other socioeconomic levels (OR 0.37 and 0.025 respectively). And children in the poorest households in 2014 were less likely to inappropriately use antibiotics for mild ARI than all other socioeconomic levels (OR 0.36). ConclusionsThese findings support, challenge, and broaden current understandings of antibiotic usage in Vietnam. Our results suggest that inappropriate antibiotic use arises from the provider and institutional level. Consequently, we argue that community education efforts and enforcing antibiotics as prescription-only is insufficient. Instead, more focus should be made on reducing financial incentives and infrastructural weaknesses at hospitals and health centres. Furthermore, our results show the need to provide the poorest households with sufficient access to antibiotics. Health policy should tackle the issue of inappropriate use of antibiotics for mild ARI among higher socioeconomic groups.