P49 Determinants of trends in reported antibiotic use for sick children from LMICs (2005–17): analysis of 132 national surveys from 73 countries

OBJECTIVES: To analyse trends in reported antibiotic use for children aged <5 years with fever, diarrhoea or cough with fast or difficult breathing (outcome) from low- and middle-income countries (LMICs) during 2005–17, disaggregated by the following user characteristics: rural/urban residence, maternal education, household wealth and healthcare source visited. METHODS: Based on 132 Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 73 LMICs, the outcome, disaggregated by user characteristics for all country-years was estimated using a hierarchical Bayesian linear regression model. RESULTS: Across LMICs during 2005–17, the greatest relative increases in the outcome occurred in rural areas, poorest quintiles and least educated populations, particularly in low-income countries and South-East Asia. In low-income countries, rural areas had a 72% relative increase from 17.8% [uncertainty interval (UI): 5.2%–44.9%] in 2005 to 30.6% (11.7%–62.1%) in 2017, compared with a 29% relative increase in urban areas from 27.1% (8.7%–58.2%) in 2005 to 34.9% (13.3%–67.3%) in 2017. Despite these increases, the outcome was consistently highest in urban areas, wealthiest quintiles, and populations with the highest maternal education. CONCLUSIONS: These estimates suggest that the increasing reported antibiotic use for sick children aged <5 years in LMICs during 2005–17 was driven by gains among groups often underserved by formal health services.