The Global Fight Against Antibiotic Resistance: An Analysis of Social and Health Seeking Determinants in Antibiotic Use in Vietnamese Children Under 5

Abstract

Antibiotic resistance is an important global issue, perpetuated by increases in antibiotic use around the world. Although resistance is a natural process, misuse of antibiotics speeds the process. In low- and middle-income countries (LMICs), the prevalence of resistant bacteria is an especially challenging issue. Due to high rates of infectious disease in LMICs and deaths from untreated bacterial infections, policy must tackle both antibiotic access and antibiotic misuse.

This paper focuses on antibiotic use in Vietnam, a prominent LMIC with high rates of antibiotic misuse. In particular, it investigates the social and health-seeking determinants that impact correct antibiotic use, antibiotic misuse, and healthcare provider type in Vietnamese children under 5 for Acute Respiratory Illness (ARI). Descriptive analyses and logistic regression models are performed on country-wide data from the United Nations Children’s Fund (UNICEF) Multiple Indicator Cluster Surveys (MICS) in 2006, 2011, 2014.

Results show that antibiotic use trends differ between individuals who self-medicate versus those who seek outside care. Correct antibiotic use increased from 2006 to 2014 only in individuals who sought an outside healthcare provider. On the flipside, antibiotic misuse is also higher in those with outside care. Furthermore, those with high socioeconomic levels have both a greater likelihood of correctly using antibiotics and of misusing the drugs. And lower socioeconomic levels still face low percentage of correct antibiotic usage, indicating a need to address access to antibiotics for those who need it. Additional distinct findings include a greater likelihood of correct antibiotic use for male children, and for children in households with a female head. There are also urban-rural differences in antibiotic usage, distinct from socioeconomic trends. Contrary to the 2010 Global Antibiotic Resistance Partnership (GARP) Situational Analysis for Vietnam, urban individuals actually had a greater likelihood of utilizing private hospitals and pharmacies than rural ones. Rural individuals were also had a greater odds of correctly using antibiotics in 2011.

In conclusion, these findings support, challenge, and broaden current understandings in literature and policy reports. Through more country-specific research, especially in LMICs, more tailored and effective policies can be implemented.