Overuse of antibiotics in the management of acute diarrhea in children under five years in four provinces of Mozambique (2014-2019)

Abstract

Background Even with great reduction in the last years, diarrhea continues as one of leading causes of hospital admission and mortality in children less than five years of age globally. The success of diarrheal disease management relies on the rapid recognition of the symptoms and adequate treatment, to which WHO guidelines, do not recommend antibiotic use for all cases of acute diarrhea in children under five years old, being reserved to specific conditions such as bloody diarrhea, co-infection, malnutrition and chronic associated conditions. Therefore, we aimed to evaluate the frequency of antibiotics use in diarrhea management in children aged 0–59 months admitted with acute diarrhea in four provinces of Mozambique, from 2014 to 2019. Methods A cross-sectional hospital-based surveillance was conducted from January 2015 to December 2019 in six sentinel sites located in four provinces. Socio-demographic, epidemiological and clinical data were obtained by interviewing the child’s caregivers and by accessing the child’s medical records and children’s vaccination card. Data collected through ViNaDia was double-entered in Epi Info^TM3.5.1. (Centers for Disease Control and Prevention, Atlanta 2008), followed by data comparison. IBM SPSS software was used to conduct the data analysis. Results During the study period 2382 children who presented at one of the study health facilities with diarrhea was enrolled through ViNaDia surveillance between 2015–2019 and a total of 85.1% (2028/2382) provided information about the use of ATB and were included in the present analysis. The majority was male. The most frequent age group was 0–11 months with 49.4%. Underweight was observed in 28.8% and wasting in 15.2%. The comorbidities observed was HIV (7.8%), malaria (7.0%), and pneumonia (2.1%). Bloody diarrhea and “rice-water” was reported in 1.5% (10/1664) and 2% (29/1664) respectively. Antibiotics use was 93.2% [95% CI: 92.0–94.2; 1890/2028]. Administration of multiple antibiotics was 49.1% [95% CI: 47.0–51.5; 930/1890]. The most prescribed antibiotics were Ampicillin (46.2%), Gentamicin (38.4%) and Cotrimoxazole (30.5%). Conclusions The results of our study indicate an overuse of antibiotics in the management of acute diarrhea in children attended in four provinces of Mozambique. The study suggests the drawing of a local guideline for the efficient management of acute diarrhea.