Non-prescription antibiotic use and its predictors among children in low-and middle-income countries: a systematic review and meta-analysis
1
Department of Pharmacy, Injibara University, Injibara, Ethiopia
2
Department of Public Health, Injibara University, Injibara, Ethiopia
3
Department of Pharmacy, Wollo University, Dessie, Ethiopia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
antibiotic use without prescription significantly contributes to the development and spread of antimicrobial resistance, which is among the leading global public health threats[1]. This systematic review and meta-analysis aim to assess non-prescription antibiotic use and predictors among children in Low and middle-income countries.
METHODS:
a comprehensive search of electronic databases was conducted from PubMed, Scopus and HINARI to identify primary studies published between 2000 and 2024. Observational studies conducted among children≤18 years old and published in English language were included. After screening, studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tool[2] and data were extracted using a checklist. Heterogeneity was assessed using forest plot, Cochran’s Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of non-prescription antibiotic use among children in low-and middle-income countries. Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger’s test.
RESULTS:
the review was conducted among 32 cross-sectional studies with a sample size of 80,133 participants. The pooled prevalence of non-prescription antibiotic use among children in low-and middle-income countries was 38.86% (95% CI 34.32, 43.40; P <0.0001) with high heterogeneity (I 2=99.38%, p<0.0001). The prevalence of non- prescribed antibiotic use among studies conducted in upper middle-income countries (30.85% (24.49%, 37.21%)) was low compared to studies conducted in LMICs (44.00% (37.72%, 52.09%). Penicillin was the most often antibiotic class used without prescription, while upper respiratory infections were the most prevalent illness/ symptoms that prompted non-prescription antibiotic use.
CONCLUSIONS:
the pooled prevalence of non-prescription antibiotic use among children in low-and middle-income countries is high indicating that two out of five children used non-prescribed antibiotics. This review is crucial for international organizations, ministry of health of low-and middle- income countries, regulatory bodies and researchers.
antibiotic use without prescription significantly contributes to the development and spread of antimicrobial resistance, which is among the leading global public health threats[1]. This systematic review and meta-analysis aim to assess non-prescription antibiotic use and predictors among children in Low and middle-income countries.
METHODS:
a comprehensive search of electronic databases was conducted from PubMed, Scopus and HINARI to identify primary studies published between 2000 and 2024. Observational studies conducted among children≤18 years old and published in English language were included. After screening, studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tool[2] and data were extracted using a checklist. Heterogeneity was assessed using forest plot, Cochran’s Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of non-prescription antibiotic use among children in low-and middle-income countries. Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger’s test.
RESULTS:
the review was conducted among 32 cross-sectional studies with a sample size of 80,133 participants. The pooled prevalence of non-prescription antibiotic use among children in low-and middle-income countries was 38.86% (95% CI 34.32, 43.40; P <0.0001) with high heterogeneity (I 2=99.38%, p<0.0001). The prevalence of non- prescribed antibiotic use among studies conducted in upper middle-income countries (30.85% (24.49%, 37.21%)) was low compared to studies conducted in LMICs (44.00% (37.72%, 52.09%). Penicillin was the most often antibiotic class used without prescription, while upper respiratory infections were the most prevalent illness/ symptoms that prompted non-prescription antibiotic use.
CONCLUSIONS:
the pooled prevalence of non-prescription antibiotic use among children in low-and middle-income countries is high indicating that two out of five children used non-prescribed antibiotics. This review is crucial for international organizations, ministry of health of low-and middle- income countries, regulatory bodies and researchers.
| eISSN: | 2654-1459 |
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