Antibiotic use without prescription among children aged under 5 years in low- and middle-income countries: a systematic review and meta-analysis

Abstract

Background: Antimicrobial resistance as a result of inappropriate use of antibiotics is one of the top global public health threats. This systematic review and meta-analysis aimed to assess the prevalence of antibiotic use without prescription among children aged under 5 years in low- and middle-income countries (LMICs).

Methods: To identify primary studies a comprehensive search of databases was conducted from PubMed, Scopus and HINARI. Observational studies conducted among children ≤5 years old and published in the English language were included. After screening, data were extracted using a checklist. Heterogeneity was assessed using forest plots, Cochran's Q test and I ². The random effects meta-analysis model was employed to pool the prevalence of antibiotic use without prescription among under-5 children in LMICs. Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test.

Findings: The review was conducted of 12 cross-sectional studies with a combined sample size of 8773 participants. The pooled prevalence of antibiotic use without prescription among under-5 children in LMICs was 33.27% (95% CI, 27.37%-39.18%; P < 0.0001) with high heterogeneity (I ² = 97.21%, P < 0.001). The pooled estimates were higher among studies from Africa (39.85%; 95% CI, 35.61%-44.09%) compared with studies from South America (28.59%; 95% CI, 24.17%-33.01%).

Conclusions: The pooled prevalence of antibiotic use without prescription among under-5 children in LMICs is high. This implies that the WHO in collaboration with the nations should develop different strategies to improve the regulatory system in LMICs and prevent the use of antibiotics without prescription among under-5 children.

Figure 1.

PRISMA flow diagram of included studies in the systematic review and meta-analysis of the prevalence of antibiotic use without prescription among under-5 children in LMICs, 2010 to 2024. *Other: advanced Google scholar and citation tracking.

Figure 2.

Forest plot of prevalence of antibiotic use without prescription among under-5 children in LMICs, 2010 to 2024.

Figure 3.

Funnel plot with 95% CI of prevalence of antibiotic use without prescription among under-5 children in LMICs, 2010 to 2024. θ_IV, is the log transformed effect size based on the Inverse Variance method.

Figure 4.

Funnel plot with pseudo-95% CI of prevalence of antibiotic use without prescription among under-5 children in LMICs, 2010 to 2023 (using trim-and-fill analysis). θ_DL is the effect size based on the DerSimonian-Laird method.