Zewdie Segenet, Kassa Assefa Andargie, Bizuneh Mekonen Melkie, Tesfaye Tegenu Chanie, Yayehrad Ashagrachew Tewabe
Department of Pharmacy, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia.
Department of Epidemiology, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia.
JAC Antimicrob Resist. 2025 Jun 6;7(3):dlaf093. doi: 10.1093/jacamr/dlaf093. eCollection 2025 Jun.
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).
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 test and . 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.
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%; < 0.0001) with high heterogeneity ( = 97.21%, 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%).
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.
抗生素使用不当导致的抗菌药物耐药性是全球最大的公共卫生威胁之一。本系统评价和荟萃分析旨在评估低收入和中等收入国家（LMICs）5岁以下儿童无处方使用抗生素的流行情况。
为确定原始研究，对PubMed、Scopus和HINARI数据库进行了全面检索。纳入了在≤5岁儿童中开展的、以英文发表的观察性研究。筛选后，使用清单提取数据。使用森林图、Cochran检验和 评估异质性。采用随机效应荟萃分析模型汇总LMICs中5岁以下儿童无处方使用抗生素的流行率。进行亚组分析和荟萃回归以确定异质性来源。使用带Egger检验的漏斗图评估发表偏倚。
对12项横断面研究进行了评价，合并样本量为8773名参与者。LMICs中5岁以下儿童无处方使用抗生素的合并流行率为33.27%（95%CI，27.37%-39.18%；<0.0001），异质性高（=97.21%，<0.001）。与南美洲的研究（28.59%；95%CI，24.17%-33.01%）相比，非洲研究的合并估计值更高（39.85%；95%CI，35.61%-44.09%）。
LMICs中5岁以下儿童无处方使用抗生素的合并流行率很高。这意味着世界卫生组织应与各国合作制定不同策略，以改善LMICs的监管系统，并防止5岁以下儿童无处方使用抗生素。
