Determinants and Patterns of Antibiotic Use in Children Under Five in Cambodia: Analysis of Demographic and Health Survey Data 2010-2022

초록

Background: Antimicrobial resistance is driven by inappropriate antibiotic use. In Cambodia, young children frequently receive antibiotics despite declining rates of common illnesses. We analyzed nationally representative data to describe trends and determinants of antibiotic use for acute respiratory infection (ARI), fever, and diarrhea among under-five children. Materials and Methods: We performed a secondary analysis of the Cambodia Demographic and Health Surveys from 2010, 2014, and 2021-2022. Caregivers reported whether children (<60 months) experienced ARI, fever, or diarrhea in the two weeks preceding the survey and whether antibiotics were administered. We calculated weighted prevalence estimates of each illness and the proportion of episodes treated with antibiotics. For fever and diarrhea separately, we fitted multivariable logistic regression models-stratified by survey year-to identify associations between antibiotic receipt and child age, sex, urban vs. rural residence, household wealth quintile, and maternal education, accounting for sampling weights and clustering. Results: Between 2010 and 2021-2022, the two-week prevalence of fever declined from 26.8% to 13.2% (P<0.001) and diarrhea from 14.5% to 6.9% (P<0.001), yet antibiotic use remained high. In 2021-2022, 53% of fever episodes and 29% of diarrheal episodes were treated with antibiotics. Urban residence was associated with higher odds of antibiotic use for fever (adjusted odds ratio [aOR], 1.85; 95% confidence interval [CI], 1.05-3.25) and diarrhea (aOR, 2.38; 95% CI, 1.02-5.54) vs. rural residence. In 2010, children in the richest quintile had greater odds of antibiotic use for fever (aOR, 2.10; 95% CI, 0.89-4.97) and diarrhea (aOR, 3.39; 95% CI, 1.61-7.11) compared to those in the poorest quintile; these disparities persisted, though attenuated, in later surveys. Conclusion: Despite substantial declines in childhood illness, antibiotic use among Cambodian children under five remains disproportionately high-especially in urban and wealthier households. Antimicrobial stewardship initiatives should focus on reducing overuse in privileged populations while ensuring equitable access in underserved areas.

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