Antibiotics are life-saving medicines, but increasing antibiotic resistant bacteria are making common infections increasingly difficult to treat, and antibiotic resistance is now recognised as one of the greatest threats to global health. The main cause of this increasing resistance is the unnecessary use of antibiotics, which forces bacteria to adapt in the so-called “selective pressure”.
During normal childbirth without complications, antibiotics should not be used; however, reports and small studies from Asian countries show alarmingly high levels of antibiotic use in these cases. Similarly, there is a worrying trend of over-prescribing and poor use of antibiotics for treating children under five years of age. Focusing particularly on Lao PDR, little is known about the situation of potential overuse and misuse of antibiotics during childbirth and for treating children.
The CAREChild project aims to understand and improve antibiotic use in relation to pregnancy, childbirth and children in Lao PDR with the long-term aim of containing antibiotic resistance.
The team will explore and assess perceptions, knowledge, attitudes and reported practice as well as actual practice among health care providers and in the community, to estimate antibiotic prescribing to estimate the situation of antibiotic resistance, focusing particularly on ESBLs in Escherichia coli in infections and carriage in faecal samples.
The study is an intervention study with a formative phase leading to the development of the intervention, which will be implemented and evaluated through time series analysis. The content of the innovative intervention will be based on qualitative and quantitative findings from the formative phase and contain two components: a participatory and process-based educational intervention aimed towards health care providers, and an mHealth component aimed at pregnant women, and mothers of children under five years of age.
The main outcome measure will be the proportion of uncomplicated vaginal deliveries during which antibiotics are used, and to show changes over time during the intervention using time series analysis over a 24-month period. Additional outcomes will be knowledge and attitudes to antibiotic use and resistance, as well as antibiotic resistance levels.
Data will be collected using structured interviews regarding knowledge and practice of antibiotic use and resistance. In addition, individual interviews and focus group discussions will be held with relevant stakeholders to further understand perceptions about antibiotic use and resistance and how the situation can be improved.
The study is expected to generate important knowledge regarding antibiotic use and resistance development in Lao PDR, but with potential implications to other South East Asian countries and beyond. Furthermore, our project aims to strengthen collaborative ties between Laos-Sweden-Vietnam and to create a long-term collaboration between the partner countries that will serve the purpose of exchange of knowledge and expertise between those countries.
The CAREChild partners are:
- Karolinska Institutet
- Ministry of Health, Department of Food and Drugs, Vientiane Laos
- University of Health Sciences, Vientiane Laos
- National Institute of Public Health, Vientiane Laos
- Health Department of Vientiane Capital, Vientiane Laos
- Hanoi Medical University, Hanoi, Vietnam
- Hanoi University of Pharmacy, Hanoi, Vietnam
Cecilia Stålsby Lundborg: Cecilia.Stalsby.Lundborg@ki.se