# A study protocol for the assessment of antibiotic use and bacterial antimicrobial resistance among children under five years of age: Implications for a resource-limited setting

## TL;DR

This study will assess antibiotic use and resistance in children under five in Sierra Leone to help improve healthcare practices in resource-limited settings.

## Contribution

The study introduces a mixed-method approach to evaluate antibiotic use and AMR in children under five in a resource-limited setting.

## Key findings

- The study will evaluate healthcare professionals' knowledge and antibiotic prescription practices.
- It will assess trends in antibiotic use and consumption among inpatient and outpatient children.
- Bacterial profiles and AMR will be investigated in children with bloodstream infections.

## Abstract

The irrational use of antibiotics to treat infections in children is a crucial contributing factor to bacterial antimicrobial resistance (AMR), which can have economic and health consequences, such as morbidity and mortality. This study aims to evaluate antibiotic use and AMR in children under five years of age in Sierra Leone.

This study will be conducted in three hospitals: Ola During Children, Kenema Government, and Magburaka Government Hospitals in Sierra Leone, among healthcare professionals and patients. A mixed-method (qualitative and quantitative) approach will be used to evaluate paediatric health professionals’ knowledge, perceptions, and antibiotic prescription practices. Additionally, two cross-sectional sub-studies will assess inpatient and outpatient trends in antibiotic use and consumption in children, and a cross-sectional observational sub-study will investigate bacterial profiles and AMR among children with bloodstream infections. The anatomical therapeutic chemical (ATC) and the World Health Organisation Access, Watch and Reserve (WHO AWaRe) classifications, days of therapy per 1,000 patient days (DOT/1000PDs), and days of therapy per 100 bed days (DOT/100BDs) will be used to determine the use and consumption. The DOT/1,000PDs and DOT/100BDs will be compared with the defined daily dose/1,000 patient days (DDD/1000PDs) and defined daily dose/100 bed days (DDD/100BDs), respectively. A pre-tested interview guide, interviewer-administered questionnaire and data collection tools adapted from previous studies will be employed for data collection. The sample sizes will be determined, and appropriate sampling methods will be used. Data will be analysed thematically using NVivo 15, and descriptive and inferential statistics using the R software.

The results of this study will inform policymakers and healthcare professionals in developing and/or implementing policies, guidelines, and educational initiatives that will promote antibiotic stewardship among children in Sierra Leone.