Trial reportBMC pediatrics2011
Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya.
Trial report in BMC pediatrics, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 33 citations in OpenAlex.
- The Impact of Antimicrobial Stewardship in Children in Low- and Middle-income Countries: A Systematic Review.The Pediatric infectious disease journal · 2022Pooled it
- Antibiotic stewardship interventions in hospitals in low-and middle-income countries: a systematic review.Bulletin of the World Health Organization · 2018Pooled it
- A systematic review of factors affecting children's right to health in cluster randomized trials in Kenya.Trials · 2014Pooled it
- Antibiotic stewardship and point-of-care testing for children in 25 low-income and lower-middle-income countries: a systematic review and meta-analysis.EClinicalMedicine · 2025Article
- The effect of antimicrobial stewardship interventions upon antimicrobial consumption and appropriateness in Vietnamese district hospitals: a cluster randomised trial.The Lancet regional health. Western Pacific · 2025Article
- State of the Art of Antimicrobial and Diagnostic Stewardship in Pediatric Setting.Antibiotics (Basel, Switzerland) · 2025Review
- Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care.Implementation science communications · 2024Article
- Effectiveness of de-implementation strategies for low-value prescribing in secondary care: a systematic review.Implementation science communications · 2023Review
- Overuse of medications in low- and middle-income countries: a scoping review.Bulletin of the World Health Organization · 2023Article
- Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications.Infection and drug resistance · 2023Review
- Strategies Used for Implementing and Promoting Adherence to Antibiotic Guidelines in Low- and Lower-Middle-Income Countries: A Systematic Review.Tropical medicine and infectious disease · 2021Review
- Practical Pharmacist-Led Interventions to Improve Antimicrobial Stewardship in Ghana, Tanzania, Uganda and Zambia.Pharmacy (Basel, Switzerland) · 2021Article
- Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study.BMC public health · 2021Article
- Magnitude and pattern of improvement in processes of care for hospitalised children with diarrhoea and dehydration in Kenyan hospitals participating in a clinical network.Tropical medicine & international health : TM & IH · 2019Observational
- Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems.Antibiotics (Basel, Switzerland) · 2018Article
- Article
- Association of the Paediatric Admission Quality of Care score with mortality in Kenyan hospitals: a validation study.The Lancet. Global health · 2018Article
- Prevalence, aetiology, treatment and outcomes of shock in children admitted to Kenyan hospitals.BMC medicine · 2016Article
- Antibiotics usage in infants during the first 18 months of life in Benin: a population-based cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2016Article
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThere are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial.
methodsRepeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention.
results9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7%) were diagnosed with diarrhoea, with 130 of these being bloody (dysentery) therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7%) of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02).
conclusionWe found some evidence that the multi-faceted, sustained intervention described in this paper led to a reduction in the inappropriate use of antibiotics in treating children with non-bloody diarrhoea.
trial registrationInternational Standard Randomised Controlled Trial Number Register ISRCTN42996612.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.