ArticleBulletin of the World Health Organization2020
Measuring antibiotic availability and use in 20 low- and middle-income countries.
Article in Bulletin of the World Health Organization, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
34 citing papers in PubMed, 3 syntheses or guidelines pooled it, 76 citations in OpenAlex.
- Consideration of antimicrobial resistance and contextual factors in infectious disease guidelines: a systematic survey.BMJ open · 2021Pooled it
- Quality of medicines for life-threatening pregnancy complications in low- and middle-income countries: A systematic review.PloS one · 2020Pooled it
- A Systematic Review on Evaluation of WHO Core Prescribing Indicators Across Healthcare Facilities in Low Resource Asian Setting: A Case of Nepal.Inquiry : a journal of medical care organization, provision and financingPooled it
- Antimicrobial stewardship in practice: determinants of prescription behaviour and developing interventions to improve surgical prophylaxis in a Rwandan tertiary hospital-a mixed methods study using the behaviour change wheel.Antimicrobial resistance and infection control · 2026Article
- The Future of Antibiotics and Artificial Intelligence: Some Thoughts from Discovery to Bedside.Infectious diseases and therapy · 2026Review
- From 60 Causes to 10 Solutions Against Antibiotics Shortages in Sweden: Platinea's Approach to Developing Policy Interventions.Antibiotics (Basel, Switzerland) · 2025Article
- Review
- Increasing the use of the WHO AWaRe system in antibiotic surveillance and stewardship programmes in low- and middle-income countries.JAC-antimicrobial resistance · 2025Review
- Mitigating inequitable access to appropriate antibiotics in low- and middle-income countries.JAC-antimicrobial resistance · 2025Review
- Knowledge, Attitudes, Motivations, Expectations, and Systemic Factors Regarding Antimicrobial Use Amongst Community Members Seeking Care at the Primary Healthcare Level: A Scoping Review.Antibiotics (Basel, Switzerland) · 2025Review
- Not forgetting the humanitarian contexts in the fight against antimicrobial resistance: Operational-driven reflection on knowledge and research gaps by Médecins Sans Frontières.PLOS global public health · 2025Review
- Widespread loss-of-function mutations implicating preexisting resistance to new or repurposed anti-tuberculosis drugs.Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy · 2024Article
- Antibiotic prescribing practices according to the AWaRe classification among children under 5 of age attending public primary care centres in four West African countries: a cross-sectional study (AIRE project, 2021-2022).BMJ paediatrics open · 2024Article
- Understanding antibiotic purchasing practices in community pharmacies: A potential driver of emerging antimicrobial resistance.Exploratory research in clinical and social pharmacy · 2024Article
- A confirmation of the predictive utility of the Antibiotic Use Questionnaire.BMC public health · 2024Article
- Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort.Annals of clinical microbiology and antimicrobials · 2024Article
- The Availability of Essential Antimicrobials in Public and Private Sector Facilities: A Cross-Sectional Survey in a District of North India.Antibiotics (Basel, Switzerland) · 2024Article
- Reported antibiotic use among patients in the multicenter ANDEMIA infectious diseases surveillance study in sub-saharan Africa.Antimicrobial resistance and infection control · 2024Article
- Feasibility and acceptability of integrating mass distribution of azithromycin to children 1-11 months into a trachoma mass drug administration campaign to reduce child mortality in Côte d'Ivoire.PLOS global public health · 2024Article
- AWaRe classification of antibiotics prescribed within 2018-2021 for hospitalised medical and surgical patients in Uyo, Nigeria.The Pan African medical journal · 2023Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
Abstract
objectiveTo assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys.
methodsWe obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization's AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated.
findingsThe surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160).
conclusionRoutine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities.
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Registered trials
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