Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countries.

Background: Approximately 240 million children worldwide are living with disabilities. Understanding the association between disability status and reported antibiotic use for common illnesses can help develop strategies to address the critical intersection of antimicrobial resistance (AMR) and disability. Methods: Data were collected from 42 low- and middle-income countries through the UNICEF-supported Multiple Indicator Cluster Survey (2017-2023). Disability status was assessed using the Washington Group-Child Functioning Module. Reported antibiotic use was measured by whether children with disabilities received antibiotic treatment for common childhood illnesses. Logistic regression models were applied to investigate the association between disability status and the prevalence of acute respiratory infection (ARI), diarrhea, and fever in the past two weeks, as well as reported antibiotic use for these illnesses. Analyses controlled for age, sex, place of residence, mother's education, the number of children under five in the household and country. Findings: The study included 301,857 children, 6.9% of whom were living with disabilities. Children with disabilities were more likely to experience common illnesses compared to those without disabilities: aOR = 1.78 (95% CI: 1.34-2.36) for ARI and aOR = 1.54 (95% CI: 1.22-1.96) for fever. The odds of antibiotic use among children with disabilities were comparable to those without disabilities: aOR = 1.13 (95% CI: 0.68-1.87) for ARI, aOR = 0.93 (95% CI: 0.64-1.36) for diarrhea, and aOR = 1.23 (95% CI: 0.81-1.86) for fever. This varied across countries, the lower-middle income countries had lower odds of reported antibiotic use for ARI and diarrhea (aOR = 0.85, 95% CI: 0.74-0.97, aOR = 0.78, 95% CI: 0.64-0.95, respectively). Lesotho, Iraq, Comoros and Honduras had higher odds of reported antibiotic use for children with disabilities, and in Pakistan where children with disabilities had lower odds of reported antibiotic use. Subgroup analyses showed that girls with disabilities were less likely to use antibiotics for diarrhea (aOR = 0.78, 95% CI: 0.63-0.96) compared to girls without disabilities. Similarly, girls with disabilities had lower odds of using antibiotics (aOR = 0.53, 95% CI: 0.29-0.98) compared to boys with disabilities. The associations also varied by impairment type, children with seeing, controlling behaviour or learning impairments are less likely to have reported antibiotic use. Interpretation: Children with disabilities are at a higher risk of developing common illnesses but are not necessarily more or less likely to use antibiotics for these conditions compared to children without disabilities. However, gender, country and impairment type disparities persist. Targeted efforts are needed to address these health inequities and ensure equitable access to care. Funding: This research was partially supported by National Natural Science Foundation of China (grant number: 72374228, 72074234), Guangdong Basic and Applied Basic Research Foundation (grant number: 2023A1515010163), Guangzhou Basic and Applied Basic Research Program (grant number: 2025A04J5118), and Fundamental Scientific Research Funds for Central Universities, China (grant number: SYSU-25wkjc02).