Inappropriate use of antibiotics in the management of diarrhoea in children under five years admitted with acute diarrhoea in four provinces of Mozambique 2014–2019

Abstract Background Even with a great reduction in the last years, diarrhoea continues to be one of the leading causes of hospital admission and mortality in children less than five years of age globally. The success of diarrhoeal disease management relies on the rapid recognition of the symptoms and adequate treatment, with World Health Organization (WHO) guidelines, limiting the use of antibiotics for all diarrhoea cases being reserved to specific circumstances. Therefore, this study aimed to evaluate the frequency of antibiotics use in diarrhoea management in children aged 0–59 months admitted with acute diarrhoea in four provinces of Mozambique, from 2014 to 2019. Methods A cross-sectional hospital-based surveillance was conducted from January 2014 to December 2019 in six sentinel sites located in four provinces. Socio-demographic, epidemiological and clinical data were obtained by interviewing the child’s caregivers and by accessing the child’s medical records and children’s vaccination card. Data collected through National Surveillance of Diarrhoea (ViNaDia) was double-entered in Epi InfoTM3.5.1. (Centers for Disease Control and Prevention, Atlanta 2008), followed by data comparison. IBM SPSS software was used to conduct the data analysis. Results During the study period 2014–2019 a total of 2382 children presenting at one of the designated health facilities were enrolled via ViNaDia surveillance. Of these 85.1% (2028/2382) provided data of antibiotics (ATB) usage and thus included in the present analysis. The majority was male with 59.3% (1203/2028), with infants aged 0–11 months composing the largest age group with 49.4% (1002/2028). Nutritional assessment revealed that 28.8% (585/2028) were underweight and 15.2% (308/2028) faced wasting. The comorbidities included human immunodeficiency virus (HIV) 7.8% (159/2028), malaria 7.0% (141/2028), and pneumonia 2.1% (42/2028). The rates of bloody diarrhoea and “rice-water” were reported in 1.5% (10/1664) and 2% (29/1664) respectively. Antibiotics use was reported in 93.2% of the children [95% CI: 92.0–94.2; 1890/2028], with s 49.1% [95% CI: 47.0–51.5; 930/1890] received more than one ATB. The most prescribed antibiotics were Ampicillin (46.2%), Gentamicin (38.4%) and Cotrimoxazole (30.5%). Conclusions The results of this study indicate inappropriate use of antibiotics in the management of acute diarrhoea in children attended in four provinces of Mozambique. The study suggests the drawing of a local guideline for the efficient management of acute diarrhoea, and the need for education on adherence of WHO recommendations on antibiotics use in acute diarrhoea.