Healthcare seeking behavior and antibiotic use for diarrhea among children in rural Bangladesh before seeking care at a healthcare facility

Appropriate healthcare utilization and compliance with the WHO treatment guidelines can significantly reduce diarrhea-related childhood mortality and morbidity, while overuse of antibiotics notably increases antibiotic resistance. We studied care-seeking behavior and antibiotic use for childhood diarrhea by analyzing data from 8294 diarrheal episodes of 1-59-month-old children visiting a tertiary-care hospital in rural Bangladesh. Overall, 55% of the study children received antibiotics, while only 6% had dysentery. Notably, 77% of the antibiotics were obtained from a local pharmacy without a prescription. Antibiotics alone, without zinc or ORS, were used by more children with dysentery than watery diarrhea (15% vs. 9%; p<0.001). While 85% of the children received ORS, only 7% received zinc and ORS without antibiotics. Children who received antibiotics before seeking care at the hospital had a significantly higher rate of hospitalization than those who did not have antibiotics (20% vs 13%; p<0.001). The factors that influenced the caregivers’ decision to seek care from the pharmacy were the desire for early recovery, traditional practices, faith in seeking care at pharmacies, and distance to a healthcare facility. Our findings warrant that reducing unnecessary antibiotic consumption requires increasing public awareness and strengthening laws on the sale of over-the-counter antibiotics.