Validity of caregivers' reports on prior use of antibacterials in children under five years presenting to health facilities in Gulu, northern Uganda

PLoS One. 2021 Sep 16;16(9):e0257328. doi: 10.1371/journal.pone.0257328. eCollection 2021.

Abstract

Introduction: Given the frequent initiation of antibacterial treatment at home by caregivers of children under five years in low-income countries, there is a need to find out whether caregivers' reports of prior antibacterial intake by their children before being brought to the healthcare facility are accurate. The aim of this study was to describe and validate caregivers' reported use of antibacterials by their children prior to seeking care at the healthcare facility.

Methods: A cross sectional study was conducted among children under five years seeking care at healthcare facilities in Gulu district, northern Uganda. Using a researcher administered questionnaire, data were obtained from caregivers regarding reported prior antibacterial intake in their children. These reports were validated by comparing them to common antibacterial agents detected in blood and urine samples from the children using liquid chromatography with tandem mass spectrometry (LC-MS/MS) methods.

Results: A total of 355 study participants had a complete set of data on prior antibacterial use collected using both self-report and LC-MS/MS. Of the caregivers, 14.4% (51/355, CI: 10.9-18.5%) reported giving children antibacterials prior to visiting the healthcare facility. However, LC-MS/MS detected antibacterials in blood and urine samples in 63.7% (226/355, CI: 58.4-68.7%) of the children. The most common antibacterials detected from the laboratory analysis were cotrimoxazole (29%, 103/355), ciprofloxacin (13%, 46/355), and metronidazole (9.9%, 35/355). The sensitivity, specificity, positive predictive value (PPV), negative predictive value and agreement of self-reported antibacterial intake prior to healthcare facility visit were 17.3% (12.6-22.8), 90.7% (84.3-95.1), 76.5% (62.5-87.2), 38.5% (33.0-44.2) and 43.9% (k 0.06) respectively.

Conclusion: There is low validity of caregivers' reports on prior intake of antibacterials by these children. There is need for further research to understand the factors associated with under reporting of prior antibacterial use.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / analysis*
  • Caregivers / statistics & numerical data*
  • Child, Preschool
  • Chromatography, Liquid
  • Ciprofloxacin / administration & dosage
  • Ciprofloxacin / analysis
  • Cross-Sectional Studies
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Metronidazole / analysis
  • Metronidazole / pharmacology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Poverty
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Tandem Mass Spectrometry
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage
  • Trimethoprim, Sulfamethoxazole Drug Combination / analysis
  • Truth Disclosure
  • Uganda / epidemiology
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Metronidazole
  • Ciprofloxacin
  • Trimethoprim, Sulfamethoxazole Drug Combination

Associated data

  • Dryad/10.5061/dryad.sj3tx9642

Grants and funding

Makerere University -SIDA collaboration (Sida PI0010) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.