Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in context
Summary: 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)...
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Elsevier
2025-07-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025002585 |
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| author | Shengyue Qiu Mingli Xu Yuanyang Wu Chaojie Liu Xiying Li Xinyi Yang Haohai Xia Ruonan Wang Zishu Ma Fanqian Meng Xinping Zhang Gordon Liu Hannah Kuper Shanquan Chen Lianping Yang |
| author_facet | Shengyue Qiu Mingli Xu Yuanyang Wu Chaojie Liu Xiying Li Xinyi Yang Haohai Xia Ruonan Wang Zishu Ma Fanqian Meng Xinping Zhang Gordon Liu Hannah Kuper Shanquan Chen Lianping Yang |
| author_sort | Shengyue Qiu |
| collection | DOAJ |
| description | Summary: 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). |
| format | Article |
| id | doaj-art-10eaebecf3ea48cdacaaccc439ceba23 |
| institution | DOAJ |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-10eaebecf3ea48cdacaaccc439ceba232025-08-20T03:16:08ZengElsevierEClinicalMedicine2589-53702025-07-018510332610.1016/j.eclinm.2025.103326Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in contextShengyue Qiu0Mingli Xu1Yuanyang Wu2Chaojie Liu3Xiying Li4Xinyi Yang5Haohai Xia6Ruonan Wang7Zishu Ma8Fanqian Meng9Xinping Zhang10Gordon Liu11Hannah Kuper12Shanquan Chen13Lianping Yang14School of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, ChinaSchool of Politics and Public Administration, South China Normal University, Guangzhou, ChinaSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaSchool of Psychology and Public Health, La Trobe University, Melbourne, AustraliaSchool of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, ChinaSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaNational School of Development, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, ChinaInternational Centre for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UKInternational Centre for Evidence in Disability, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Corresponding author.School of Public Health, Medical Division, Sun Yat-sen University, Guangzhou, China; Institute for Global Health and Development, Peking University, Beijing, China; Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China; Corresponding author. School of Public Health, Sun Yat-sen University, No.74 Zhongshan Second Road, Yuexiu District, Guangzhou, 510080, China.Summary: 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).http://www.sciencedirect.com/science/article/pii/S2589537025002585Child illnessDisabilityAntibioticsEquityLow- and middle-income countries |
| spellingShingle | Shengyue Qiu Mingli Xu Yuanyang Wu Chaojie Liu Xiying Li Xinyi Yang Haohai Xia Ruonan Wang Zishu Ma Fanqian Meng Xinping Zhang Gordon Liu Hannah Kuper Shanquan Chen Lianping Yang Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in context EClinicalMedicine Child illness Disability Antibiotics Equity Low- and middle-income countries |
| title | Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in context |
| title_full | Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in context |
| title_fullStr | Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in context |
| title_full_unstemmed | Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in context |
| title_short | Antibiotic use for common illnesses in children living with disability: a multi-country study across 42 low- and middle-income countriesResearch in context |
| title_sort | antibiotic use for common illnesses in children living with disability a multi country study across 42 low and middle income countriesresearch in context |
| topic | Child illness Disability Antibiotics Equity Low- and middle-income countries |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025002585 |
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