Facilitating appropriate antibiotic use in respiratory tract infections in children in Kyrgyzstan

Context

In the Kyrgyz Republic, an interagency programme and an action plan to contain AMR have been developed, but these are currently still under discussion. While the Ministry of Health (MOH) is committed to AMR mitigation by supporting rational antibiotic use, lack of resources and evidence-based research mean that many issues are not currently being addressed. There are limited studies on AMR in the Kyrgyz Republic, so despite being a member of the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR) network, they are not reporting data into the network. In addition, there are large gaps in the training of doctors, nurses and pharmacists, so the issue of rational prescription of antibiotics has not been resolved.

Problem

Respiratory tract infections (RTIs) are the most common cause of contact to the health system and are the main reason for antibiotic overuse at the primary care level around the world. Acute lower respiratory infections (ALRI) are the most common cause of death among children under 5 globally. In 2020, respiratory diseases accounted for 49.7% of child morbidity in children aged 0-14 years in the Kyrgyz Republic.

With increasing vaccine coverage, and a range of causes of respiratory infections, only a small proportion of these illnesses require antibiotics. In the Kyrgyz Republic, most children are diagnosed and treated at a primary care clinic, primarily by mid-level providers (nurses and feldshers) with only limited access to diagnostic equipment. To assist health care providers in diagnosing under these conditions, various algorithms have been used but this approach has been shown to overdiagnose pneumonia and result in the unnecessary prescription of antibiotics. New approaches to diagnosing and treating respiratory infections in children are needed.

Project overview

The project will be made up of several components including:

• An individually randomized controlled trial to determine the effectiveness of a point of care test (POCT) to measure the level of C-reactive protein (CRP), an inflammation marker which can be used to indicate severe infection. This diagnostic tool helps health care workers to identify whether children with RTIs need antibiotics. The trial will be carried out in 14 different primary health care centres in the Chui and Naryn regions of Kyrgyzstan.
• An implementation research component documenting the study from inception, including qualitative interviews to ascertain the barriers and enablers to implementation as well as other implementation research outcomes such as acceptability, adoption, appropriateness, cost-effectiveness, coverage, feasibility, fidelity and sustainability.
• A health economic study to assess the economic feasibility of the intervention.
• A microbiological study to identify pathogens causing RTIs in children in the study areas.

Outcomes

1. a 10% reduction in the unnecessary use of antibiotics among children in the intervention group
2. increased knowledge of how the intervention works
3. increased knowledge regarding antibiotic sensitivity of the bacteria causing RTIs among children in the study areas
4. information on the cost-effectiveness of the intervention.