RT Journal Article SR Electronic T1 Antibiotic use for acute respiratory infections among under-5 children in Bangladesh: a population-based survey JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e004010 DO 10.1136/bmjgh-2020-004010 VO 6 IS 4 A1 Md Zakiul Hassan A1 Mohammad Riashad Monjur A1 Md Abdullah Al Jubayer Biswas A1 Fahmida Chowdhury A1 Mohammad Abdullah Heel Kafi A1 Jeffrey Braithwaite A1 Adam Jaffe A1 Nusrat Homaira YR 2021 UL http://gh.bmj.com/content/6/4/e004010.abstract AB Introduction Despite acute respiratory infections (ARIs) being the single largest reason for antibiotic use in under-5 children in Bangladesh, the prevalence of antibiotic use in the community for an ARI episode and factors associated with antibiotic use in this age group are unknown.Methods We analysed nationally representative, population-based, household survey data from the Bangladesh Demographic and Health Survey 2014 to determine the prevalence of antibiotic use in the community for ARI in under-5 children. Using a causal graph and multivariable logistical regression, we then identified and determined the sociodemographic and antibiotic source factors significantly associated with the use of antibiotics for an episode of ARI.Results We analysed data for 2 144 children aged <5 years with symptoms of ARI from 17 300 households. In our sample, 829 children (39%) received antibiotics for their ARI episode (95% CI 35.4% to 42.0%). Under-5 children from rural households were 60% (adjusted OR (aOR): 1.6; 95% CI 1.2 to 2.1) more likely to receive antibiotics compared with those from urban households, largely driven by prescriptions from unqualified or traditional practitioners. Private health facilities were 50% (aOR: 0.5; 95% CI 0.3 to 0.7) less likely to be sources of antibiotics compared with public health facilities and non-governmental organisations. Age of children, sex of children or household wealth had no impact on use of antibiotics.Conclusion In this first nationally representative analysis of antibiotic use in under-5 children in Bangladesh, we found almost 40% of children received antibiotics for an ARI episode. The significant prevalence of antibiotic exposure in under-5 children supports the need for coordinated policy interventions and implementation of clinical practice guidelines at point of care to minimise the adverse effects attributed to antibiotic overuse.Data are available in a public, open access repository. The Demographic and Health Surveys are publicly available to researchers on request.