ABSTRACT
Objective To describe antibiotic prescribing practices
using the WHO AWaRe (Access, Watch, Reserve)
classification in West African children under 5 years of age
attending public primary health centres (PHCs).
Design Cross-sectional study.
Setting The AIRE project implemented the systematic
use of pulse oximetry into integrated management of
childhood illness consultations in West African countries
(Burkina Faso, Guinea, Mali and Niger). We described
antibiotic prescriptions for outpatient children at 16 PHCs
and for severe cases referred at district hospitals.
Patients Between 14 June 2021 and 19 June 2022,
15 854 outpatients were included: 968 neonates and young
infants (0–28 days) and 14 886 children (2–59 months).
Among them, 78 (8.1%) neonates and young infants and
385 (2.6%) children were hospitalised. We evaluated
58 hospitalised neonates and young infants and 275
hospitalised children, respectively.
Main outcome measures Frequency of antibiotic
prescriptions according to the AWaRe classification
recommended by WHO.
Results At the PHC level, proportions of neonates
and young infants with ≥1 antibiotic prescription were
83%, 62%, 71% and 59% in Burkina Faso, Guinea, Mali
and Niger, respectively. A total of 805 antibiotics were
prescribed (85% Access and 13% Watch). The proportions
of children with ≥1 antibiotic prescription reached 71%,
66%, 63% and 36% in Burkina Faso, Guinea, Mali and
Niger, respectively. Out of the 9630 antibiotics prescribed,
93% were Access (mainly amoxicillin), and 7% Watch. At
the hospital level, Watch antibiotics were mainly prescribed
for severe cases referred. No Reserve antibiotics were
prescribed.
Conclusions High proportions of antibiotics
were prescribed to outpatient children included,
the appropriateness of which needs further study.
Nevertheless, in every country, the proportion prescribed in the Access group reached the minimum threshold of
60% of all antibiotic prescriptions, as recommended by
WHO

Antibiotic prescribing practices , children under 5 of age public primary care cente, West African