Factors Influencing Inappropriate Antibiotic Use Among Children Under the Age of 5 in Cambodia: Analysis of CDHS 2014


Inappropriate Antibiotic Use
Children Under the Age of Five
Nonbloody diarrhea
Cambodia Demographic and Health Survey



Inappropriate antibiotic use in children under the age of five (U5) is a global public health concern. Unnecessary antibiotics have been prescribed to treat common illnesses in children, particularly acute respiratory infections, diarrhea, and fever. The majority of antibiotic misuse is frequently found in low- and middle-income countries, including Cambodia. The study aimed to identify factors influencing inappropriate antibiotic use among children under 5 years old who had a minor illness, including nonpneumonia (cough or cold) and nonbloody diarrhea.


This study analyzed existing data from the Cambodia Demographic Health Survey (CDHS) 2014, which included a total of 7,044 children U5. We used weight analysis to take into account the sampling weight using STATA version 14. Descriptive analysis was performed to describe sociodemographic data, treatment-seeking behavior and prevalence of common illnesses, including nonpneumonia and nonbloody diarrhea. The chi-square test was used to assess the initial association between independent variables and inappropriate use of antibiotics. Multivariable logistic regression analysis was performed to evaluate factors independently associated with inappropriate use of antibiotics in U5 children.


Overall, the proportions of U5 children with nonpneumonia and nonbloody diarrhea were 12.8% and 11.3%, respectively. Among those who were sick with minor illnesses, most sought medical care at private clinics, followed by pharmacies and public health facilities. The prevalence of inappropriate antibiotic use in nonpneumonia children U5 was high (73.9%), while its determinants consisted of rural residence (AOR = 2.2, 95% CI = 1.2–3.9, p<0.01), unemployed mother (AOR = 2.4, 95% CI = 1.1–5.4, p=0.034), the use of public health facilities (AOR = 2.7, 95% CI = 1.2–6.3, p=0.018) and private health facilities (AOR = 2.5, 95% CI = 1.4–4.5, p<0.01). However, there was less than 5.0% inappropriate use of antibiotics among U5 children with nonbloody diarrhea. Only households in the middle wealth index were independently associated with lower use of inappropriate antibiotics for nonbloody diarrhea among U5 children (AOR = 0.05, 95% CI = 0.01–0.5; p<0.01).


The study highlighted the high prevalence of inappropriate use of antibiotics to treat nonpneumonia and the relatively low treatment of nonbloody diarrhea children U5. Therefore, antibiotic regulation should be enforced more, particularly for the treatment of nonpneumonia, and effective antibiotic stewardship should be encouraged. Further investigation should be considered when new CDHS data are available. Additionally, exploring in-depth information from healthcare facilities and communities is necessary to monitor the trend of antibiotic use among U5 children.