Table 2 Primary findings – Non-prescription use of antibiotics

Child’s Symptoms

Nature of symptoms:

* Cough

* Diarrhea

* Fever

* Colds/respiratory illness

* Difficulty breathing

* [33, 34, 36, 44, 48, 49, 52]

* [33, 35,36,37, 50]

* [32, 34, 44, 54]

* [32, 35, 40, 49]

* [33, 48]

* Vietnam, Cambodia, Nigeria, Tanzania¹

* Vietnam, Bangladesh, Guatemala¹

* Vietnam, Cambodia, Bangladesh³

* Vietnam, Yemen, Nigeria¹

* Vietnam, Nigeria¹

Severity of symptoms (conflicting findings):

* Children given unprescribed antibiotics for more severe/prolonged illness or multiple symptoms.

* Children given unprescribed antibiotics for perceived minor illness.

* [33, 37]

* [32, 35, 43, 51]

* Vietnam, Bangladesh¹

* Vietnam, Srpska, China¹

Access to antibiotics

(i.e., availability to over-the-counter/affordable antibiotics or storing antibiotics in the home or sharing).

* [33,34,35,36,37, 41, 42, 46,47,48,49,50,51,52,53,54]

* Vietnam, Bangladesh, China, Uganda, Peru, Nigeria, Guatemala, Tanzania, Malawi¹

Barriers to healthcare

* Greater distance to travel:

* Poor road conditions:

* Lack of transportation:

* Insufficient time, money or service availability:

* [36, 37, 46, 53, 54]

* [36, 37]

* [36, 37, 53]

* [35, 43, 47, 49, 52, 54]

* Vietnam, Bangladesh, Uganda, Malawi¹

* Vietnam, Bangladesh¹

* Vietnam, Bangladesh, Malawi¹

* Vietnam, Srpska, Peru, Nigeria, Tanzania, Bangladesh¹

External advice and influences

* Advice of others(i.e., drug store suppliers, known health professionals, friends or relatives):

* Social and cultural norms:

* [32, 34, 35, 44, 47,48,49, 52, 54]

* [36, 46, 53, 54]

* Vietnam, Cambodia, Peru, Nigeria, Tanzania, Bangladesh¹

* Vietnam, Uganda, Malawi, Bangladesh³

Parent-related determinants

Knowledge (conflicting findings):

* Limited knowledge and unprescribed use.

* No association between knowledge and unprescribed antibiotic use.

* Knowledge of prescription requirements was associated with increased likelihood of parents storing leftover antibiotics.

* [34, 35, 37, 38, 40,41,42, 45, 51]

* [47]

* [42]

* Vietnam, Bangladesh, Nigeria, Yemen, China, Tanzania¹

* Peru²

* China³

Attitudes and beliefs (conflicting findings):

* Parental beliefs about the efficacy of antibiotics and unprescribed use.

* Parental attitudes the child’s condition is too minor to see a doctor and experience using prescribed antibiotics to treat similar symptoms.

* Poor parental attitudes about the appropriate use of antibiotics.

* Parental attitudes not related to unprescribed antibiotic use.

* [33,34,35,36, 49, 51, 52]

* [43, 51]

* [40, 45]

* [47]

* Vietnam, Nigeria, China, Tanzania¹

* Srpska, China¹

* Yemen, Tanzania²

* Peru²

Socio-demographic characteristics

Parent education (conflicting findings):

* Higher educated parents less likely to give unprescribed antibiotics.

* Higher educated parents more likely to give unprescribed antibiotics.

* [38]

* [32, 36]

* Nigeria³

* Vietnam³

Parent age (conflicting findings):

* Older parents/caregivers more likely to give unprescribed antibiotics.

* Younger parents more likely to give unprescribed antibiotics.

* [41]

* [38]

* China³

* Nigeria³

Child age(conflicting findings):

* Increasing age of child associated with unprescribed antibiotic use.

* Younger children more likely to be treated with antibiotics by the parent.

* [51]

* [37, 48]

* China³

* Bangladesh, Nigeria²

Multiple household members:

* [41, 51]

* China³