Author(s): Hindum Lanyero 1,*, Jaran Eriksen 2,3, Celestino Obua 4, Cecilia Stålsby Lundborg 2, Sarah Nanzigu 1, Agaba Katureebe 5, Joan N. Kalyango 6,7, Moses Ocan 1
Antibacterials are a valuable resource, the benefit of their use should however be weighed against the potential risk both to the society and the patient [1,2]. A number of factors need to be considered when deciding to use antibacterials in managing acute respiratory tract infections (ARIs) . The first being the microbiology, as the infection can be bacterial, fungal, viral, parasitic or mixed  and the second being the need for antibacterials, since most of these conditions are self-limiting .
Acute respiratory tract infections (ARIs) are usually viral, especially in children under five years, and do not require use of antibacterials . However, studies have reported that in most cases these conditions tend to be treated inappropriately with antibacterials [7-9]. A study in Kampala, Uganda reported a 43% prevalence of antibacterial use in treating children under five years with symptoms of ARIs . This high prevalence of antibacterial use is a major public health concern, since it potentially promotes emergence of bacterial resistance, poor clinical outcomes, increased mortality and wastage of financial resources .
Factors influencing inappropriate antibacterial use among children under five years include, self-medication, financial limitations, poor access to healthcare services, lack of diagnostic tools, non-adherence to treatment guidelines, workload among healthcare workers, prescribing as per patient expectations and weak regulatory systems [10,11]. A study carried out to determine factors that influence antibacterial prescribing for ARIs in primary care facilities reported that, healthcare providers are highly influenced to prescribe antibacterials by patient expectations, clinical uncertainty and workload induced time pressures . A study in Kampala, Uganda reported that location of household, level of education of child care-giver, confidence to self-diagnose ARIs, treatment seeking behavior and access to antibacterials; predict self-medication with antibacterials in children under five years with symptoms of ARIs .
Northern Uganda suffered more than two decades of armed conflict which affected the healthcare infrastructure. The region has disproportionately low attraction and retention of healthcare professionals in addition to lacking functional healthcare facilities especially in rural communities. While inappropriate use of antibacterials in children under five years has been documented in most low and middle income countries (LMICs), little is known of the prevalence of antibacterial use in children under five years with symptoms of ARIs in northern Uganda [7,8]. This study therefore investigated prevalence of, and factors associated with, use of antibacterials in management of symptoms of ARIs in children under five years in rural communities of Gulu district, northern Uganda.
Materials and methods
Study design, site and population
A cross-sectional household survey was carried out from November 2018 to February 2019 in rural communities of Gulu district, northern Uganda. Gulu is a district in northern Uganda. The national census in 2014 estimated Gulu's population at 152,276. The economic activity of 90% of the population is subsistence agriculture . For more than two decades of armed conflict...