Community Education and Surveillance of Antibiotics Use: Experimental Evidence from Nepal

Abstract

We investigate the effectiveness of an educational intervention targeted at parents of children to encourage judicious use of antibiotics in a cluster randomized trial in urban Nepal. The intervention was delivered by community nurses during a household visit, supplemented by periodic reinforcement videos during the study period. We tracked child illness episodes and medication use using a mobile application. Among 238 reported episodes, antibiotics were used in 42% episodes, 65% of these without a physician's prescription. The intervention reduced non-prescription antibiotic use by 13.4 percentage points (41.1% at the base). It did not reduce the overall use of antibiotics. Treatment households were 29 percentage points more likely to seek care at a hospital or a clinic during illness, but incurred 58% higher medication costs due to formal health service use. The findings suggest that education interventions targeted to the population can reduce non-prescribed antibiotic use significantly and confirm the viability of mobile applications as a tool for monitoring antibiotics use in communities.