Community-based intervention reduces antibiotic use in Burkina Faso and DRC

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medRxiv Published April 24, 2026 Medically reviewed April 24, 2026 Study authors: Ingelbeen, B.; Valia, D.; Mbangi, B.; van Kleef, E.; Campbell, L.; Kouanda, S. J.; Muaka, C.-A. M. K… DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider that community-based education and provider feedback reduced Watch-group antibiotic use in two African countries.

A cluster randomised controlled trial in Burkina Faso and Democratic Republic of Congo evaluated a community-based behavioural intervention bundle comprising community health education campaigns, educational and feedback sessions with providers, and AWaRe Book guidance. The study included 44 villages with at least 500 inhabitants and at least one health centre or medicine vendor. Baseline surveys assessed 5532 patients, and post-intervention surveys assessed 4898 patients.

The primary outcome was Watch-group antibiotic use, cluster-adjusted and offset for healthcare utilisation. In intervention clusters, Watch-group antibiotic use decreased, while it increased in control clusters. The adjusted prevalence ratio was 0.33 (95%CI 0.14-0.78). Patient management through simulated patient visits was assessed as a secondary outcome; however, changes in patient management scores were limited.

Safety and tolerability were not reported; adverse events, serious adverse events, and discontinuations were not reported. The follow-up duration was nine months. Key limitations include the limited changes in patient management scores and the community-level nature of the outcome.

In practice, reduced community-level use of broad-spectrum antibiotics could help slow community-acquired pathogens’ increasing resistance to clinically important antibiotics. These findings support consideration of similar community-based strategies while acknowledging the limited effect on patient management scores and the need for further evaluation.

Study Details

Study typeRct

Sample sizen = 5,532

EvidenceLevel 2

PublishedApr 2026

View Original Abstract ↓

Background Increasing Watch-group antibiotic use may be contributing to antimicrobial resistance burden in sub-Saharan Africa. We evaluated the effect of a community-based, co-created intervention bundle targeting all community-level healthcare providers and communities they serve, on Watch-group antibiotic use and patient management. Methods In a cluster-randomised, controlled trial in Burkina Faso (BF) and Democratic Republic of Congo (DRC), 44 villages with at least 500 inhabitants and at least one health centre or medicine vendor were randomly allocated 1:1 to intervention or control arms, using the RAND function in Excel. Over nine months, three intervention rounds consisted of community health education campaigns and educational/feedback sessions with providers, introducing AWaRe Book guidance for infections with highest antibiotic use. We measured baseline-to-post-intervention changes in Watch-group antibiotic use through repeated patient surveys (100 per provider per village), cluster-adjusted and offset for healthcare utilisation (primary outcome), and patient management through simulated patient visits (secondary outcome). Field workers conducting patient surveys and simulated patient visits were masked. CABU-EICO was registered on clinicaltrials.gov/study/NCT05378880. Findings At baseline (Oct 26, 2022 to Mar 13, 2023), 5532 patients were surveyed (3558 in BF; 1974 in DRC); post-intervention (Nov 6, 2023 to Apr 3, 2024), 4898 patients (3180 in BF; 1718 in DRC). Surveys were completed at 63 health centres, 60 pharmacies, and 41 informal vendors. A total of 1092 simulated patient visits were completed across both periods. Weighted prevalence of Watch-group antibiotic use decreased from 26.8% (95%CI 8.8-44.8) to 17.1% (95%CI 7.7-26.5) in intervention and increased from 13.4% (95%CI4.8-22) to 21.2% (95%CI8.9-34) in control clusters; adjusted prevalence ratio 0.33 (95%CI 0.14-0.78). Changes in patient management scores were limited. Interpretation The behavioural intervention bundle substantially reduced Watch-group antibiotic use and did not negatively impact patient management, highlighting the potential of antibiotic use improvements across healthcare providers. Reduced community-level use of broad-spectrum antibiotics could help slow community-acquired pathogens' increasing resistance to clinically important antibiotics. Funding JPI-AMR, Research Foundation-Flanders