Medication use in children from the 2015 Pelotas (Brazil) birth cohort aged between three months and four years

Farías-Antúnez, Simone; Silveira, Marysabel Pinto Telis; Domingues, Marlos Rodrigues; Silveira, Mariângela Freitas da; Bertoldi, Andréa Dâmaso

doi:10.1590/0102311X00117221

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ARTICLE • Cad. Saúde Pública 38 (3) • 2022 • https://doi.org/10.1590/0102311X00117221 copy

Medication use in children from the 2015 Pelotas (Brazil) birth cohort aged between three months and four years

Uso de medicação em crianças da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 2015 com três meses a quatro anos de idade

Uso de medicación en niños, desde los tres meses hasta los cuatro años de edad, en una cohorte de nacimiento de 2015 en Pelotas, Rio Grande do Sul, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Medication use is an important part of the health process and prevalence of its use among infants can reach up to 65% in their first months of life. The excessive use of medication could lead to an increase in their potential harm, surpassing their benefits. Considering this, this study aimed to describe medication use in children aged 3, 12, 24, and 48 months. Standardized questionnaires were applied to assess patterns and covariables of medication use. Medication use was investigated as an outcome and defined as the receipt of any medication within 15 days before the interview. Prevalence of medication use and 95% confidence intervals (95%CI) were described using chi-squared tests. Prescription source and frequency of use were also reported, along with the most frequent medication in each follow-up. Medication use prevalence was 67.2% (95%CI: 65.8; 68.6), 68.2% (95%CI: 66.8; 69.6), 52.4% (95%CI: 50.9; 54.0), 47.2% (95%CI: 45.7; 48.8), at 3, 12, 24, and 48 months, respectively. We observed a decrease in the proportion of medically prescribed medications and an increase in self-medication over the years. Drugs for gastrointestinal disorders (A03), vitamins (A11), analgesics (N02), anti-inflammatories (M01), and nasal formulations (R01) were the most frequently used medications. We found that children under four years of age comprised over 50% of the total use of medications and self-medication. These results highlight the need to warn caregivers on the importance of proper professional examination and prescription before they administer medications to children.

Keywords:
Drug Utilization; Infant; Preschool Child; Longitudinal Studies; Child Care

Characteristics	Medication use [OR * (95%CI)]
	3 months	12 months	24 months	48 months
	[n = 4,110]	[n = 4,018]	[n = 4,014]	[n = 4,010]
Maternal
Age (years)	p = 0.838	p = 0.189	p = 0.419	p = 0.011
< 19	1.00	1.00	1.00	1.00
20-24	0.93 (0.75; 1.16)	1.12 (0.90; 1.40)	1.16 (0.94; 1.44)	1.23 (0.99; 1.52)
25-30	0.90 (0.72; 1.13)	1.26 (1.00; 1.57)	1.16 (0.94; 1.44)	1.31 (1.06; 1.62)
> 30	0.95 (0.76; 1.19)	1.23 (0.98; 1.53)	1.07 (0.86; 1.32)	1.43 (1.16; 1.78)
Educational attainment (years)	p < 0.001	p < 0.001	p < 0.001	p = 0.030
0-4	1.00	1.00	1.00	1.00
5-8	1.02 (0.80; 1.30)	1.21 (0.95; 1.55)	1.16 (0.91; 1.47)	1.06 (0.83; 1.36)
9-12	1.27 (1.00; 1.61)	1.54 (1.21; 1.97)	1.32 (1.04; 1.66)	1.14 (0.90; 1.45)
> 12	1.92 (1.49; 2.47)	2.13 (1.65; 2.76)	1.80 (1.42; 2.29)	1.34 (1.05; 1.71)
Family income (minimum wage)	p = 0.244	p = 0.570	p = 0.219	p = 0.565
≤ 1	1.00	1.00	1.00	1.00
1.1-3.0	1.05 (0.85; 1.29)	1.06 (0.86; 1.31)	1.10 (0.90; 1.35)	1.01 (0.82; 1.24)
3.1-6.0	1.10 (0.86; 1.40)	1.04 (0.81; 1.33)	1.25 (0.99; 1.57)	0.96 (0.76; 1.21)
6.1-10.0	1.38 (0.97; 1.96)	1.34 (0.93; 1.92)	1.35 (0.98; 1.86)	1.08 (0.78; 1.49)
Skin color	p = 0.007	p = 0.096	p = 0.520	p = 0.325
White	1.00	1.00	1.00	1.00
Black	0.75 (0.62; 0.90)	0.84 (0.70; 1.00)	0.92 (0.77; 1.10)	0.92 (0.77; 1.10)
Mixed-race/Yellow/Other	0.93 (0.76; 1.13)	0.86 (0.71; 1.06)	0.92 (0.76; 1.11)	0.89 (0.73; 1.07)
Living with a partner	p = 0.018	p = 0.079	p = 0.517	p = 0.698
No	1.00	1.00	1.00	1.00
Yes	0.80 (0.65; 0.96)	1.19 (0.98; 1.44)	0.94 (0.78; 1.13)	0.94 (0.80; 1.16)
Child
Sex	p = 0.057	p = 0.001	p = 0.086	p = 0.623
Male	1.00	1.00	1.00	1.00
Female	0.88 (0.77; 1.00)	1.20 (0.70; 0.92)	0.90 (0.79; 1.02)	1.03 (0.89; 1.31)
Gestational age (weeks)	p < 0.001	p = 0.032	p = 0.552	p = 0.202
Preterm (< 37)	1.00	1.00	1.00	1.00
Early term (37-38)	0.60 (0.47; 0.75)	0.77 (0.62; 0.95)	0.97 (0.80; 1.17)	1.08 (0.90; 1.31)
Full term (39-40)	0.46 (0.37; 0.57)	0.75 (0.61; 0.93)	0.99 (0.82; 1.19)	0.93 (0.77; 1.13)
Late & post term (41-42)	0.44 (0.33; 0.59)	0.68 (0.51; 0.92)	0.83 (0.63; 1.10)	0.93 (0.71; 1.23)
Type of delivery	p = 0.190	p = 0.061	p < 0.001	p = 0.024
Vaginal	1.00	1.00	1.00	1.00
Cesarean section	1.10 (0.95; 1.27)	1.15 (0.99; 1.34)	1.29 (1.12; 1.47)	1.17 (1.02; 1.34)
Breastfeeding duration (months)	p = 0.007	p = 0.468	p = 0.276	p = 0.237
No breastfeeding	1.10 (0.90; 1.35)	0.90 (0.73; 1.10)	1.05 (0.86; 1.27)	0.95 (0.77; 1.17)
≤ 6	1.31 (1.11; 1.54)	1.05 (0.89; 1.24)	1.16 (1.00; 1.27)	1.08 (0.92; 1.25)
7-12	1.00 (0.82; 1.22)	0.95 (0.78; 1.17)	1.06 (0.88; 1.27)	1.17 (0.97; 1.41)
> 12	1.00	1.00	1.00	1.00
Maternal perception of child’s health		p < 0.001	p < 0.001	p < 0.001
Excellent	-	1.00	1.00	1.00
Very good/Good	-	1.53 (1.33; 1.76)	1.66 (1.45; 1.90)	1.60 (1.40; 1.83)
Regular/Bad	-	4.08 (2.70; 6.16)	3.99 (3.02; 5.28)	4.54 (3.39; 6.01)

Characteristics	Total cohort [n = 4,275]	3 months [n = 4,110]	12 months [n = 4,018]	24 months [n = 4,014]	48 months [n = 4,010]	p-value *
Characteristics	%	%	%	%	%	p-value *
Maternal
Age (years)						0.952
< 19	14.5	14.6	14.5	14.4	14.5
20-24	23.7	23.7	23.6	23.7	23.8
25-30	29.0	29.1	29.1	29.0	28.9
> 30	32.8	32.6	32.8	32.9	32.8
Educational attainment (years)						0.882
0-4	9.2	9.0	8.9	8.9	8.8
5-8	25.6	25.7	25.5	25.8	26.0
9-12	34.1	34.4	34.8	34.5	34.8
> 12	31.1	38.9	30.8	30.8	30.4
Family income (minimum wage)						0.698
≤ 1	12.6	12.6	12.5	12.5	12.4
1.1-3.0	47.1	47.1	47.1	47.3	47.7
3.1-6.0	26.4	26.5	26.6	26.5	26.5
6.1-10.0	7.6	7.5	7.5	7.4	7.4
> 10.0	6.3	6.3	6.3	6.3	6.0
Skin color						0.751
White	70.9	70.8	70.9	70.7	70.3
Black	15.6	15.7	15.8	15.9	16.0
Mixed-race/Yellow/Other	13.5	13.5	13.3	13.4	13.7
Living with a partner						0.991
No	14.2	14.2	13.9	14.0	14.2
Yes	85.8	85.8	86.1	86.0	85.8
Child
Sex						0.977
Male	50.6	50.5	50.9	50.6	50.6
Female	49.4	49.5	49.1	49.4	49.4
Gestational age (weeks)						0.994
Preterm (< 37)	15.5	14.7	14.6	14.7	14.7
Early term (37-38)	37.1	37.2	37.4	37.4	37.2
Full term (39-40)	39.7	40.2	40.1	39.9	40.2
Late & post term (41-42)	7.8	7.9	7.9	8.0	7.8
Type of delivery						0.973
Vaginal	34.8	35.1	35.0	35.1	35.2
Cesarean section	65.2	64.9	65.9	64.9	64.8
Breastfeeding duration (months)						0.013
No breastfeeding	18.6	16.7	15.8	15.3	13.3
≤ 6	33.5	34.2	34.5	34.9	35.7
7-12	16.4	16.9	17.2	17.1	17.5
> 12	31.5	32.2	32.5	32.7	33.5
Maternal perception of child’s health						< 0.001
Excellent	-	-	47.8	40.0	38.0
Very good/Good	-	-	47.4	52.8	55.1
Regular/Bad	-	-	4.8	7.2	6.8

Characteristics	Medications use prevalence [% (95%CI)]
Characteristics	3 months [n = 4.106]	12 months [n = 4.017]	24 months [n = 4.005]	48 months [n = 3.994]
Maternal
Age (years)
< 19	64.3 (60.4; 68.1)	59.5 (55.4; 63.4)	46.3 (42.3; 50.4)	39.4 (35.5; 43.4)
20-24	65.6 (62.6; 68.5)	66.2 (63.1; 69.2)	52.3 (49.1; 55.5)	45.7 (42.6; 48.9)
25-30	66.9 (64.2; 69.6)	70.7 (68.0; 73.2)	54.2 (51.3; 57.0)	48.2 (45.3; 51.1)
> 30	69.9 (67.4; 72.3)	71.4 (68.9; 73.8)	53.8 (51.1; 56.4)	51.0 (48.3; 53.7)
Educational attainment (years)	60.5 (55.4; 65.4)	57.1 (51.9; 62.2)	44.7 (39.6; 49.9)	43.0 (37.9; 42.3)
0-4	61.1 (58.1; 64.0)	61.5 (58.5; 64.4)	48.3 (45.3; 51.4)	43.4 (40.4; 46.4)
5-8	66.4 (63.9; 68.8)	68.8 (66.3; 71.1)	51.5 (48.9; 54.2)	46.9 (44.3; 49.5)
9-12	75.1 (72.7; 77.4)	76.4 (73.9; 78.6)	59.3 (56.5; 62.0)	52.2 (49.4; 55.0)
> 12	60.5 (55.4; 65.4)	57.1 (51.9; 62.2)	44.7 (39.6; 49.9)	43.0 (37.9; 42.3)
Family income (minimum wage)
≤ 1	62.1 (57.8; 66.2)	60.4 (56.1; 64.6)	46.0 (41.7; 50.4)	43.5 (39.2; 48.0)
1.1-3.0	64.8 (62.7; 66.9)	66.4 (64.3; 68.5)	50.2 (48.0; 52.5)	46.3 (44.0; 48.5)
3.1-6.0	69.0 (66.1; 71.6)	70.2 (67.3; 72.8)	55.6 (52.6; 58.6)	47.3 (44.3; 50.3)
6.1-10.0	76.4 (71.4; 80.9)	78.3 (73.2; 82.6)	60.0 (54.3; 65.5)	52.4 (46.6; 58.0)
> 10.0	77.2 (71.7; 81.9)	76.8 (71.2; 81.6)	60.5 (54.3; 66.3)	56.7 (50.3; 62.8)
Skin color
White	69.2 (67.5; 70.8)	70.4 (68.7; 72.0)	53.9 (52.1; 55.8)	48.6 (46.8; 50.5)
Black	60.2 (56.4; 63.9)	62.8 (58.9; 66.5)	48.9 (45.0; 52.8)	44.6 (40.8; 48.5)
Mixed-race/Yellow/Other	64.9 (60.8; 68.8)	63.2 (59.0; 67.2)	48.8 (44.6; 53.0)	43.3 (39.2; 47.5)
Living with a partner
No	31.3 (27.6; 35.2)	61.4 (57.3; 65.4)	50.7 (46.7; 54.8)	45.4 (41.3; 49.5)
Yes	67.0 (65.4; 68.5)	69.3 (67.8; 70.8)	52.8 (51.1; 54.4)	47.6 (45.9; 49.2)
Child
Sex
Male	68.8 (66.7; 70.7)	70.5 (68.5; 72.4)	53.9 (51.7; 56.0)	46.9 (44.8; 49.1)
Female	65.6 (63.5; 67.7)	65.8 (63.7; 67.9)	51.0 (48.8; 53.2)	47.6 (45.4; 49.8)
Gestational age (weeks)
Preterm (< 37)	78.7 (75.2; 81.8)	73.1 (69.4; 76.6)	53.3 (49.3; 57.3)	47.4 (43.4; 51.5)
Early term (37-38)	69.6 (67.2; 71.8)	69.2 (66.8; 71.5)	53.3 (50.8; 55.8)	50.1 (47.6; 52.7)
Full term (39-40)	62.3 (60.0; 64.7)	66.6 (64.3; 69.9)	52.5 (50.0; 54.9)	45.1 (42.7; 47.5)
Late & post term (41-42)	59.4 (54.0; 64.7)	62.3 (56.8; 67.5)	46.7 (41.3; 52.2)	44.2 (38.8; 49.8)
Type of delivery
Vaginal	63.3 (60.8; 65.8)	63.5 (60.9; 66.0)	46.8 (44.2; 49.4)	43.3 (40.7; 45.9)
Cesarean section	69.3 (67.5; 71.0)	70.8 (69.0; 72.5)	55.6 (53.6; 57.4)	49.4 (47.5; 51.3)
Breastfeeding duration (months)
No breastfeeding	67.0 (63.4; 70.4)	65.3 (61.5; 68.9)	51.3 (47.3; 55.2)	44.8 (40.6; 49.1)
≤ 6	71.0 (68.6; 73.3)	69.4 (66.9; 71.8)	54.3 (51.7; 56.9)	47.6 (45.1; 50.2)
7-12	-	69.9 (65.4; 72.3)	53.2 (49.5; 56.9)	50.8 (47.1; 54.5)
> 12	-	68.0 (65.4; 70.4)	50.6 (47.9; 53.3)	45.9 (43.3; 48.6)
Maternal perception of child’s health
Excellent	-	64.1 (62.0; 66.2)	44.8 (42.4; 47.3)	39.4 (37.0; 41.9)
Very good/Good	-	70.6 (68.5; 72.6)	55.5 (53.3; 57.6)	49.5 (47.4; 51.6)
Regular/Bad	-	85.0 (79.1; 89.3)	72.8 (67.3; 77.6)	72.5 (66.9; 77.5)
Total	67.2 (65.8; 68.6)	68.2 (66.8; 69.6)	52.4 (50.9; 54.0)	47.2 (45.7; 48.8)

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[1] Correspondência
S. Farías-Antúnez Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas. Rua Marechal Deodoro 1160, 4° andar, Pelotas, RS 96020-080, Brasil. simonefarias86@yahoo.com.br