Non-prescription antibiotic use among children in the Kurdistan Region of Iraq: a multicentre cross-sectional survey of caregivers

Abstract Background Non-prescription antibiotic use in children drives antimicrobial resistance, yet data from Iraq are scarce. We estimated its prevalence, patterns and determinants in the Kurdistan Region of Iraq. Methods In this multicentre, hospital-based cross-sectional study (September–October 2026), 300 caregivers of children aged 6 months to < 12 years were recruited consecutively at hospitals in Ranya, Sulaymaniyah and Erbil (100 per site; participation 93.8%) and interviewed face-to-face. Determinants were assessed with multivariable and Firth penalised logistic regression. Results In the previous 6 months, 67.3% (95% CI 61.8–72.4) of children had received a non-prescription antibiotic, ranging from 48.0% in Sulaymaniyah to 83.0% in Ranya. Most courses were obtained from pharmacies (69.3%), given for fever (44.6%) and lasted < 5 days (60.4%); 39.6% were WHO Watch antibiotics. Half of households (51.3%) stored antibiotics, and 75.7% of caregivers had poor knowledge. Residence in Ranya (aOR 12.21, 95% CI 3.19–46.75; adjusted prevalence ratio 1.30, 1.13–1.61), higher knowledge (aOR 0.74 per correct answer, 0.62–0.87) and more appropriate attitudes (aOR 0.78 per point, 0.68–0.90) were independently associated with non-prescription use; Firth estimates were consistent. Conclusions Two in three children received antibiotics without a prescription, mainly from pharmacies. Enforcing prescription-only dispensing, engaging pharmacists in stewardship and educating caregivers are urgently needed.