Background: Antimicrobial resistance, driven by inappropriate use and overuse of antibiotics, is a major public health threat. Diarrhea and respiratory illness are the leading causes of pediatric healthcare visits in low- and middle-income countries like Bangladesh. Despite clear WHO guidelines recommending limited use of antibiotics for these conditions, potentially inappropriate or non-prescription antibiotic use remains a concern. Methods: We interviewed caregivers of 3025 under-5 children via cellphones to assess common illnesses, associated care-seeking practices, and antibiotic use for diarrhea and respiratory illnesses experienced by their children in the prior 14 days. Caregivers were identified through hospital outpatient screening and were contacted over the phone for the interview at least two months after that hospital visit. Results: Among the participants, 116 (3.8%) reported diarrheal disease and 570 (18.8%) experienced respiratory illness during the preceding 2-week recall period. Among the children with diarrhea, 52.6% received antibiotics, and 73.8% obtained them over the counter from pharmacies. Among those with respiratory illness, 26.3% received antibiotics, and 58% procured them from local drugstores without a prescription from a registered physician. For diarrhea, azithromycin and metronidazole were the commonly used antibiotics, while for respiratory illness, cefixime and azithromycin were frequently used. Notably, 68% of the diarrheal children either sought care from local drugstores, were self-medicated, or did not receive any formal treatment. Conventional practice, long wait times at healthcare facilities, distance, and poverty were the main reasons for not seeking care from a registered healthcare provider. Conclusions: Understanding community-level antibiotic use and care-seeking behavior is essential to strengthening antibiotic stewardship and child health programs. Our findings suggest the need for context-sensitive community education, improved access to appropriate care, and enforcement of regulations restricting the over-the-counter sale of antibiotics to curb irrational and excessive antibiotic use.

: The rapid loop-mediated isothermal amplification-based diagnostic test (RLDT) has been validated as a simple, sensitive, and rapid tool for detecting Shigella spp. from fresh or frozen stool. When stool is unavailable or difficult to transport, rectal swabs (RSs) in Cary–Blair medium, stool collected in buffered glycerol saline (BGS), or stool-dipped swabs (SDSs) in Cary–Blair medium offer alternatives that can be easily collected and transported without maintaining a cold chain. This study evaluated the performance of RLDTs for detecting Shigella spp. from RSs, stool collected in BGS, and SDSs compared with fresh stool (FS). Paired RSs and FS were collected from 105 children younger than 5 years old at two hospitals in Bangladesh. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were determined along with the agreement between assays using kappa statistics. The RLDTs detected Shigella in approximately 38–40% of samples across all sample types. Rectal swabs in Cary–Blair medium and SDS each showed 97.6% sensitivity and 100% specificity, with PPVs of 100% and NPVs of 98.5% (RSs) and 98.4% (SDSs) compared with FS; stool collected in BGS samples demonstrated the highest sensitivity (100%) and NPV (100%), with 98.4% specificity and 97.6% PPV. All alternative specimen types showed almost perfect agreement with FS. The RLDT performed well using RSs, indicating a practical alternative to stool for detecting Shigella . The assay was also reliable with stool collected in BGS and SDSs. Broader adoption of RLDTs could improve diagnostic capacity and strengthen surveillance and control efforts.