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This study will evaluate the impact of vaccination on reducing carriage prevalence of resistant<jats:italic>Streptococcus pneumoniae<\/jats:italic>and extended spectrum beta-lactamase-producing<jats:italic>Escherichia coli<\/jats:italic>and<jats:italic>Klebsiella<\/jats:italic>species. We will leverage two large ongoing cluster-randomised vaccine evaluations in Malawi assessing; first, adding a booster dose to the 13-valent pneumococcal conjugate vaccine (PCV13) schedule, and second, introduction of the RTS,S\/AS01 malaria vaccine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>Six cross-sectional surveys will be implemented within primary healthcare centres (n=3000 users of outpatient facilities per survey) and their local communities (n=700 healthy children per survey): three surveys in Blantyre district (PCV13 component) and three surveys in Mangochi district (RTS,S\/AS01 component). We will evaluate antibiotic prescription practices and AMR carriage in children \u22643 years. For the PCV13 component, surveys will be conducted 9, 18 and 33 months following a 3+0\u2009to 2+1 schedule change. For the RTS,S\/AS01 component, surveys will be conducted 32, 44 and 56 months post-RTS,S\/AS01 introduction. Six health centres in each study component will be randomly selected for study inclusion. Between intervention arms, the primary outcome will be the difference in penicillin non-susceptibility prevalence among<jats:italic>S. pneumoniae<\/jats:italic>nasopharyngeal carriage isolates in healthy children. The study is powered to detect an absolute change of 13\u2009percentage points (ie, 35% vs 22% penicillin non-susceptibility).<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>This study has been approved by the Kamuzu University of Health Sciences (Ref: P01-21-3249), University College London (Ref: 18331\/002) and University of Liverpool (Ref: 9908) Research Ethics Committees. Parental\/caregiver verbal or written informed consent will be obtained prior to inclusion or recruitment in the health centre-based and community-based activities, respectively. Results will be disseminated via the Malawi Ministry of Health, WHO, peer-reviewed publications and conference presentations.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-069560","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T14:01:15Z","timestamp":1683900075000},"page":"e069560","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Cross-sectional health centre and community-based evaluation of the impact of pneumococcal and malaria vaccination on antibiotic prescription and usage, febrile illness and antimicrobial resistance in young children in Malawi: the IVAR study protocol"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04078997","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03806465","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1980-5410","authenticated-orcid":false,"given":"David","family":"Singleton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Ibarz-Pavon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5285-7039","authenticated-orcid":false,"given":"Todd D","family":"Swarthout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farouck","family":"Bonomali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Cornick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akuzike","family":"Kalizang\u2019oma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noah","family":"Ntiza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Comfort","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael","family":"Chipatala","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wongani","family":"Nyangulu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Chirombo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gift","family":"Kawalazira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry","family":"Chibowa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Mwansambo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth Mphatso","family":"Maleta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"French","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4573-449X","authenticated-orcid":false,"given":"Robert S","family":"Heyderman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,12]]},"reference":[{"key":"2023051207001090000_13.5.e069560.1","unstructured":"WHO . 10 global health issues to track in 2021. 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