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The aim of this study was to describe how utilizing antibiotics for children under five years of age in the Democratic Republic of the Congo (DRC) is experienced by various healthcare providers. A phenomenographic approach was employed to analyse data from individual interviews with 14 healthcare workers of the Eastern DRC, including medical doctors, nurses and practicing pharmacists. Two overarching themes with their corresponding categories emerged: \u201cFactors influencing antibiotic use\u201d and \u201cOperating within a weak healthcare system\u201d. Healthcare providers consistently described widespread self-medication practices in children, driven largely by financial constraints within the population. Although many providers recognized the risks associated with inappropriate antibiotic use, their decisions were heavily influenced by systemic limitations and community expectations. A major concern raised was the increasing failure of antibiotics in treatment. This study highlights the complex factors shaping antibiotic use and prescription practices in Eastern DRC, where healthcare workers operate within a fragmented healthcare system. Addressing antibiotic resistance in such settings requires coordinated local and global efforts focused on promoting responsible antibiotic use, strengthening healthcare infrastructure, providing continuous education, establishing national guidelines, and improving community awareness and access to quality care.<\/jats:p>","DOI":"10.1186\/s13756-025-01596-5","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T13:27:20Z","timestamp":1753968440000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare workers\u00b4 perspectives on antibiotic utilization in children under five years of age in the Eastern Democratic Republic of the Congo"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7149-7742","authenticated-orcid":false,"given":"Jeanni\u00e8re T.","family":"Manegabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Mwangi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Mulindwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sumaili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloire M.","family":"Kapalata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rune","family":"Andersson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margret","family":"Lepp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florida","family":"Muro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susann","family":"Skovbjerg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Emg\u00e5rd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archippe M.","family":"Birindwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"issue":"10325","key":"1596_CR1","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","volume":"399","author":"Global burden of","year":"2022","unstructured":"Global burden of. 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