AbstractObjectivesOur aims were to examine the geographic, socio-economic and behavioural factors associated with disease and antibiotic consumption in Nepal between 2006 and 2016 and to explore healthcare seeking patterns and the source of antibiotics.MethodsCross-sectional data from children under five in households in Nepal was extracted from the 2006, 2011 and 2016 Demographic Health Surveys (DHS). Univariate and multivariate analyses were carried out to assess the association of disease prevalence and antibiotic use with age, sex, ecological zone, urban/rural location, wealth index, maternal smoking, use of clean fuel, sanitation, nutrition, access to healthcare and vaccinations.ResultsPrevalence of fever, acute respiratory infection (ARI) and diarrhoea decreased between 2006 and 2016, while the proportion using antibiotics increased. Wealth, use of clean fuel, improved toilet sanitation, nutrition and access to healthcare were associated with reduced rates of disease. Those in the highest wealth index use less antibiotics and antibiotic consumption in rural areas surpassed urban regions over time. Health-seeking from the private sector has overtaken government facilities since 2006 with antibiotics mainly originating from pharmacies and private hospitals. Adherence to WHO recommended antibiotics has reduced over time.ConclusionsWith rising wealth, there has been a decline in disease prevalence but an increase in antibiotic use with more access to unregulated sources. Understanding antibiotic use and identifying associated behavioural and socio-economic factors may help to inform interventions to reduce inappropriate antibiotic use whilst ensuring access to those who need them.