1. Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach
- Author
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Malee Sunpuwan, Proochista Ariana, Georgina Amankwah, H. Rogier van Doorn, Hanh Hong Nguyen, Fezile Wagner, Sabina Asiamah, Margaret Gyapong, Betuel Sigaúque, Wasif A. Khan, Martha Ali Abdulai, Heiman F. L. Wertheim, Chuc Thi Kim Nguyen, Khátia Munguambe, Kwaku Poku Asante, Osman Sankoh, John W. Williams, John Kinsman, Nga T. T. Do, Esperança Sevene, Johannes John-Langba, Mohammad Matin, Toan Khanh Tran, Ellen Boamah-Kaali, Phuc Dang Ho, Sabeena Ahmed, Mohammad Mahbubul Karim, Olga Cambaco, F. Xavier Gómez-Olivé, Sureeporn Punpuing, Mary Pomaa Agyekum, Huong Thi Lan Vu, Samuel Afari-Asiedu, and Stephen Tollman
- Subjects
Male ,Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi ,Health Knowledge, Attitudes, Practice ,Asia ,medicine.drug_class ,030231 tropical medicine ,Antibiotics ,Psychological intervention ,MEDLINE ,Ghana ,Health Services Accessibility ,South Africa ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Drug Misuse ,Residence Characteristics ,Surveys and Questionnaires ,Environmental health ,medicine ,Humans ,030212 general & internal medicine ,Medical prescription ,Developing Countries ,Poverty ,Mozambique ,Qualitative Research ,Community based ,Bangladesh ,Low income and middle income countries ,Public Health, Global Health, Social Medicine and Epidemiology ,General Medicine ,Health Care Service and Management, Health Policy and Services and Health Economy ,Articles ,Health Services ,Thailand ,Anti-Bacterial Agents ,Intervention (law) ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] ,Vietnam ,Evaluation Studies as Topic ,Africa ,Income ,Female ,Business - Abstract
Background Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. Methods We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016–Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. Findings Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. Interpretation Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. Funding Wellcome Trust and Volkswagen Foundation.
- Published
- 2021