Every medicine is medicine; exploring inappropriate antibiotic use at the community level in rural Ghana

Afari-Asiedu, Samuel; Hulscher, Marlies; Abdulai, Martha Ali; Boamah-Kaali, Ellen; Asante, Kwaku Poku; Wertheim, Heiman

doi:10.1186/s12889-020-09204-4

Cited by 30 publications

(29 citation statements)

References 18 publications

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“…This issue needs to be considered before other issues of demand are addressed. 31 Community members should be able to distinguish an antibiotic from other commonly sold medicines, such as painkillers or antipyretics, regardless of where they obtain the medicine. Clear labelling of antibiotics empowers community members to be conscious about use of antibiotics and enables them to put any future communication campaign about better use of antibiotics into practice.…”

Section: Discussionmentioning

confidence: 99%

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

Nguyen

et al. 2021

The Lancet Global Health

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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 healthcare 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.

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Section: Discussionmentioning

confidence: 99%

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

Nguyen

et al. 2021

The Lancet Global Health

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159

155

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Section: Discussionmentioning

confidence: 99%

“…The lack of knowledge about antibiotics contributes to their inappropriate use [ 36 , 37 ]. In Ghana, Afari-Asiedu et al found that antibiotics were used to treat stomachache and sores on the body [ 36 ]. In our study population, awareness about the risks of antibiotics was low and most participants were unfamiliar with the notion that inappropriate use of antibiotics could lead to antibacterial resistance.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study on community use of antibiotics in Kinshasa, Democratic Republic of Congo

et al. 2022

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Background Resistance to antibiotics is an increasing and major threat to global health. While the large majority of antimicrobial use occurs in the community where antibiotics are available without prescription, we did not find any studies investigating community-level factors influencing the inappropriate use of antibiotics in the Democratic Republic of Congo (DRC), where non-prescription antibiotic use is prevalent. Methods This qualitative study was conducted from April 1st 2019 to May 5th 2019 and consisting of in-depth semi-structured interviews, utilizing purposive and snowball sampling schemes to recruit adult heads of households in the Pakadjuma slum, in Kinshasa, DRC. Participants with differing medical and educational backgrounds were selected. We employed a thematic analysis approach to explore community knowledge and use of antibiotics in the sampled population. Results A total of 18 participants with a median age of 35 years were interviewed. The majority was female (77.7%), had at least a secondary education (83.4%), and unemployed (61.1%). We found that participants were familiar with the term “antibiotics”, but had limited knowledge of the indications and risks of antibiotics, including the risk of antibiotic resistance. Inappropriate use of antibiotics was common and there was frequent self-medication of non-prescribed medicines for a range of non-indicated conditions such as menstruation. Having limited income was the most commonly reported reason for not visiting a health facility for appropriate health care. Conclusion Inappropriate use of antibiotics is a widespread practice and is influenced by lack of adequate knowledge of antibiotic use, indications and risks, prevalent self-medication, and financial barriers to accessing appropriate health care. There is need for both community education as well as structural interventions addressing poverty in order to reduce the inappropriate use of antibiotics in the Pakadjuma slum in Kinshasa.

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“…It also increases the chance of ABR development [14]. Some of these antibiotics used in this manner are for indications that, in principle, do not require antibiotics [15]. Accordingly, non-prescribed antibiotic use must become the usual choice of providers and consumers for most self-limiting illnesses [16].…”

Section: Introductionmentioning

confidence: 99%

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

Edessa

Assefa

Dessie

et al. 2022

J of Pharm Policy and Pract

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Background Non-prescribed antibiotic use is an emerging risky practice around the globe. An inappropriate use involving nonprescription access is one cause of the rapid increase in antibiotic resistance. Children commonly encounter many self-limiting illnesses for which they frequently use antibiotics without prescription. However, no specific and conclusive evidence exists to inform actions against this unsafe practice. We thus aimed to estimate the pooled proportion of non-prescribed antibiotic use for children at community levels in low- and middle-income countries. Methods A systematic search of records was conducted from PubMed/Medline, Embase, Scopus, CINAHL, and Google scholar. Eligible English-language publications were original articles which reported on community-based non-prescribed antibiotic use for children and conducted in low- and middle-income countries. Study features and the number of antibiotics used without prescriptions were extracted and pooled for effect sizes employing a random-effects model. The pooled proportion of non-prescribed antibiotic use was estimated as a percentage. Results In this analysis, we included a total of 39 articles consisting of 40,450 participants. Of these, 16,315 participants used non-prescribed antibiotics. The pooled percentage for this use of non-prescribed antibiotics was 45% (95% CI: 40–50%). The estimate was considerably higher in studies involving simulated patient methods (56%; 95% CI: 49–62%) than those studies with community surveys (40%; 95% CI: 34–46%) (P = 0.001). It was also varied by the recall period of antibiotics use—56% (95% CI: 50–62%) for instantly observed practice, 36% (95% CI: 22–50%) for within two week recall, 35% (95% CI: 26–45%) for 1–6 months recall, and 46% (95% CI: 37–54%) for more than six months recall (P = 0.001). Primary access points for the non-prescribed antibiotic uses were retail drug outlets. Conclusions We found that nearly half of the antibiotics used for children in community settings were without prescriptions. For these unsafe practices, caregivers accessed antibiotics mainly from drug outlets. Hence, context-specific educational and regulatory interventions at these outlets and the community levels are the first steps to improving antibiotic usage for children in low- and middle-income countries. Trial registration number: CRD42021288971 (PROSPERO). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288971.

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Every medicine is medicine; exploring inappropriate antibiotic use at the community level in rural Ghana

Cited by 30 publications

References 18 publications

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

A qualitative study on community use of antibiotics in Kinshasa, Democratic Republic of Congo

Non-prescribed antibiotic use for children at community levels in low- and middle-income countries: a systematic review and meta-analysis

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