Knowing antimicrobial resistance in practice: a multi-country qualitative study with human and animal healthcare professionals

Abstract

Background: Antimicrobial resistance (AMR) is a growing global problem. Raising awareness is central to global and national action plans to address AMR in human and livestock sectors. Evidence on the best ways to reduce antibiotic use, and the impact of awareness raising activities is mixed. This paucity of evidence is acute in Low-Middle-Income Country (LMIC) settings, where healthcare professionals who prescribe and dispense antimicrobial medicines are often assumed to have limited awareness of AMR and limited knowledge of the optimum use of antimicrobials. Objectives: This research aimed to explore AMR awareness among human and animal healthcare professionals and the contextual issues influencing the relationship between awareness and practices of antimicrobial prescribing and dispensing across different LMIC settings. Methods: Qualitative interviews and field observations were undertaken in seven study sites in Ethiopia, India, Nigeria, the Philippines, Sierra Leone and Vietnam. Data included transcripts from interviews with 244 purposively sampled healthcare professionals, analysed for crosscutting themes. Results: AMR awareness was high among human and animal healthcare professionals. This awareness of AMR did not translate into reduced prescribing and dispensing; rather, it linked to the ready use of next-line antibiotics. Contextual factors that influenced prescribing and dispensing included antibiotic accessibility and affordability; lack of local antibiotic sensitivity information; concerns over hygiene and sanitation; and interaction with medical representatives. Conclusions: The high awareness of AMR in our study populations did not translate into reduced antibiotic prescribing. Contextual factors such as improved infrastructure, information and regulation seem essential for reducing reliance on antibiotics.

Raising awareness of antimicrobial resistance in rural aquaculture practice in Bangladesh through digital communications: a pilot study

“…As an example, our animation was used alongside other digital materials during AMR awareness week (18-24 November 2019), which led to an additional 1214 new viewers in those 6 days alone. This study supports others that have shown an urgent need for more research into the most appropriate content of AMR awareness campaigns, to ensure that they achieve their intention to effect behavioural changes [18,19]. Future studies should assess to what extent these digital materials impact on behaviours associated with usage.…”

Towards a bottom-up understanding of antimicrobial use and resistance on the farm: A knowledge, attitudes, and practices survey across livestock systems in five African countries

“…Importantly, and as our results among farmers suggest, solely providing information on antimicrobial use and AMR to agrovets is unlikely to promote more prudent dispensing practices. Indeed, in a survey of agrovets in Africa and Asia, knowledge of AMR did not translate into prudent use (e.g., reduced dispensing) but was linked to less prudent practices (i.e., use of next-line antibiotics) [54]. In addition, the double role played by agrovets-those who give advice that leads to antimicrobial use and those who stand to benefit financially from the sales of antimicrobials-gives rise to moral hazard that must be considered when designing interventions.…”

Knowledge, Attitude and Practice of Community Pharmacists Regarding Antibiotic Use and Infectious Diseases: A Cross-Sectional Survey in Hungary (KAPPhA-HU)

“…All healthcare professionals (HCPs), including nurses, technicians, pharmacists and physicians, have a responsibility in their clinical practice in keeping ABs effective [12][13][14][15][16][17][18]. Around 90% of AB consumption in human medicine occurs in outpatient settings; therefore, it is imperative to administer these drugs only in cases where it is appropriate [19][20][21].…”