Patterns of self-medication with antibiotics in Maputo City: a qualitative study

Abstract

BackgroundMozambique classifies but does not yet enforce antibiotics as prescription-only-medicine (POM) allowing the public access to a variety of antibiotics that otherwise are provided on prescription. This contributes to the growing practice of self-medication with antibiotics (SMA) which systematically exposes individuals to the risk of developing antibiotic resistance, antibiotic side effects and increases the health service costs and morbidity. This study aimed at describing the patterns of SMA among Maputo city pharmacy customers.MethodsA qualitative study conducted between October 2018 and March 2019 was developed with thirty-two pharmacy customers and seventeen pharmacists. Using convenience sampling, customers were recruited after buying antibiotics without prescription from nine private pharmacies. Of the thirty-two participants, twenty participated in in-depth interviews and twelve in two focus groups discussions (FGD) with six participants each. Purposive sampling and a snowball technique were used to recruit pharmacists. The transcripts were coded and analyzed using latent content analysis. Nvivo 11 was used to store and retrieve the data. The COREQ (Tong, 2007) checklist for interviews and FGD was performed.ResultsCustomers admitted practices of SMA, pharmacists admitted dispensing a variety of antibiotics without prescription. Non-prescribed antibiotics (NPA) were obtained through five different patterns including; using the generic name, describing the physical appearance and using empty package, describing symptoms or health problem to pharmacists, using old prescriptions and sharing antibiotics with family, friends, and neighbors.ConclusionDifferent patterns of SMA are contributing to the indiscriminate use of antibiotics among customers. The NPA utilization is perceived as an expression of self-care where participants experience self-perceived symptoms and indulge in self-treatment as a method of caring for themselves. Moreover, antibiotics are mostly used to treat diseases that do not necessarily need antibiotics. Strong and effective public health education and promotion initiatives should be implemented to discourage inappropriate utilization of antibiotics and SMA practices.

Community knowledge and practices regarding antibiotic use in rural Mozambique: where is the starting point for prevention of antibiotic resistance?

“…Despite the fact that antibiotics in Mozambique may be presented in different pharmaceutical forms or capsules of colours which may confuse the users, one important finding was the ability of some participants to define antibiotics, influenced by their familiarisation with Amoxicillin, which locally is typically presented in the form of yellow and red tipped capsules. This finding is concordant to the recent research conducted by Torres (2019) in Mozambique, which reported that participants reported to know Amoxicillin, describing the capsules with in red and yellow colour [ 30 ]. Apart from limiting their conceptualisation to an attempt to characterise Amoxicillin, they were not able to conceptually distinguish antibiotics from other types of medicines.…”

“…The first official situation analysis on antibiotic use and resistance in Mozambique suggests that there are likely high levels of inappropriate antibiotic use at the community level and it recommends the rationalisation of antibiotic use in the community as one of the strategies to reduce antibiotic resistance [ 29 ]. Two recent studies conducted in Mozambique confirmed both the existence of inappropriate use of antibiotics at the community level and the prevalence of self-medication via the purchase of non-prescribed antibiotics [ 28 , 30 ]. Additionally, both studies conducted in urban areas revealed the limited knowledge of antibiotic use that the study population held.…”

The prevalence and patterns of self‐medication with antibiotics in Jordan: A community‐based study

“…The improper use of antibiotics through self‐medication is associated with substantial adverse reactions, such as antibiotic resistance, toxicity and treatment insufficiency 14,16 . Self‐medication with antibiotics can be divided into: (i) direct self‐medication which includes patients purchasing antibiotics without a prescription, reusing old prescriptions and leftover antibiotics and (ii) indirect self‐medication which refers to purchasing antibiotics after seeking the advice of a pharmacist or accepting the antibiotics recommended by friends and family members 4,17 …”

<p>Prevalence and Factors Associated with Parents Self-Medicating Under-Fives with Antibiotics in Bagamoyo District Council, Tanzania: a Cross-Sectional Study</p>

“…18 Evidence has accumulated concerning SMA in different sub-Saharan African countries and for different populations. 3,17,19,20 Among those studies addressing antibiotic self-medication, few have covered parents self-medicating their under-fives. Since children are at an increased risk of succumbing to infectious diseases because of their relatively less developed immune systems, 21 they are more prone to SMA.…”