Prevalence and determinants of self-medication with antibiotics among general population in Afghanistan

Roien, Rohullah; Bhandari, Divya; Hosseini, Sayed Mohammad Reza; Mosawi, Sayed Hussain; Ataie, Mohammad Arif; Ozaki, Akihiko; Martellucci, Cecilia Acuti; Kotera, Yasuhiro; Delshad, Mohammad Hossein; Sawano, Toyoaki; Qaderi, Shohra; Sah, Ranjit; Tanimoto, Tetsuya; Pourhaji, Fatemeh; Ramoozi, Abbas Ali; Arif, Shamim; Mehtarkhel, Shamsullah; Madadi, Shekiba; Mousavi, Sayed Hamid

doi:10.1080/14787210.2021.1951229

Cited by 17 publications

(17 citation statements)

References 32 publications

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“…Doctors struggle on a daily basis: on the one hand there is external pressure to appropriately prescribe fewer antibiotics (a long-term goal) but on the other hand there are daily encounters with patients and caretakers expecting to receive antibiotics. In treating patients "holistically," practitioners may prescribe antibiotics for sore throats [55].…”

Section: Plos Onementioning

confidence: 99%

‘They eat it like sweets’: A mixed methods study of antibiotic perceptions and their use among patients, prescribers and pharmacists in a district hospital in Kabul, Afghanistan

Burtscher¹,

Bergh

Nasim³

et al. 2021

PLoS ONE

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Background Antibiotic resistance is a growing public health threat. In Afghanistan, high levels of indiscriminate antibiotic use exist, and healthcare programmes are not informed by understanding of local attitudes towards rational antibiotic use. Médecins Sans Frontières is an international non-governmental organization providing healthcare services to the Ahmad Shah Baba (ASB) District Hospital in Kabul, Afghanistan, since 2009. This mixed-methods study aimed to explore the perceptions and attitudes toward antibiotics among patients, prescribers, and pharmacists in the ASB District hospital outpatient department. Methods and findings Knowledge of antibiotics including their purpose and function, how and why they are used, and drivers for choice of antibiotic was examined at patient, prescriber, and provider-level. The first phase of the study, an exploratory qualitative component using an interpretative approach, was used to inform the second phase, a structured survey. Thirty-six interviews were conducted with 39 participants (21 patients or caretakers and 18 hospital health workers). Three hundred and fifty-one (351) patients and caretakers completed the second phase, the structured survey. This study found that poor knowledge of antibiotics and antibiotic resistance is a driving factor for inappropriate use of antibiotics. Participant perceptions of living in a polluted environment drove the high demand and perceived ‘need’ for antibiotics: patients, doctors and pharmacists alike consider dirty and dusty living conditions as causes of ‘disease’ in the body, requiring antibiotics to ‘clean’ and ‘strengthen’ it. Conclusions Findings highlight the need for strategies to improve awareness and knowledge of the general public, improve practice of doctors and pharmacists, regulate antibiotic dispensing in private pharmacies, and implement antibiotic stewardship in hospitals.

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Section: Plos Onementioning

confidence: 99%

‘They eat it like sweets’: A mixed methods study of antibiotic perceptions and their use among patients, prescribers and pharmacists in a district hospital in Kabul, Afghanistan

Burtscher¹,

Bergh

Nasim³

et al. 2021

PLoS ONE

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“…One of the most common wrong practices in Pakistan is self-medication or the misuse of antibiotics in which the people usually take the medication without any consultation from physicians or clinicians [ 15 , 17 , 20 ]. Mindful of the worst AMR situation in Pakistan, the current study was conducted with the concept of self-medication among youth, asking why students choose self-medication, why a number of students were taking antibiotics, where did they gain knowledge about self-medication or to treat the illness/disease, and how did they combat seasonal and routine health issues.…”

Section: Discussionmentioning

confidence: 99%

“…The main problems related to self-medication are increased resistance to pathogens, causing serious health hazards such as prolonged suffering and adverse reactions. Nowadays, antimicrobial resistance is a worldwide problem that may be caused by antibiotics given without prescription [ 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Self-Medication as an Important Risk Factor for Antibiotic Resistance: A Multi-Institutional Survey among Students

et al. 2022

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Self-medication is an important issue, especially in developing countries. Self-medication is the concept in which individuals use medicine to ease and manage their minor illnesses. The current survey was designed to conduct interviews at different universities based on the availability of the students from August 2021 to October 2021 in Hazara region of Khyber Pakhtunkhwa (KPK), Pakistan. Overall, 1250 questionnaires were distributed to students from various departments. Students of microbiology (n = 305, 24.4%) and agriculture 236 (n = 18.8%) were the most elevated members in this study, while other participants were from medical lab technology (n = 118, 9.4%), chemistry (n = 103, 8.2%), food science (n = 92, 7.3%), business administration (n = 83, 6.6%), sociology (n = 78, 6.2%), math/physics (n = 6, 14.8%), Pak study (n = 58, 4.6%), English (n = 47, 3.7%), and psychology (n = 19, 1.5%). Students working towards their Bachelor numbered (n = 913, 73.0%), Master (minor) numbered (n = 80, 6.4%), Master (major) numbered (n = 221, 17.6%), and Doctorate numbered (n = 36, 2.8%). The age group of participants was majorly 20–25 years (61.0%), while others belonged to the age groups 25–30 years (20.6%), 30–35 years (9.8%), and 35–40 years (8.4%). The mean and standard deviation of daily practices of self-medication were observed (M = 416.667, SD = 1,026,108.667) and p = 0.002. The mean and standard deviation of daily practices of antibiotic knowledge was (M = 431.5, SD = 1,615,917) and p = 0.002. Antimicrobial agents were leading over others with 631 (50.4%), followed by anti-inflammatory with 331 (26.4%), multivitamins with 142 (11.3%), gynecological purpose with 59 (4.7%), and analgesic with 72 (5.7%), while the lowest frequency rate was observed against herbal remedies with 15 (1.2%). The results of the current study concluded that students practiced self-medication for reasons such as convenience to obtain these medications from cheap sources and to avoid the fee of a physician. They searched for the medicine on social media platforms and purchased it blindly from the pharmacy without any prescription from a physician.

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“…Several other studies from different settings in the LMICs also reported similar percentages of non-prescribed antibiotic use by communities as the usual unnecessary or inappropriate options for most self-limiting illnesses. This unsafe antibiotic practice spanned from 36.1% to 73.2% [84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100]. The non-prescribed antibiotic use for children was relatively higher among under-five children (i.e., 46%) than in the subgroup of children under 13 years (i.e., 41%).…”

Section: Discussionmentioning

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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Prevalence and determinants of self-medication with antibiotics among general population in Afghanistan

Cited by 17 publications

References 32 publications

‘They eat it like sweets’: A mixed methods study of antibiotic perceptions and their use among patients, prescribers and pharmacists in a district hospital in Kabul, Afghanistan

‘They eat it like sweets’: A mixed methods study of antibiotic perceptions and their use among patients, prescribers and pharmacists in a district hospital in Kabul, Afghanistan

Self-Medication as an Important Risk Factor for Antibiotic Resistance: A Multi-Institutional Survey among Students

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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