Self-medication with antibiotics in Maputo, Mozambique: practices, rationales and relationships

Abstract

Self-medication, as a form of self-care, is a common practice worldwide, and often involves the use of both over-the-counter and prescription-only medicines, including antibiotics, anti-malarials and others. Increasing concerns over the global emergence and spread of antimicrobial resistance point to the need to reduce and optimise the use of antimicrobial medicines, both in human and animal health. Over the past few decades, numerous studies on self-medication with antibiotics have sought to determine the prevalence, risks and/or factors related to 'inappropriate' use in different parts of the world. Yet much of this literature tends to follow a rather normative approach, which regards such practices as problematic and often irrational, frequently overlooking structural aspects, situated circumstances and individuals' own reasoning. Based on a mixed methods social science research project in Maputo, which included a household survey, observations in pharmacies and interviews with users and healthcare providers, this paper aims to discuss self-medication in light of local users' everyday practical reasoning. While situating selfmedication within local contextual contingencies, the analysis highlights the ways in which personal and socially shared experiences, articulated with forms of knowledge and information provided by different sources, shape and inform practices of and attitudes towards self-medication with antibiotics. By looking at self-medication beyond (non-)prescription use, and by examining individuals' decisions within their socioeconomic and therapeutic landscapes in Maputo, this study sheds light on the structural and relational factors that contribute to certain consumption practices that do not always follow biomedical recommendations of 'rational' or 'appropriate' use, helping to deconstruct and further problematise the various legitimate meanings and understandings of 'responsible' use.

Pharmacists’ practices for non-prescribed antibiotic dispensing in Mozambique

“…It is therefore, important to contextually examine the sociocultural, economic and political contingencies that may influence the needs for antibiotics by consider the individual’s rationales as integrant part of the solution. 5 Also, engage with all different enablers and actors to tackle the behaviour and the misconceptions about antibiotics by illustrating the disadvantages, the risks and the consequences of self-medication with antibiotics and educate pharmacy clients to improve antibiotic use could be useful.…”

“…76 While studies have reported inappropriate and high rates of antibiotic prescription in other settings evidence shows that the most prescribed antibiotics are at the same time, the most requested non-prescribed antibiotics, with antibiotics such amoxicillin, amoxicillin with clavulanic acid, metronidazole and cotrimoxazole being in the top of the list. 5 , 48 , 79 , 80 The patients’ expectations for antibiotics prescriptions are one of the causes of pressure for physicians to prescribe. 77 Pharmacists, therefore, criticise the physicians for contributing to strengthen the public belief that antibiotics are effective and quick to treat all diseases.…”

“… 7 - 9 These practices result from a complex interaction between several factors notably; health care providers’ prescribing practices, pharmacists’ dispensing practices, health care facilities’ conditions, individuals’ and communities’ beliefs on the healing power of antibiotics, health-seeking behaviours, individual responsibility for one’s own health, patients’ expectations, previous experience with antibiotics, and individuals’ self-care practices. 5 , 7 , 8 , 10 - 13 Nonetheless, incorrect diagnosis, incorrect therapeutic choice, inappropriate drug and dose selections, and insufficient treatment duration, frequently accompanied the non-prescribed utilization of antibiotics adding risks to individuals’ health. 4 , 5 , 7 , 14 , 15 …”

“… 5 , 7 , 8 , 10 - 13 Nonetheless, incorrect diagnosis, incorrect therapeutic choice, inappropriate drug and dose selections, and insufficient treatment duration, frequently accompanied the non-prescribed utilization of antibiotics adding risks to individuals’ health. 4 , 5 , 7 , 14 , 15 …”

Epidemiology of Self-Medication Practice among Libyans: A Systematic Review and Meta-Analysis

“…ractices of self-medication is commonly seen phenomenon and known to cause a global public health issues [1]. The term self-medication, as described by WHO, represents to the utilization of medication without medical prescription to treat self-diagnosed illnesses or to promote health [2].…”