‘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

Abstract

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.

Influences on treatment-seeking and antibiotic use for common illnesses in eastern China

“…Antibiotics are understood as strong and powerful medicines among patients in our study, in keeping with views on antibiotics in other LMIC settings [ 27 ]. However, in contrast with the exclusively positive views on antibiotics reported from some studies in other countries [ 25 , 43 ] and with older practices of using antibiotics for prophylaxis or as long as feeling unwell in China [ 44 ], our study finds that most patients are concerned about the harms of antibiotics as well as their effectiveness and had made efforts to reduce usage, such as delaying the initiation of antibiotics for common illness. These changes probably relate to the influence of AMR public information and education campaigns over recent years in China, as well as the increased pathways to get access to health information, including the trend that young adults in China and worldwide seek health information and antibiotic related information from Internet [ 45 – 47 ].…”