Objective To evaluate and compare the prevalence, reasons, sources and factors associated with self‐medication with antibiotics (SMA) within Africa. Methods Systematic review and meta‐analysis. An electronic search of PubMed and Google Scholar databases was performed for observational studies conducted between January 2005 and February 2020. Two reviewers independently screened abstracts and full texts using the PRISMA flowchart and performed quality assessment of eligible studies. Both qualitative and quantitative syntheses were carried out. Results Forty studies from 19 countries were eligible for qualitative synthesis. The prevalence of SMA in Africa ranged from 12.1% to 93.9% with a median prevalence of 55.7% (IQR 41–75%). Western Africa was the sub‐region with the highest reported prevalence of 70.1% (IQR 48.3–82.1%), followed by Northern Africa with 48.1% (IQR 41.1–64.3%). We identified 27 antibiotics used for self‐medication from 13 different antibiotic classes. Most frequently used antibiotics were penicillins (31 studies), tetracyclines (25 studies) and fluoroquinolones (23 studies). 41% of these antibiotics belong to the WHO Watch Group. The most frequent indications for SMA were upper respiratory tract infections (27 studies), gastrointestinal tract symptoms (25 studies) and febrile illnesses (18 studies). Common sources of antibiotics used for self‐medication were community pharmacies (31 studies), family/friends (20 studies), leftover antibiotics (19 studies) and patent medicine stores (18 studies). The most frequently reported factor associated with SMA was no education/low educational status (nine studies). Conclusions The prevalence of SMA is high in Africa and varies across sub‐regions with the highest prevalence reported in Western Africa. Drivers of SMA are complex, comprising of socio‐economic factors and insufficient access to health care coupled with poorly implemented policies regulating antibiotic sales.
As Africa prepares to overcome the difficult challenges of COVID-19 vaccination roll-outs, a number of factors, including equitable access, effective and efficient sufficient supply chains, a scope of established determinants will need to be considered in order to enhance vaccine acceptability and uptake. In this commentary, we present six major determinants of vaccine acceptability and uptake in Africa. We summarize these determinants with the acronym VAMRIS: V= Vaccine hesitancy; A= Attitude and uptake by health care workers; M= Misinformation; R= Religion; I= Immunization roll out plans; S= Social influences and enabling environment. Understanding determinants of COVID-19 vaccine acceptability will guide public health officials make informed decisions. As the Vaccine becomes progressively available, strategies for efficient roll-out to achieve massive uptake by the targeted population will depend on a number of factors. These include: community engagement efforts; types of health promotion activities and/or messages; community sensitization to dispel myths and misconceptions; endorsements and buy-ins from local champions, celebrities, authorities; logistic considerations; and incentives to health counsellors/workers to create demand. Copyright © 2020 Wirsiy et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
Background Ebola virus disease (EVD) is a severe, often fatal illness in humans and nonhuman primates caused by the Ebola virus. The recently approved rVSV-EBOV vaccine is not available in many high-risk countries hence prevention is paramount. The design of effective prevention interventions requires an understanding of the factors that expose communities at risk. It was based on this that we investigated the Baka community of Abong-Mbang Health District in tropical rain forest of Cameroon. Methods A cross-sectional study was conducted with participants randomly selected from 13 villages in Abong-Mbang by multi-stage cluster sampling. A questionnaire was administered to them to collect demographic information, data on knowledge of EVD, their feeding and health-seeking behaviour. Data was analyzed using the chi-square test. Knowledge of EVD was assessed using an 8 item Morisky Scale. An adapted Threat Capability Basic Risk Assessment Guide was used to determine their risk of exposure to infection. Results A total of 510 participants, most of whom were hunters (31.4%), farmers (29.8%), and had primary education (62.7%), were included in this study. Although 83.3% participants had heard of EVD, most (71%) did not know its cause. Their source of information was mainly informal discussions in the community (49%). Misconceptions were identified with regards to the cause and mode of transmission. Only 43.1% accepted EVD could be transmitted from human-to-human. Generally, participants’ knowledge of EVD was poor. Demographic factors such as level of education, occupation and ethnic group significantly affected knowledge of EVD. The majority of participants were at a very high risk of exposure to infection as they consumed various forms of bush meat and were involved in other risky practices such as scarification and touching of corpses. Although over half of participants seek medical care, most of them preferred traditional medicine. Socio-cultural and service-related factors were deterrent factors to medical care. Conclusion Participants generally had poor knowledge of EVD and were at high risk of infection. We recommend rigorous sensitization campaigns in the study area to educate the population on EVD and clarify the misconceptions identified. EVD surveillance is recommended particularly as outbreaks have often been reported in the Congo Basin.
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