Addressing the threat of antibiotic resistance in Thailand: monitoring population knowledge and awareness

Abstract

The 2015 Global action plan on antimicrobial resistance (GAP-AMR) highlights the key importance of improving awareness and understanding of antimicrobial resistance among consumers. While low levels of awareness are not exclusive to consumers in low- and middle-income countries, the challenges to improving understanding are compounded in these settings, by factors such as higher rates of antibiotic self-medication and availability through informal suppliers. In 2016, Thailand set an ambitious target to increase, by 2021, public knowledge of antibiotic resistance and awareness of appropriate use of antibiotic by 20%. This involved first establishing baseline data by incorporating a module on antibiotic awareness into the 2017 national Health and Welfare Survey conducted by the National Statistical Office. The benefit of this approach is that the data from the antibiotic module are collected in parallel with data on socioeconomic, demographic and geospatial parameters that can inform targeted public communications. The module was developed by review of existing tools that have been used to measure public awareness of antibiotics, namely those of the Eurobarometer project of the European Union and a questionnaire developed by the World Health Organization. The Thai module was constructed in such a way that results could be benchmarked against those of the other survey tools, to allow international comparison. The Thai experience showed that close collaboration between the relevant national authorities allowed smooth integration of a module on antibiotic awareness into the national household survey. To date, evidence from the module has informed the content and strategy of public communications on antibiotic use and misuse. Work is under way to select the most robust indicators to use in monitoring progress. The other Member States of the World Health Organization South-East Asia Region can benefit from Thailand's experiences in improvement of monitoring population knowledge and awareness.

Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages

“…A major complication of these messages in our field sites was that people were often unfamiliar with the technical term "antibiotic" (Tangcharoensathien et al, 2018), people might not realise which medicines have antibiotic ingredients (e.g. Mybacin Lozenges cough drops, containing 2.5 mg neomycin), and vernacular notions like "germ killer" in Thailand may not be congruent with biomedical definitions of antibiotics (including e.g.…”

“…12 We considered the outcome of the activity to be people's knowledge of and attitudes towards antibiotic use, and their treatment-seeking behaviour relating to healthcare utilisation and medicine use. We limited ourselves to general medicine access because earlier research had highlighted the generally high rates of medicine use in Thailand (WHO SEARO, 2016, p. 47) and in order to accommodate people's uncertainty when describing medicine that might have been an antibiotic (Tangcharoensathien et al, 2018). In addition to these overall outcomes for Research Question 1, the descriptive analysis also involved a specific analysis of contextual factors for Research Question 2:…”

“…primary care units, hospitals) was often difficult to understand for members of the general population, but also that language barriers extended beyond linguistics into the underlying conceptions of illness and medicine (Khine Zaw et al, 2018;Haenssgen et al, 2018a). For example, the idea of an "antibiotic" or "antimicrobial" is more difficult to absorb in the absence of bacteria and viruses as disease-causing agents in the popular understanding of medicine in Thailand (Tangcharoensathien et al, 2018). The introduction of new terms for commonly used medicine could then potentially spark interest and a desire to learn more, but it could also remain unintelligible or, worse, create confusion that can change behaviours in unintended and harmful ways.…”

Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR

“…However, other authors have cautioned against backlashes from fear-based AMR narratives [10,36]. Problems like adverse behavioural reactions, stigma, or public resentment may be accentuated yet further in situations like ours where antibiotics cannot be easily identified and people might not actively distinguish between antibiotics and other types of pharmaceuticals [37].…”

Outputs, Outcomes, and Behavioural Impacts of an Antibiotic-Related Educational Activity in Lao PDR

“…Rai village also indicates that such strategies could have a serious backlash [23]. Problems like adverse behavioural reactions, stigma, or public resentment may be accentuated further in situations like ours where antibiotics cannot be easily identified and people might not actively distinguish between antibiotics and other types of pharmaceuticals [37].…”