Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia

Haenssgen, Marco Johannes; Charoenboon, Nutcha; Zanello, Giacomo; Mayxay, Mayfong; Reed‐Tsochas, Felix; Lubell, Yoel; Wertheim, Heiman; Lienert, Jeffrey; Xayavong, Thipphaphone; Zaw, Yuzana Khine; Thepkhamkong, Amphayvone; Sithongdeng, Nicksan; Khamsoukthavong, Nid; Phanthavong, Chanthasone; Boualaiseng, Somsanith; Vongsavang, Souksakhone; Wibunjak, Kanokporn; Chai-in, Poowadon; Thavethanutthanawin, Patthanan; Althaus, Thomas; Greer, Rachel; Nedsuwan, Supalert; Wangrangsimakul, Tri; Limmathurotsakul, Direk; Elliott, Elizabeth; Ariana, Proochista

doi:10.1136/bmjopen-2018-028224

Cited by 47 publications

(61 citation statements)

References 26 publications

(25 reference statements)

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“…Yet mainstream public health education messages are not appropriate for those experiencing hardship and abject poverty on a daily basis [ 11 ]. Educational campaigns need to be complemented by upstream drivers of AMR such as poverty and unemployment and structural violence [ 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review of studies on AMR showed that addressing the social determinants of poverty is an essential yet neglected step in addressing AMR [ 12 ]. In LMICs structural, social, political and economic barriers impede access to prescription medicines, and health system development challenges compromise intervention efforts [ 8 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Chowdhury

Williams

Wertheim

et al. 2019

Global Health Action

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Background The use of large quantities of antimicrobial drugs for human health and agriculture is advancing the predominance of drug resistant pathogens in the environment. Antimicrobial resistance is now a major public health threat posing significant challenges for achieving the Sustainable Development Goals. In Bangladesh, where over one third of the population is below the poverty line, the achievement of safe and effective antibiotic medication use for human health is challenging. Objective To explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective. Methods This qualitative study comprises the second phase of the multi-country ABACUS (Antibiotic Access and Use) project in Matlab, Bangladesh. Information was collected through six focus group discussions and 16 in-depth interviews. Informants were selected from ten villages in four geographic locations using the Health and Demographic Surveillance System database. The Access to Healthcare Framework guided the interpretation and framing of the findings in terms of individuals’ abilities to: perceive, seek, reach, pay and engage with healthcare. Results Village pharmacies were the preferred and trusted source of antibiotics for self-treatment. Cultural and religious beliefs informed the use of herbal and other complementary medicines. Advice on antibiotic use was also sourced from trusted friends and family members. Access to government-run facilities required travel on poorly maintained roads. Reports of structural corruption, stock-outs and patient safety risks eroded trust in the public sector. Some expressed a willingness to learn about antibiotic resistance. Conclusion Antimicrobial resistance is both a health and development issue. Social and economic contexts shape medicine seeking, use and behaviours. Multi-sectoral action is needed to confront the underlying social, economic, cultural and political drivers that impact on the access and use of antibiotic medicines in Bangladesh.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Chowdhury

Williams

Wertheim

et al. 2019

Global Health Action

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“…The international AMR community now acknowledges that, for maximal effect, large-scale awareness campaigns should be integrated within industry-wide AMR behavioural policy strategies [4,17]. Our preliminary data suggest that, by rapidly and effectively engaging rural aquaculture communities, digital communications could effectively support this.…”

Section: Discussionmentioning

confidence: 85%

Raising awareness of antimicrobial resistance in rural aquaculture practice in Bangladesh through digital communications: a pilot study

Thornber

Huso

Rahman³

et al. 2019

Global Health Action

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One of the key strategic objectives of the World Health Organisation's global antimicrobial resistance (AMR) action plan is to improve public awareness and understanding of this issue. Very few AMR awareness campaigns have targeted the animal production sector, particularly in low-and middle-income countries (LMICs) where rural communities can be geographically difficult to access via traditional face-to-face community engagement methods. Aquaculture is a major food production industry in Bangladesh and across Asia, an area which poses a significant risk to global AMR dissemination. In this pilot study, we sought to investigate the potential for digital communication materials to rapidly and effectively communicate AMR messages to rural aquaculture farmers in Bangladesh. Working with stakeholders from the Bangladesh aquaculture industry, we developed a 4-minute digital animation designed specifically for this audience and assessed its capacity to engage and communicate AMR messages to farmers. We then conducted a small-scale social media campaign, to determine the potential for rapidly disseminating AMR awareness materials to a large audience across Bangladesh, where there is an extensive 4 G internet network and an everincreasing proportion of the population (57% as of December 2019) have mobile internet access. Thirty-six farmers were surveyed: all of them liked this method of communication and 97% said it would change the way they use antibiotics in the future. Through the social media campaign, the animation received 9,100 views in the first 2 weeks alone. Although preliminary, these results demonstrate the huge potential for digital communication methods for the rapid and widespread communication of AMR awareness materials to rural aquaculture communities in Bangladesh and across Asia. Our results support the need for more research into the most appropriate and effective content of AMR awareness campaigns for aquaculture communities and question the need for explaining the science underlying AMR in such communication materials.

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“…(25) Previous study has demonstrated that the link between antibiotic knowledge and attitude towards antibiotic is weak in the context of LMIC. (26) As people from rural areas become more nancially secure, they also become more empowered and assertive towards their health.…”

Section: Discussionmentioning

confidence: 99%

“…In other words, their attitude towards handling antibiotic is inappropriate not because of ignorance but because they are now able to exercise this assertiveness. (26) Factors associated with inappropriate attitude towards antibiotic usage…”

Section: Discussionmentioning

confidence: 99%

Factors associated with inappropriate attitude towards antibiotic usage among outpatients of a large public primary care center in Malaysia: A cross sectional study.

Zubaidi¹,

Malek²,

Ismail³

2020

Preprint

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Background: Antibiotic resistance is one of the biggest global threat in modern medicine. The situation is even more consequential in lower-and middle-income countries (LMIC) as financial limitations and political instability may become barriers to an impactful health policy. Therefore, The World Health organization has urge all nations to increase public awareness on antibiotic through effective educational interventions. In order for interventions to be successful, it is important to acknowledge that each country is unique in its problems as the demographic in LMIC are diverse. This study aims to identify the community’s attitude appropriateness towards antibiotic usage and their knowledge gaps, the relationship between antibiotic knowledge and their attitude as well as factors associated with inappropriate attitude towards antibiotic among outpatients attending an established primary care specialist center in Malaysia.Methodology : This cross-sectional study was conducted among 256 respondents attending a public primary care specialist clinic center. Those who fulfilled the inclusion and exclusion criteria from June to August 2017 were given a self-administered, validated and translated questionnaire. Pearson correlation was used to deduce the relationship between knowledge and attitude. Chi square test, independent t-test and multiple logistic regression were used to determine factors associated with inappropriate attitude towards antibiotic.Results: It was found that the respondents’ mean attitude and knowledge score were 29.5 ± 4.19 and 5.94 ± 2.4 respectively. The highest inappropriate attitude response was expecting antibiotic from the doctor for common colds and the most frequent incorrect knowledge response was on the domain of role of antibiotics. There is a weak positive relationship between antibiotic knowledge and attitude (r=0.315, n=256, p=0.0001). Respondents with low education level and poor antibiotic knowledge were at least 2.5 times more likely to have inappropriate attitude when handling antibiotics.Conclusion: Our study demonstrated the common inappropriate attitude towards antibiotic and areas of knowledge gap among the population. Antibiotic education should be incorporated in non-pharmacological measures of viral illnesses that is targeted among those with low education and poor antibiotic knowledge. The weak relationship between antibiotic knowledge and attitude suggest that health campaign should focus on behavioral change rather than a theoretical approach.

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Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia

Cited by 47 publications

References 26 publications

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Raising awareness of antimicrobial resistance in rural aquaculture practice in Bangladesh through digital communications: a pilot study

Factors associated with inappropriate attitude towards antibiotic usage among outpatients of a large public primary care center in Malaysia: A cross sectional study.

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