Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

Abstract

In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.

Determinants of Inappropriate Antibiotics Use in Rural Central Ghana Using a Mixed Methods Approach

“…An observational study was conducted using quantitative and qualitative methods to examine household factors which influence antibiotic use among community members in Ghana between January 2016 and July, 2018 (18). The study employed three consecutive approaches.…”

“…The sample size used for this study was 1,100 household. The detailed description and calculation of the sample size for this study has been reported in the published study protocol (18). In brief, from previous studies, it was expected that on average about 70% of antibiotic use will be classified as inappropriate.…”

“…The main study outcome was inappropriate antibiotic use, which was defined as either antibiotic use without prescription, not completing treatment course or non-adherence to instruction for antibiotic use from the provider (formal or informal) (18). 'Yes' responses to all or any of the three questions by a respondent was considered to be inappropriate antibiotic use.…”

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

“…This qualitative exploratory cross-sectional study is one component in a larger multi-country research project ABACUS (Antibiotic Access And Use) [ 36 ] which assessed and compared community-based antibiotic access and use in Bangladesh, South Africa, Ghana, Vietnam, Thailand and Mozambique. http://www.indepth-network.org/projects/abacus .…”

“…Sampling and recruitment followed the ABACUS study protocol under the direction of the third author (HW) [ 36 ]. Fourth and fifth authors (WAK and AM respectively) were ABACUS study investigators in the Matlab site.…”