Healthcare seeking outside healthcare facilities and antibiotic dispensing patterns in rural Burkina Faso: A mixed methods study

Abstract

Objective Optimising antibiotic use is important to limit increasing antibiotic resistance. In rural Burkina Faso, over‐the‐counter dispensing of antibiotics in community pharmacies and non‐licensed medicine retail outlets facilitates self‐medication. We investigated its extent, reasons and dispensing patterns. Methods In an exploratory mixed‐method design conducted between October 2020 and December 2021, this study first explored illness perceptions, the range of healthcare providers in communities, antibiotics knowledge and reasons for seeking healthcare outside healthcare facilities. Second, frequencies of illness and healthcare utilisation in the last 3 months were quantitatively measured. Results Participants distinguished between natural and magico‐religious illnesses, according to origins. For illnesses considered to be ‘natural’, healthcare was mainly sought at healthcare facilities, private pharmacies and informal drug outlets. For illnesses considered as magico‐religious, traditional healers were mainly visited. Antibiotics were perceived in the community as medicines similar to painkillers. Healthcare‐seeking outside healthcare facilities was reported by 660/1973 (33.5%) participants reporting symptoms, including 315 (47.7%) to informal vendors. Healthcare seeking outside facilities was less common for 0–4‐year‐olds (58/534, 10.9% vs. 379/850, 44.1% for ≥5‐year‐olds) and decreased with improving socio‐economic status (108/237, 45.6% in the lowest quintile; 96/418, 23.0% in the highest). Reported reasons included financial limitation, and also proximity to informal drug vendors, long waiting times at healthcare facilities, and health professionals' non‐empathetic attitudes towards their patients. Conclusion This study highlights the need to facilitate and promote access to healthcare facilities through universal health insurance and patient‐centred care including reducing patients' waiting time. Furthermore, community‐level antibiotic stewardship programmes should include community pharmacies and informal vendors.

Evaluating the effect of a behavioural intervention bundle on antibiotic use, quality of care, and household transmission of resistant Enterobacteriaceae in intervention versus control clusters in rural Burkina Faso and DR Congo (CABU-EICO)

“…Pilot studies in the HDSS of both settings, con rmed that health centres (66% in Nanoro, 68% in Kimpese), private clinics (none in Nanoro, 4% in Kimpese), community pharmacies (17% in Nanoro) and informal medicine vendors (16% in Nanoro, pharmacies and informal vendors 18% in Kimpese) were the main sources of antibiotics (12,13). Frequent consumption of non-prescribed antibiotics was reported by community members exiting from these local medicine stores, with a signi cant proportion consisting of Watch antibiotics (20% in Nanoro and 24% in Kimpese).…”