“If You Do Not Take the Medicine and Complete the Dose…It Could Cause You More Trouble”: Bringing Awareness, Local Knowledge and Experience into Antimicrobial Stewardship in Tanzania

Abstract

Antimicrobial resistance (AMR) is a global health issue disproportionately affecting low- and middle-income countries. In Tanzania, multi-drug-resistant bacteria (MDR) are highly prevalent in clinical and community settings, inhibiting effective treatment and recovery from infection. The burden of AMR can be alleviated if antimicrobial stewardship (AMS) programs are coordinated and incorporate local knowledge and systemic factors. AMS includes the education of health providers to optimise antimicrobial use to improve patient outcomes while minimising AMR risks. For programmes to succeed, it is essential to understand not just the awareness of and receptiveness to AMR education, but also the opportunities and challenges facing health professionals. We conducted in-depth interviews (n = 44) with animal and human health providers in rural northern Tanzania in order to understand their experiences around AMR. In doing so, we aimed to assess the contextual factors surrounding their practices that might enable or impede the translation of knowledge into action. Specifically, we explored their motivations, training, understanding of infections and AMR, and constraints in daily practice. While providers were motivated in supporting their communities, clear issues emerged regarding training and understanding of AMR. Community health workers and retail drug dispensers exhibited the most variation in training. Inconsistencies in understandings of AMR and its drivers were apparent. Providers cited the actions of patients and other providers as contributing to AMR, perpetuating narratives of blame. Challenges related to AMR included infrastructural constraints, such as a lack of diagnostic testing. While health and AMR-specific training would be beneficial to address awareness, equally important, if not more critical, is tackling the challenges providers face in turning knowledge into action.

Antimicrobial Stewardship in Resource-Limited Settings

“…To address these challenges, multiple aspects of healthcare delivery must be addressed. Building local capacity and training healthcare professionals is crucial [22][23][24]. This means providing education and training on antimicrobial stewardship principles, appropriate use, and infection prevention and control measures [25].…”

“…Promoting rational prescribing practices and patient education is crucial in shifting cultural and behavioural factors contributing to antimicrobial misuse [20]. Public awareness campaigns and educating patients about the risks of inappropriate antimicrobial use and the importance of completing prescribed treatments are vital strategies [23].…”

“…Numerous studies have explored the implementation of antimicrobial stewardship programmes in resource-poor settings, revealing their potential to reduce Antimicrobial Stewardship in Resource-Limited Settings DOI: http://dx.doi.org/10.5772/intechopen.114057 inappropriate antimicrobial prescribing and improve adherence to guidelines. The key to success lies in tailored training and education programmes that address the unique challenges of such settings [15,22,23,31]. Evidence-based local procedures and protocols are crucial in tackling antimicrobial resistance and enhancing patient outcomes.…”

“…Collaborating with local communities and engaging community leaders can promote sustainability by fostering ownership and support for ASPs [30]. Engaging patients and their families in antimicrobial stewardship efforts can also increase awareness and guideline adherence [23]. Integrating ASPs into existing healthcare systems is crucial for long-term sustainability [17,24,38].…”

Social Dimensions of Antimicrobial Resistance and an Anthropological Approach: Analytic Review

“…2 It is within this context that an anthropological approach becomes relevant and indispensable. 3 This approach posits that an exhaustive understanding of AMR involves integrating socio-cultural determinants, 4 local health practices, 5 and structural inequalities into existing health strategies. 6 The current discourse on AMR is enriched by recognizing the value of ethnomedicine and medical anthropology, 3 extends the understanding of health to encompass the cultural, social, and structural determinants that critically influence health outcomes.…”