Medical doctor’s perspectives on antibiotic self-medication in pregnant women from a Sub-Saharan African country

Abstract

Background. In 1987 the World Bank, in collaboration with WHO and UNFPA, launched the Safe Motherhood Initiative (SMI) to help raise global awareness about the impact of maternal mortality and morbidity. Although the SMI has been a global priority in recent years, the implications of self-medication in pregnancy on meeting SDG-3 initiatives in sub-Saharan Africa have yet to be addressed. Nigeria has one of the highest rates of antibiotic misuse during pregnancy (37%). Furthermore, antibiotics consumed during pregnancy are linked to birth defects. Past research suggests Nigerian medical doctors are influential stakeholders who can help develop policy guidance to reduce antibiotic self-medication in pregnant women. Thus, this study explored the perspectives of Nigerian medical doctors regarding antibiotic self-medication during pregnancy. Method. Semi-structured interviews were conducted with 24 medical doctors working in three Nigerian tertiary hospitals. All interviews were conducted remotely, using Zoom Video Communications software. Thematic analysis was used to analyse the data. Several checks for methodological rigour were performed. Results. Seven distinct themes emerged: prescribing antibiotics; easy availability of antibiotics; self-medication with antibiotics; use of medicinal herbs; detecting self-medication; lack of policy guidelines on antibiotic self-medication; and side effects. The doctors’ major perspectives were that during pregnancy, the antibiotics are easily available without prescription, self-medicated without any policy guidelines, side effects alone were not sufficient proof of self-medication, and herbal medication are frequently used. . Conclusions. The data suggests antimicrobial misuse in pregnancy, especially the use of herbal medicines, is a recognised problem. The project highlights a need for policy guidance on antibiotic stewardship, including point-of-care testing to detect antibiotic self-medication in pregnant women. Implications for SMI campaigns in sub-Saharan Africa are considered.