Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand

Haenssgen, Marco Johannes; Charoenboon, Nutcha; Xayavong, Thipphaphone; Althaus, Thomas

doi:10.1136/bmjgh-2020-003779

Cited by 13 publications

(12 citation statements)

References 70 publications

(62 reference statements)

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“…(8, 32) Whilst practice has generally been assumed to be improved by increased public awareness of AMR, social scientists have suggested that in LMICs precarity (lack of predictability or security) and weak social support are more important determinants of antibiotic use. (33)(34)(35) Although women in this study had very limited knowledge of AMR, these recent ndings suggest educational activities will not be su cient to improve their use of antibiotics. Further, structures such as healthcare systems, market driven antibiotic sales and income and gender inequalities are clearly affecting antibiotic use in children in Northern Tanzania.…”

Section: Category: Adherence To Prescriptionmentioning

confidence: 72%

Antibiotic use in children under five years of age in Northern Tanzania; the experiences of the caring mothers

Emgård

Mwangi²,

Mayo

et al. 2022

Preprint

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Background: Antimicrobial resistance is a serious threat to the global achievements in child health thus far. Previous studies have found high use of antibiotics in children in Northern Tanzania, but the experiences of the primary care-givers, who play a key role in accessing and administering antibiotics for the sick child, has remained largely unknown. We aimed to understand mothers’ conceptions of antibiotic use in their children, which is of importance when forming strategies to improve antibiotic use in the community. Method: A qualitative study including eight focus group discussions with mothers of under-five children in Moshi urban and rural districts, Northern Tanzania, was performed during 2019. The discussions were recorded, transcribed verbatim, translated to English and analysed according to the phenomenographic approach. Findings: Three conceptual themes emerged during analysis; (1) conceptions of disease and antibiotics, (2) accessing treatment and (3) administering antibiotics. Antibiotics were often perceived as a universal treatment for common symptoms or diseases in children with few side-effects. Although mothers preferred to attend a healthcare facility, unforeseen costs, long waits and lack of financial support from their husbands, pose barriers for care-seeking. However, pharmacies were perceived as a cheap and convenient option to access previously used or prescribed antibiotics. Some mothers sought advice from a trusted neighbour regarding when to seek care, thus resembling the function of the community health worker (CHW). Conclusions: To improve antibiotic use in children under five years of age in Northern Tanzania, we suggest targeting behaviour of individuals alone will not be sufficient. Improving structures, including the healthcare system and socio-economic inequality, are needed for sustained results. In the meantime, equipping CHWs to support women in appropriate healthcare seeking for their children, may be a feasible target for intervention.

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Section: Category: Adherence To Prescriptionmentioning

confidence: 72%

Antibiotic use in children under five years of age in Northern Tanzania; the experiences of the caring mothers

Emgård

Mwangi²,

Mayo

et al. 2022

Preprint

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“…A large survey in Salavan Province between 2017 and 2018 revealed that among 796 participants from communities, 39% claimed that they used antibiotics during their previous illness and 22% admitted that they used antibiotics without indications or from informal sources. 63 ‘Ampi’ or ampicillin was the most commonly mentioned antibiotic, by 76% of 775 survey participants, and wound treatment (44%) was the main reason for antibiotic use in Salavan in the same period. 64 In Vientiane and Champasak Provinces, among 500 adults who self-medicated with antimicrobials for reproductive tract infections during the previous year, ampicillin (165 (33%)) was the most frequently used, and more than 50% used unrecommended combined medications.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antimicrobial use and resistance data in human and animal sectors in the Lao PDR: evidence to inform policy

et al. 2021

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ObjectivesTo review the scientific evidence base on antimicrobial use (AMU) and antimicrobial resistance (AMR) in human and animal sectors in the Lao PDR (Laos).MethodsWe reviewed all publications from July 1994 (the first article describing AMR in Laos) to December 2020. Electronic searches were conducted using Google Scholar and PubMed with specific terms relating to AMR and AMU in Lao, French and English languages.FindingsWe screened 1,357 peer-reviewed and grey reports by title and abstract and then full articles/reports. Of 80 included, 66 (83%) related to human health, nine (11%) to animal health, four (5%) to both animal and human health and one (1%) to the environment. Sixty-two (78%) were on AMR and 18 (22%) on AMU. Extended spectrum beta lactamase-producing Escherichia coli was the greatest concern identified; the proportion of isolates increased fivefold from 2004 to 2016 (2/28 (7%) to 27/78 (35%)) from blood cultures submitted to the Microbiology Laboratory, Mahosot Hospital, Vientiane. Carbapenem resistant Escherichia coli was first identified in 2015. Methicillin-resistant Staphylococcus aureus (MRSA) was uncommon, with 15 cases of MRSA from blood cultures between its first identification in 2017 and December 2020. AMR patterns of global antimicrobial resistance surveillance system (GLASS) target pathogens from livestock were less well documented. There were few data on AMU in human health and none on AMU in livestock. The first hospital AMU survey in Laos showed that 70% (1,386/1,981) of in-patients in five hospitals from 2017 to 2018 received antimicrobial(s). Antibiotic self-medication was common.ConclusionAMR in Laos is occurring at relatively low proportions for some GLASS pathogens, giving the country a window of opportunity to act quickly to implement strategies to protect the population from a worsening situation. Urgent interventions to roll out new guidelines with enhanced one-health antibiotic stewardship, reduce antibiotic use without prescriptions, enhance surveillance and improve understanding of AMU and AMR are needed.

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“…A recent report on AMR and social science identifies three areas to address antibiotic use, namely practice, structures and networks [8,45]. Whilst practice has generally been assumed to be improved by increased public awareness of AMR, social scientists have suggested that in LMICs precarity (lack of predictability or security) and weak social support are more significant determinants of antibiotic use [46][47][48]. Although women in this study had very limited knowledge of AMR, these recent findings suggest educational activities will not be sufficient to improve their use of antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic use in children under 5 years of age in Northern Tanzania: a qualitative study exploring the experiences of the caring mothers

Emgård

Mwangi

Mayo

et al. 2022

Antimicrob Resist Infect Control

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Background Antimicrobial resistance is a serious threat to the global achievements in child health thus far. Previous studies have found high use of antibiotics in children in Northern Tanzania, but the experiences of the primary care-givers, who play a key role in accessing and administering antibiotics for the sick child, have remained largely unknown. Therefore, the aim of this study was to understand mothers’ conceptions of antibiotic use in their children, which is of importance when forming strategies to improve antibiotic use in the community. Method A qualitative study including eight focus group discussions with mothers of under-five children in Moshi urban and rural districts, Northern Tanzania, was performed during 2019. The discussions were recorded, transcribed verbatim, translated into English and analysed according to the phenomenographic approach. Findings Three conceptual themes emerged during analysis; (1) conceptions of disease and antibiotics, (2) accessing treatment and (3) administering antibiotics. Antibiotics were often perceived as a universal treatment for common symptoms or diseases in children with few side-effects. Although mothers preferred to attend a healthcare facility, unforeseen costs, long waits and lack of financial support from their husbands, posed barriers for healthcare seeking. However, pharmacies were perceived as a cheap and convenient option to access previously used or prescribed antibiotics. Some mothers sought advice from a trusted neighbour regarding when to seek healthcare, thus resembling the function of the community health worker. Conclusions To improve antibiotic use in children under 5 years of age in Northern Tanzania, the precarious situation that women often find themselves in as they access treatment for their sick children needs to be taken into consideration. It is necessary to improve structures, including the healthcare system, socioeconomic inequalities and promoting gender equality both in the household and in the public arena to reduce misuse of antibiotics. Meanwhile, equipping community health workers to support Tanzanian women in appropriate healthcare seeking for their children, may be a feasible target for intervention.

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Precarity and clinical determinants of healthcare-seeking behaviour and antibiotic use in rural Laos and Thailand

Cited by 13 publications

References 70 publications

Antibiotic use in children under five years of age in Northern Tanzania; the experiences of the caring mothers

Antibiotic use in children under five years of age in Northern Tanzania; the experiences of the caring mothers

Antimicrobial use and resistance data in human and animal sectors in the Lao PDR: evidence to inform policy

Antibiotic use in children under 5 years of age in Northern Tanzania: a qualitative study exploring the experiences of the caring mothers

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