Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site

Watkins, Jocelyn Anstey; Wagner, Fezile; Gómez‐Olivé, Francesc Xavier; Wertheim, Heiman; Sankoh, Osman; Kinsman, John

doi:10.4269/ajtmh.18-0171

Cited by 23 publications

(22 citation statements)

References 63 publications

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“…Additional factors also limited access in South Africa, including ability to reach and to pay. 14 One exception was rural Mozambique, a low-income country with a relatively small proportion of antibiotics purchased without prescription (67 [8·0%] of 839), caused not by better enforcement but rather by limited access, as well as availability of free health care provided by clinical studies to participating patients. 15 , 16 Our findings confirm the common practice of accessing antibiotics without prescriptions in LMICs that has previously been reported.…”

Section: Discussionmentioning

confidence: 99%

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

Nguyen

et al. 2021

The Lancet Global Health

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Background Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. Methods We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2•5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. Findings Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55•2% of antibiotics dispensed without prescription), Bangladesh (45•7%), and Ghana (36•1%), but less so in Mozambique (8•0%), South Africa (1•2%), and Thailand (3•9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through healthcare facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. Interpretation Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. Funding Wellcome Trust and Volkswagen Foundation.

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Section: Discussionmentioning

confidence: 99%

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

Nguyen

et al. 2021

The Lancet Global Health

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145

155

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“…A semi-structured interview guide (see Additional file 1) was used to explore participants’ knowledge, attitudes and perceptions regarding antibiotics and ABR. The guide was developed based on an extensive literature review [8, 12, 13, 17–23], and was validated by a panel of experts consisting of two senior academics with expertise in pharmacy practice and a senior academic with expertise in infectious diseases. Minor revisions were made according to their feedback.…”

Section: Methodsmentioning

confidence: 99%

“…To design effective educational interventions, it is essential to understand public knowledge, attitudes and perceptions regarding antibiotics and ABR [16]. Previous qualitative studies have explored public attitudes towards and perceptions of antibiotics and ABR in European countries [17], India [18], New Zealand [19], Sweden [20], Australia [21], Sri Lanka [22], South Africa [23], Albania [24], Indonesia [25] and the United Kingdom (UK) [26–30]. Overall, these studies indicated that the general public and patients had inadequate knowledge and misconceptions about antibiotics and ABR.…”

Section: Introductionmentioning

confidence: 99%

Low-income community knowledge, attitudes and perceptions regarding antibiotics and antibiotic resistance in Jelutong District, Penang, Malaysia: a qualitative study

et al. 2019

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Background Understanding community perspectives on antibiotics and antibiotic resistance (ABR) is a key component in designing educational interventions to combat ABR at the community level in Malaysia. Therefore, this study aimed to explore community residents’ knowledge, attitudes and perceptions regarding antibiotics and ABR in Jelutong District, Penang, Malaysia. Moreover, it intended to identify areas of focus to be addressed when designing an educational intervention to increase residents’ knowledge and change their attitudes and perceptions. Methods A qualitative approach was adopted to gain a deeper understanding of community residents’ knowledge, attitudes and perceptions regarding antibiotics and ABR. A purposive sampling was employed. Twenty-two residents (aged ≥18 years) were interviewed with the aid of a semi-structured interview guide. All interviews were audio recorded, transcribed verbatim and thematically analysed. Results The majority of the participants asserted that antibiotics could be effective against viral infections. Moreover, many participants were unaware that antibiotics have adverse effects. Some acquired antibiotics from a community pharmacy without a prescription, took antibiotics given to them by their family or friends, or took leftover antibiotics prescribed for a previous illness. A few indicated that they would request antibiotics from their physician when they had viral infections. More than half of the participants discontinued taking antibiotics when their symptoms improved. The majority stated that ABR occurs when the body becomes used to antibiotics. Most participants were unaware of the causes, consequences and prevention of ABR. In fact, they were not concerned about it. As a result, only a few perceived themselves as having responsibility for preventing this problem. Conclusions The community residents had misconceptions about antibiotics and ABR, negative attitudes towards antibiotics and negative perceptions of ABR. The areas of focus that need to be addressed when designing an educational intervention to increase the general public knowledge and change their attitudes and perceptions are the appropriate use of antibiotics and their adverse effects; the importance of adhering to antibiotic therapy; and the definition, causes, consequences and prevention of ABR.

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“…Qualitative interviews and focus groups were held with 60 community members. They suggested the need for strong sales regulations and context-specific educational campaigns to promote the safer use of antibiotics [ 138 ].…”

Section: What Do People Know?mentioning

confidence: 99%

Prevention of antibiotic resistance – an epidemiological scoping review to identify research categories and knowledge gaps

Wall

2019

Global Health Action

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Background: Antibiotics have become the cornerstone for the treatment of infectious diseases and contributed significantly to the dramatic global health development during the last 70 years. Millions of people now survive what were previously life-threatening infections. But antibiotics are finite resources and misuse has led to antibiotic resistance and reduced efficacy within just a few years of introduction of each new antibiotic. The World Health Organization rates antibiotic resistance as a 'global security threat' impacting on global health, food security and development and as important as terrorism and climate change. Objectives: This paper explores, through a scoping review of the literature published during the past 20 years, the magnitude of peer-reviewed and grey literature that addresses antibiotic resistance and specifically the extent to which "prevention" has been at the core. The ultimate aim is to identify know-do gaps and strategies to prevent ABR. Methods: The review covers four main data bases, Web of Science, Medline, Scopus and Ebsco searched for 2000-17. The broader research field "antibiotic OR antimicrobial resistance" gave 431,335 hits. Narrowing the search criteria to "Prevention of antibiotic OR antimicrobial resistance" resulted in 1062 remaining titles. Of these, 622 were unique titles. After screening of the 622 titles for relevance, 420 abstracts were read, and of these 282 papers were read in full. An additional 53 references were identified from these papers, and 64 published during 2018 and 2019 were also included. The final scoping review database thus consisted of 399 papers. Results: A thematic structure emerged when categorizing articles in different subject areas, serving as a proxy for interest expressed from the research community. The research area has been an evolving one with about half of the 399 papers published during the past four years of the study period. Epidemiological modelling needs strengthening and there is a need for more and better surveillance systems, especially in lower-and middle-income countries. There is a wealth of information on the local and national uses and misuses of antibiotics. Educational and stewardship programmes basically lack evidence. Several studies address knowledge of the public and prescribers. The lessons for policy are conveyed in many alarming reports from national and international organizations. Conclusions: Descriptive rather than theoretical ambitions have characterized the literature. If we want to better understand and explain the antibiotic situation from a behavioural perspective, the required approaches are lacking. A framework for an epidemiological causal web behind ABR is suggested and may serve to identify entry points for potential interventions.

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Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site

Cited by 23 publications

References 63 publications

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

Low-income community knowledge, attitudes and perceptions regarding antibiotics and antibiotic resistance in Jelutong District, Penang, Malaysia: a qualitative study

Prevention of antibiotic resistance – an epidemiological scoping review to identify research categories and knowledge gaps

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