The ‘Drug Bag’ method: lessons from anthropological studies of antibiotic use in Africa and South-East Asia

Abstract

Understanding the prevalence and types of antibiotics used in a given human and/or animal population is important for informing stewardship strategies. Methods used to capture such data often rely on verbal elicitation of reported use that tend to assume shared medical terminology. Studies have shown the category ‘antibiotic’ does not translate well linguistically or conceptually, which limits the accuracy of these reports. This article presents a ‘Drug Bag’ method to study antibiotic use (ABU) in households and on farms, which involves using physical samples of all the antibiotics available within a given study site. We present the conceptual underpinnings of the method, and our experiences of using this method to produce data about antibiotic recognition, use and accessibility in the context of anthropological research in Africa and South-East Asia. We illustrate the kinds of qualitative and quantitative data the method can produce, comparing and contrasting our experiences in different settings. The Drug Bag method can produce accurate antibiotic use data as well as provide a talking point for participants to discuss antibiotic experiences. We propose it can help improve our understanding of antibiotic use in peoples’ everyday lives across different contexts, and our reflections add to a growing conversation around methods to study ABU beyond prescriber settings, where data gaps are currently substantial.

Antibiotic practices among household members and their domestic animals within rural communities in Cumilla district, Bangladesh: a cross-sectional survey

“…The final obvious key limitation of the study is that we relied on self-reported responses, which are inevitably prone to respondent recall bias and social desirability bias. Obtaining more objective data in such surveys and contexts is very difficult, but future work could test possible methodological innovations [70].…”

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

“…Researchers in the social sciences remind us of the dangers of injecting subjective bias and unfair judgement into scientific debate [ 19 , 20 ]. Anthropological studies of antibiotic use in Sub-Saharan Africa and South-East Asia used the ‘drug bag’ method to address conceptual and semantic issues [ 21 ]. By ‘appropriate’ use we mean that if a medicine is used appropriately (in a clinical sense) it is safe and effective in treating the disease.…”

Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE): protocol for a multisite prospective observational study of the causes of fever in Africa and Asia

“…Details of this method have been described elsewhere. 39 The second phase is longitudinal ethnographic fieldwork, including participant observation and key informant interviews with residents, medicine retailers (pharmacists, drug shop workers and market vendors) and healthcare workers in clinics and hospitals. With prescribers and retailers, qualitative methods are complemented and contextualised by the collection of quantitative data about antimicrobial prescription, stocks and sales.…”