scholarly journals No prescription? No problem: drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries: a systematic review of qualitative studies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sewunet Admasu Belachew ◽  
Lisa Hall ◽  
Daniel Asfaw Erku ◽  
Linda A. Selvey
Keyword(s):  
Public Awareness ◽  
Antibiotic Use ◽  
Qualitative Studies ◽  
Retail Outlet ◽  
Middle Income ◽  
Global Challenge ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
Retail Outlets ◽  
Low And Middle Income

Abstract Background Non-prescription dispensing of antibiotics, one of the main sources of antibiotic misuse or over use, is a global challenge with detrimental public health consequences including acceleration of the development of antimicrobial resistance, and is facilitated by various intrinsic and extrinsic drivers. The current review aimed to systematically summarise and synthesise the qualitative literature regarding drivers of non-prescribed sale of antibiotics among community drug retail outlets in low and middle income countries. Methods Four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) and reference lists of the relevant articles were searched. The Joanna Briggs Institute’s Critical Appraisal Checklist for qualitative studies was used to assess the quality of included studies. The enhancing transparency in reporting the synthesis of qualitative research statement was used to guide reporting of results. Data were coded using NVivo 12 software and analysed using both inductive and deductive thematic analysis. Results A total of 23 articles underwent full text review and 12 of these met the inclusion criteria. Four main themes were identified in relation to facilitators of non-prescribed sale of antibiotics among community drug retail outlets: i) the business orientation of community drug retail outlets and tension between professionalism and commercialism; ii) customers’ demand pressure and expectation; iii); absence of or a lax enforcement of regulations; and iv) community drug retail outlet staff’s lack of knowledge and poor attitudes about antibiotics use and scope of practice regarding provision. Conclusions This review identified several potentially amendable reasons in relation to over the counter dispensing of antibiotics. To contain the rise of antibiotic misuse or over use by targeting the primary drivers, this review suggests the need for strict law enforcement or enacting new strong regulation to control antibiotic dispensing, continuous and overarching refresher training for community drug retail outlet staff about antibiotic stewardship, and holding public awareness campaigns regarding rational antibiotic use.

scholarly journals Defending Comprehensive Tobacco Control Policy Implementation in Nepal From Tobacco Industry Interference (2011–2018)

2020 ◽  
Vol 22 (12) ◽  
pp. 2203-2212 ◽  
Author(s):  
Dharma N Bhatta ◽  
Eric Crosbie ◽  
Stella A Bialous ◽  
Stanton Glantz
Keyword(s):  
Tobacco Control ◽  
Tobacco Industry ◽  
Public Awareness ◽  
Control Policy ◽  
Control Law ◽  
Middle Income ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
The Law ◽  
Low And Middle Income

Abstract Introduction Nepal passed a comprehensive tobacco control law in 2011. Tobacco control advocates successfully countered tobacco industry (TI) interference to force implementation of law. Aims and Methods Policy documents, news stories, and key informant interviews were triangulated and interpreted using the Policy Dystopia Model (PDM). Results The TI tried to block and weaken the law after Parliament passed it. Tobacco control advocates used litigation to force implementation of the law while the TI used litigation in an effort to block implementation. The TI argued that tobacco was socially and economically important, and used front groups to weaken the law. Tobacco control advocates mobilized the media, launched public awareness campaigns, educated the legislature, utilized lawsuits, and monitored TI activities to successfully counter TI opposition. Conclusions Both tobacco control advocates and the industry used the discursive and instrumental strategies described in the PDM. The model was helpful for understanding TI activities in Nepal and could be applied to other low- and middle-income countries. Civil society, with the help of international health groups, should continue to track TI interference and learn the lessons from other countries to proactively to counter it. Implications The PDM provides an effective framework to understand battles over implementation of a strong tobacco control law in Nepal, a low- and middle-income country. The TI applied discursive and instrumental strategies in Nepal in its efforts to weaken and delay the implementation of the law at every stage of implementation. It is important to continuously monitor TI activities and learn lessons from other countries, as the industry often employ the same strategies globally. Tobacco control advocates utilized domestic litigation, media advocacy, and engaged with legislators, politicians, and other stakeholders to implement a strong tobacco control law. Other low- and middle-income countries can adapt these lessons from Nepal to achieve effective implementation of their laws.

scholarly journals Characteristics of a Nationwide Voluntary Antibiotic Resistance Awareness Campaign in India; Future Paths and Pointers for Resource Limited Settings/Low and Middle Income Countries

2019 ◽  
Vol 16 (24) ◽  
pp. 5141
Author(s):  
Ashok J. Tamhankar ◽  
Ramesh Nachimuthu ◽  
Ravikant Singh ◽  
Jyoti Harindran ◽  
Gautam Kumar Meghwanshi ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
World Health ◽  
Awareness Campaign ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
Resource Limited ◽  
Low And Middle Income

Antibiotic resistance has reached alarming proportions globally, prompting the World Health Organization to advise nations to take up antibiotic awareness campaigns. Several campaigns have been taken up worldwide, mostly by governments. The government of India asked manufacturers to append a ‘redline’ to packages of antibiotics as identification marks and conducted a campaign to inform the general public about it and appropriate antibiotic use. We investigated whether an antibiotic resistance awareness campaign could be organized voluntarily in India and determined the characteristics of the voluntarily organized campaign by administering a questionnaire to the coordinators, who participated in organizing the voluntary campaign India. The campaign characteristics were: multiple electro–physical pedagogical and participatory techniques were used, 49 physical events were organized in various parts of India that included lectures, posters, booklet/pamphlet distribution, audio and video messages, competitions, and mass contact rallies along with broadcast of messages in 11 local languages using community radio stations (CRS) spread all over India. The median values for campaign events were: expenditure—3000 Indian Rupees/day (US$~47), time for planning—1 day, program spread—4 days, program time—4 h, direct and indirect reach of the message—respectively 250 and 500 persons/event. A 2 min play entitled ‘Take antibiotics as prescribed by the doctor’ was broadcast 10 times/day for 5 days on CRS with listener reach of ~5 million persons. More than 85%ofcoordinators thought that the campaign created adequate awareness about appropriate antibiotic use and antibiotic resistance. The voluntary campaign has implications for resource limited settings/low and middle income countries.

scholarly journals Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns

2021 ◽  
Author(s):  
Eleanor MacPherson ◽  
Joanna Reynolds ◽  
Esnart Sanudi ◽  
Alexander Nkaombe ◽  
John Mankhomwa ◽  
...  
Keyword(s):  
Low Income ◽  
Public Awareness ◽  
Antibiotic Use ◽  
Subsistence Farming ◽  
Formal Sector ◽  
Middle Income ◽  
The Public ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
The Right

Drug resistant infections are increasing across the world and urgent action is required to preserve current classes of antibiotics. Antibiotic use practices in low-and-middle-income countries have gained international attention, especially as antibiotics are often accessed beyond the formal health system. Public awareness campaigns have gained popularity, often conceptualising antimicrobial resistance (AMR) as a problem of excess, precipitated by irrational behaviour. Insufficient attention has been paid to people’s lived experiences of accessing medicines in low-income contexts. In Chikwawa District, Malawi, a place of extreme scarcity, our study aimed to understand the care and medicine use practices of households dependent on subsistence farming. Adopting an anthropological approach, we undertook medicine interviews (100), ethnographic fieldwork (six-month period) and key informant interviews (33) with a range of participants in two villages in rural Chikwawa. The most frequently used drugs were cotrimoxazole and amoxicillin, not considered to be of critical importance to human health. Participants recognised that keeping, sharing, and buying medicines informally was not the “right thing.” However, they described using antibiotics and other medicines in these ways due to conditions of extreme precarity, the costs and limitations of seeking formal care in the public sector, and the inevitability of future illness. Our findings emphasise the need in contexts of extreme scarcity to equip policy actors with interventions to address AMR through strengthening health systems, rather than public awareness campaigns that foreground overuse and the dangers of using antibiotics beyond the formal sector.

scholarly journals 2031. Impact of Education and Antibiotic Guidelines on Dispensing Antibiotics with Community Pharmacists in a Low- and Middle-Income Country

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S682-S682
Author(s):  
Smitha Gudipati ◽  
Deepak Bajracharya ◽  
Lenjana Jimee ◽  
Gina Maki ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
Antibiotic Use ◽  
Educational Assessment ◽  
The Body ◽  
Control Groups ◽  
Post Intervention ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Control ◽  
Low And Middle Income

Abstract Background Non-prescription use of antibiotics in low- and middle-income countries has contributed to significant antimicrobial resistance (AMR). Henry Ford Health System has partnered with multinational organizations in Nepal to address the need for increasing awareness of AMR and implementation of effective antimicrobial stewardship. This partnership confirmed the importance of increasing knowledge and awareness regarding AMR and antibiotic use to community pharmacists. The present pilot study assessed if outpatient antibiotic dispensing guidelines given to community pharmacists could result in a reduction of unneeded antibiotic use. Methods Nine community pharmacies from Kathmandu were selected of which two were used as controls. Seven pharmacists were educated on the appropriate use of antibiotics, and outpatient dispensing before and after guidelines at all pharmacies were evaluated. The pharmacists were given guidelines on antibiotic use and duration needed for common bacterial infections encountered. Controls were not given guidelines. At baseline and post-intervention (1 week), pill counts were performed of the top six antibiotics that were dispensed by the pharmacist. Pharmacists were requested to keep a log of how many antibiotics were dispensed for one week. The pharmacists also were requested to fill out a post-intervention educational assessment to evaluate retention. Results Pill count pre-intervention was 15,856 and 1512 and post-intervention was 11,168 and 1,440 in the intervention and control groups respectively (Table 1). A post-intervention educational assessment revealed that both the intervention and control groups believed antibiotics can treat viruses (57% vs. 50%) and that antibiotics do not kill good bacteria that protect the body from infection (57% vs. 50%) (Table 2). Conclusion There was no difference in the dispensing of antibiotics between pre- and post-intervention. The findings of this study show significant room for improvement in continuing education about antibiotic use in outpatient pharmacies. Further studies are needed to target outpatient antibiotic dispensing with education and identifying economic or other incentives in hopes of reducing the burden of AMR in low- and middle-income countries. Disclosures All authors: No reported disclosures.

scholarly journals Childhood vaccines and antibiotic use in low- and middle-income countries

Nature ◽  
2020 ◽  
Vol 581 (7806) ◽  
pp. 94-99 ◽  
Author(s):  
Joseph A. Lewnard ◽  
Nathan C. Lo ◽  
Nimalan Arinaminpathy ◽  
Isabel Frost ◽  
Ramanan Laxminarayan
Keyword(s):  
Antibiotic Use ◽  
Middle Income ◽  
Middle Income Countries ◽  
Childhood Vaccines ◽  
Low And Middle Income

scholarly journals Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

2017 ◽  
Vol 2 ◽  
pp. 58 ◽  
Author(s):  
Heiman F.L. Wertheim ◽  
Nguyen Thi Kim Chuc ◽  
Sureeporn Punpuing ◽  
Wasif Ali Khan ◽  
Margaret Gyapong ◽  
...  
Keyword(s):  
Cultural Context ◽  
Qualitative Interviews ◽  
Antibiotic Use ◽  
Community Members ◽  
Multi Centre Study ◽  
Middle Income ◽  
Social Interventions ◽  
Middle Income Countries ◽  
Actual Use ◽  
Low And Middle Income

In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.

scholarly journals A Systems Dynamics Approach to Understanding the Determinants of Antenatal Care Utilization in Low-and Middle-Income Countries

2020 ◽  
Vol 9 (4) ◽  
pp. 111-128
Author(s):  
Hasifah Kasujja Namatovu ◽  
Agnes Rwashana Semwanga
Keyword(s):  
Antenatal Care ◽  
Support Groups ◽  
Holistic Approach ◽  
Care Utilization ◽  
Middle Income ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
Antenatal Care Utilization ◽  
Context Specific ◽  
Low And Middle Income

There has been low adherence of antenatal care utilization (ANC) in low and middle-income countries (LMIC) despite its associated negative outcome on women and their unborn babies. Although several studies have examined ANC, the majority focus on isolated aspects and do not explore the holistic approach to understand its dynamics. The system dynamics approach provides a deeper understanding of the phenomenon by examining the underlying factors, causes, effects, feedback, and delays. This study aimed at understanding factors that influence ANC utilization using the system's dynamics approach. An interpretive systematic review to establish multifaceted and context-specific processes was done between May and November 2019. Data from 24 articles were synthesized and used to build causal loop diagrams, which were validated through focus group discussions and interviews with stakeholders. Results revealed human resource numbers and welfare, awareness campaigns, peer support groups, and community-based engagement as key leverage points towards ANC improvement.

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