scholarly journals Knowledge and behavior of consumers towards the non-prescription purchase of antibiotics: An insight from a qualitative study from New Delhi, India

2021 ◽  
Vol 19 (1) ◽  
pp. 2206
Author(s):  
Anita Kotwani ◽  
Jyoti Joshi ◽  
Anjana S. Lamkang ◽  
Ayushi Sharma ◽  
Deeksha Kaloni
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Use ◽  
Health Concern ◽  
Public Healthcare ◽  
Evidence Based ◽  
Self Medication ◽  
Middle Income ◽  
Awareness Campaigns ◽  
The Government ◽  
And Behavior

Background: In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers’ views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population. Objective: To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions. Methods: 72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis. Results:  Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers’ knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money.  Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics. Conclusions: The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations.

scholarly journals Unsafe “crossover-use” of chloramphenicol in Uganda: importance of a One Health approach in antimicrobial resistance policy and regulatory action

2021 ◽  
Author(s):  
Kayley D. McCubbin ◽  
John W. Ramatowski ◽  
Esther Buregyeya ◽  
Eleanor Hutchinson ◽  
Harparkash Kaur ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Focus Group ◽  
Low Income ◽  
One Health ◽  
Antibiotic Use ◽  
Regulatory Action ◽  
Health Concern ◽  
Drug Shop ◽  
Human Consumption ◽  
Human Use

AbstractSince the introduction of antibiotics into mainstream health care, resistance to these drugs has become a widespread issue that continues to increase worldwide. Policy decisions to mitigate the development of antimicrobial resistance are hampered by the current lack of surveillance data on antibiotic product availability and use in low-income countries. This study collected data on the antibiotics stocked in human (42) and veterinary (21) drug shops in five sub-counties in Luwero district of Uganda. Focus group discussions with drug shop vendors were also employed to explore antibiotic use practices in the community. Focus group participants reported that farmers used human-intended antibiotics for their livestock, and community members obtain animal-intended antibiotics for their own personal human use. Specifically, chloramphenicol products licensed for human use were being administered to Ugandan poultry. Human consumption of chloramphenicol residues through local animal products represents a serious public health concern. By limiting the health sector scope of antimicrobial resistance research to either human or animal antibiotic use, results can falsely inform policy and intervention strategies. Therefore, a One Health approach is required to understand the wider impact of community antibiotic use and improve overall effectiveness of intervention policy and regulatory action.

scholarly journals Over-the-Counter Sale of Antibiotics in India: A Qualitative Study of Providers’ Perspectives across Two States

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1123
Author(s):  
Anita Kotwani ◽  
Jyoti Joshi ◽  
Anjana Sankhil Lamkang
Keyword(s):  
Prescription Drugs ◽  
Action Plan ◽  
Public Healthcare ◽  
Indian States ◽  
Over The Counter ◽  
Face To Face ◽  
Inappropriate Use ◽  
Awareness Campaigns ◽  
Poor Access ◽  
The Government

India has one of the highest rates of antimicrobial resistance (AMR) worldwide. Despite being prescription drugs, antibiotics are commonly available over-the-counter (OTC) at retail pharmacies. We aimed to gain insight into the OTC sale of antibiotics at retail pharmacies and to elucidate its underlying drivers. We conducted face-to-face, in-depth interviews using convenience sampling with 22 pharmacists and 14 informal dispensers from 36 retail pharmacies across two Indian states (Haryana and Telangana). Thematic analysis revealed that antibiotics were often dispensed OTC for conditions e.g., fever, cough and cold, and acute diarrhea, which are typically viral and self-limiting. Both Access and Watch groups of antibiotics were dispensed for 1–2 days. Respondents had poor knowledge regarding AMR and shifted the blame for OTC practices for antibiotics onto the government, prescribers, informal providers, cross practice by alternative medicine practitioners, and consumer demand. Pharmacists suggested the main drivers for underlying OTC dispensing were commercial interests, poor access to public healthcare, economic and time constraints among consumers, lack of stringent regulations, and scanty inspections. Therefore, a comprehensive strategy which is well aligned with activities under the National Action Plan-AMR, including stewardship efforts targeting pharmacists and evidence-based targeted awareness campaigns for all stakeholders, is required to curb the inappropriate use of antibiotics.

scholarly journals Knowledge, Attitudes and Practices of Veterinarians Towards Antimicrobial Resistance and Stewardship in Nigeria

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 453
Author(s):  
Usman O. Adekanye ◽  
Abel B. Ekiri ◽  
Erika Galipó ◽  
Abubakar Bala Muhammad ◽  
Ana Mateus ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Action Plan ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Health Concern ◽  
Attitudes And Practices ◽  
Laboratory Services ◽  
Knowledge Attitudes And Practices

Antimicrobial resistance (AMR) is a global health concern and the inappropriate use of antibiotics in animals and humans is considered a contributing factor. A cross-sectional survey to assess the knowledge, attitudes and practices of veterinarians regarding AMR and antimicrobial stewardship was conducted in Nigeria. A total of 241 respondents completed an online survey. Only 21% of respondents correctly defined the term antimicrobial stewardship and 59.8% were unaware of the guidelines provided by the Nigeria AMR National Action Plan. Over half (51%) of the respondents indicated that prophylactic antibiotic use was appropriate when farm biosecurity was poor. Only 20% of the respondents conducted antimicrobial susceptibility testing (AST) frequently, and the unavailability of veterinary laboratory services (82%) and the owner’s inability to pay (72%) were reported as key barriers to conducting AST. The study findings suggest strategies focusing on the following areas may be useful in improving appropriate antibiotic use and antimicrobial stewardship among veterinarians in Nigeria: increased awareness of responsible antimicrobial use among practicing and newly graduated veterinarians, increased dissemination of regularly updated antibiotic use guidelines, increased understanding of the role of good biosecurity and vaccination practices in disease prevention, and increased provision of laboratory services and AST at affordable costs.

scholarly journals The Socio-cultural Dynamics of Antibiotic Misuse in Hyderabad City, India: a Qualitative Study of Dentist and Pharmacist

2019 ◽  
Vol 2 (3) ◽  
pp. 197-202
Author(s):  
Shoeb Ahmed
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Cultural Practices ◽  
Pharmacy Practice ◽  
Public Health Problem ◽  
Antibiotic Use ◽  
Cultural Dynamics ◽  
Dental Infection ◽  
Structured Interviews ◽  
Self Medication

 Background: Antibiotic resistance and antibiotic-associated adverse events are rapidly escalating and considered as a global health threat and public health problem. There is poor evidence base on the contextual specificities and everyday use of antibiotic in public health dentistry and pharmacy dispensing practices. The study explores the socio-cultural dynamics emergent around antimicrobials in the Indian Public dentistry and pharmacy practice in India. Methods: Using purposive sampling, dentists and pharmacists were recruited for the study in Hyderabad City, Telangana State, India. Using semi-structured interviews, dentists and pharmacists were asked about how antibiotics were prescribed and dispensed, perceptions of antibiotic use in community and socio-cultural norms prevailing in the use of the antimicrobial practice. Results: The dominant themes, emerged by both dentists and pharmacists, was the avoidance of dentist visit on encountering dental infection, reliance on self-medication, use of over-the-counter antibiotics and easy accessibility of antibiotics without prescription as a primary driver of antibiotic misuse and development of antimicrobial resistance, which is associated with socio-cultural practices and economic problems.  Conclusions: The speculations of qualitative responses to antimicrobial resistance are profoundly entangled in the specificities of dental infection management across cultures and locales in daily life. This study emphasizes the need for enforcement of regulatory mechanism on antibiotic dispensing over the counters, educating dental patients in avoiding self medications, educational and training initiatives are necessary to sensitize and rationalize dentist and pharmacist in the use of antibiotics. 

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 Trends in child growth failure among children under five years of age in Ethiopia: Evidence from the 2000 to 2016 Demographic and Health Surveys

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254768
Author(s):  
Tolesa Bekele ◽  
Patrick Rawstorne ◽  
Bayzidur Rahman
Keyword(s):  
Growth Failure ◽  
Total Sample ◽  
Child Growth ◽  
World Health ◽  
Health Concern ◽  
Demographic And Health Surveys ◽  
Z Score ◽  
Middle Income ◽  
The Government ◽  
Health Organization

Introduction In a majority of low- and middle-income countries (LMICs), levels of child growth failure (CGF) have steadily declined since 2000. However, some countries show a different trend. Despite continued investment from the government of Ethiopia as well as donors, CGF levels are still high in Ethiopia. This study aimed to assess trends in CGF and associated sociodemographic, economic and water, sanitation, and hygiene (WASH) factors from 2000 to 2016 in Ethiopia. Methods Data were taken from four rounds of the Ethiopia Demographic and Health Survey (EDHS). Children aged between 0 to 59 months were included. CGF indicators were categorised based on height-for-age z-score (HAZ) < -2 Standard deviation (SD), weight-for-age z-score (WAZ) < -2 SD and weight-for-height z-score (WHZ) < -2 SD. CGF trends were estimated for predicted probabilities and odds ratios (ORs) between 2000 and 2016. Results A total sample size of 31978 for HAZ, 32045 for WAZ and 32246 for WHZ were included in the current study. Stunting decreased from an adjusted odds ratio (AOR) = 0.77 (95% CI: 0.67 to 0.88) in 2005 to an AOR = 0.45 (95% CI: 0.39 to 0.53) in 2016 compared with the year 2000. Compared with data in 2000, underweight decreased from an AOR of 0.70 (95% CI: 0.61 to 0.80) in 2005 to an AOR of 0.43 (95% CI: 0.36 to 0.50) in 2016. Wasting declined from an AOR of 0.91 (95% CI: 0.75 to 1.10) in 2005 to an AOR of 0.76 (95% CI: 0.61 to 0.94) in 2016, compared with data in 2000. Conclusions Between 2000 to 2016, there was a decline in CGF levels albeit the levels are still relatively high compared with the World Health Organization (WHO) cut-off levels for public health concern. Observed rates of change varied across sociodemographic, economic and WASH factors which suggest that interventions tailored towards addressing the imbalances across those factors are required.

scholarly journals Population knowledge and awareness of antibiotic use and antimicrobial resistance: results from national household survey 2019 and changes from 2017

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Viroj Tangcharoensathien ◽  
Sunicha Chanvatik ◽  
Hathairat Kosiyaporn ◽  
Supapat Kirivan ◽  
Wanwisa Kaewkhankhaeng ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Health Professionals ◽  
Household Survey ◽  
Antibiotic Use ◽  
Specific Information ◽  
Thai Population ◽  
National Strategic Plan ◽  
National Household Survey ◽  
The Government ◽  
Rational Use Of Antibiotics

Abstract Background Lack of knowledge and awareness on antimicrobial resistance (AMR) can result in irrational use of antibiotics, which is one of the major drivers of AMR. One goal of the Thailand National Strategic Plan on AMR (2017-2021) is a 20% increase in public knowledge and awareness of antibiotic use and AMR by 2021. This study assesses antibiotic use, level of knowledge and awareness of antibiotic use and AMR and the factors associated with their knowledge and awareness in the Thai population in 2019. It compares findings with a similar national survey in 2017. Methods An AMR module was integrated into the Health and Welfare Survey, a biennial national household survey conducted by the National Statistical Office since 2017. The 2019 survey took place in March, through face-to-face interviews with 27,900 Thai adults aged 15 years or above who participated in the survey and compares 2019 findings with those from 2017. Results One month prior to the survey, 6.3% of population reported use of antibiotics (reduced from 7.9% to 2017), of which 98.1% received antibiotics through healthcare professionals and almost half (43.2%) for flu symptoms. During the last 12 months, 21.5% of Thai adults received information on the appropriate use of antibiotics and AMR (increased from 17.8% to 2017); mostly through health professionals (82.7%). On knowledge, 24.3% of adults gave correct answers to more than three out of six statements (three true and three false statements) (increased from 23.7% to 2017). The overall mean score of awareness of appropriate antibiotic use and AMR is 3.3 out of total score of 5. Conclusions Although progress was made on knowledge and awareness between 2017 and 2019, certain practices, such as use of antibiotics for flu symptoms and receiving information about antibiotic use and AMR, are inappropriate and inadequate. These findings require significant action, notably strengthening health professionals’ ability to prescribe and dispense antibiotics appropriately and effective communication with patients. The government should promote specific information on rational use of antibiotics and AMR to specific target groups.

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 Self-Medication with Antibiotics among University Students in LMIC: A systematic review and meta-analysis

2019 ◽  
Vol 13 (08) ◽  
pp. 678-689 ◽  
Author(s):  
Rixiang Xu ◽  
Tingyu Mu ◽  
Guan Wang ◽  
Jing Shi ◽  
Xin Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
University Students ◽  
Meta Analysis ◽  
Antibiotic Use ◽  
Self Medication ◽  
Middle Income ◽  
Inappropriate Use ◽  
Middle Income Countries ◽  
Effective Interventions ◽  
Pooled Prevalence

Introduction: Self-medication with antibiotics (SMA) is common among university students in low and middle-income countries (LMICs). However, there has been no meta-analysis and systematic review in the population. Methodology: A literature search was conducted using PubMed, Embase and Web of Science for the period from January 2000 to July 2018. Only observational studies that had SMA among university students from LMICs were included. A random-effects model was applied to calculate the pooled effect size with 95% confidence interval (CI) due to the expected heterogeneity (I2 over 50%). Results: The pooled prevalence of SMA of overall included studies was 46.0% (95% CI: 40.3% to 51.8%). Africa had the highest pooled prevalence of SMA among university students (55.30%), whereas South America had the lowest prevalence (38.3%). Among individual LMICs, the prevalence of SMA among university students varied from as low as 11.1% in Brazil to 90.7% in Congo. Conclusions: The practice of SMA is a widespread phenomenon among university students in LMICs and is frequently associated with inappropriate use. Effective interventions such as medication education and stricter governmental regulation concerning antibiotic use and sale are required to be established in order to deal with SMA properly.

scholarly journals Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae as a Proxy Composite Indicator of Antimicrobial Resistance in a Community in Thailand

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Visanu Thamlikitkul ◽  
Teerawit Tangkoskul ◽  
Chakkraphong Seenama
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Use ◽  
Composite Indicator ◽  
Beta Lactamase ◽  
Carriage Rate ◽  
Extended Spectrum Beta Lactamase ◽  
Household Level ◽  
Fecal Carriage ◽  
And Behavior ◽  
Self Administered Questionnaire

Abstract Background Increasing awareness of and understanding about antimicrobial resistance (AMR), promoting changes in behavior, and monitoring of AMR in the community are challenging, as AMR is associated with many contributing factors that are difficult to assess individually. This study aimed to determine the effectiveness of a community-based AMR campaign for improving awareness, understanding, and behavior relating to antibiotic use and AMR in Thailand and to assess if fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae could be a proxy composite indicator of AMR in the community. Methods This study was conducted in 4 communities that are home to approximately 400 000 people. A self-administered questionnaire on awareness, understanding, and behavior relating to antibiotic use and AMR was responded to by 20 521 and 19 634 adults before and immediately after the AMR campaign, respectively, at the household level. Fecal samples were collected from 534 adults before the AMR campaign and from 709 adults at 18 months after the AMR campaign to determine presence of ESBL-producing Enterobacteriaceae. Results Awareness, understanding, and behavior relating to antibiotic use and AMR, as assessed by a self-administered questionnaire, were significantly improved after the AMR campaign. The fecal carriage rate of ESBL-producing Enterobacteriaceae decreased from 66.5% before to 44.6% after the AMR campaign (P &lt; .01). Conclusions Our AMR campaign was effective for improving awareness, understanding, and behavior relating to antibiotic use and AMR among people in the community at the household level, and the prevalence of fecal carriage of ESBL-producing Enterobacteriaceae seemed to be decreased after the AMR campaign. Fecal carriage rate of ESBL-producing Enterobacteriaceae may be a proxy composite indicator of AMR in the community.

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