Publication: Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach
Issued Date
2021-05-01
Resource Type
ISSN
2214109X
Other identifier(s)
2-s2.0-85104108687
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Mahidol University
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SCOPUS
Bibliographic Citation
The Lancet Global Health. Vol.9, No.5 (2021), e610-e619
Suggested Citation
Nga T.T. Do, Huong T.L. Vu, Chuc T.K. Nguyen, Sureeporn Punpuing, Wasif Ali Khan, Margaret Gyapong, Kwaku Poku Asante, Khatia Munguambe, F. Xavier Gómez-Olivé, Johannes John-Langba, Toan K. Tran, Malee Sunpuwan, Esperanca Sevene, Hanh H. Nguyen, Phuc D. Ho, Mohammad Abdul Matin, Sabeena Ahmed, Mohammad Mahbubul Karim, Olga Cambaco, Samuel Afari-Asiedu, Ellen Boamah-Kaali, Martha Ali Abdulai, John Williams, Sabina Asiamah, Georgina Amankwah, Mary Pomaa Agyekum, Fezile Wagner, Proochista Ariana, Betuel Sigauque, Stephen Tollman, H. Rogier van Doorn, Osman Sankoh, John Kinsman, Heiman F.L. Wertheim Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach. The Lancet Global Health. Vol.9, No.5 (2021), e610-e619. doi:10.1016/S2214-109X(21)00024-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78252
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Title
Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach
Author(s)
Nga T.T. Do
Huong T.L. Vu
Chuc T.K. Nguyen
Sureeporn Punpuing
Wasif Ali Khan
Margaret Gyapong
Kwaku Poku Asante
Khatia Munguambe
F. Xavier Gómez-Olivé
Johannes John-Langba
Toan K. Tran
Malee Sunpuwan
Esperanca Sevene
Hanh H. Nguyen
Phuc D. Ho
Mohammad Abdul Matin
Sabeena Ahmed
Mohammad Mahbubul Karim
Olga Cambaco
Samuel Afari-Asiedu
Ellen Boamah-Kaali
Martha Ali Abdulai
John Williams
Sabina Asiamah
Georgina Amankwah
Mary Pomaa Agyekum
Fezile Wagner
Proochista Ariana
Betuel Sigauque
Stephen Tollman
H. Rogier van Doorn
Osman Sankoh
John Kinsman
Heiman F.L. Wertheim
Huong T.L. Vu
Chuc T.K. Nguyen
Sureeporn Punpuing
Wasif Ali Khan
Margaret Gyapong
Kwaku Poku Asante
Khatia Munguambe
F. Xavier Gómez-Olivé
Johannes John-Langba
Toan K. Tran
Malee Sunpuwan
Esperanca Sevene
Hanh H. Nguyen
Phuc D. Ho
Mohammad Abdul Matin
Sabeena Ahmed
Mohammad Mahbubul Karim
Olga Cambaco
Samuel Afari-Asiedu
Ellen Boamah-Kaali
Martha Ali Abdulai
John Williams
Sabina Asiamah
Georgina Amankwah
Mary Pomaa Agyekum
Fezile Wagner
Proochista Ariana
Betuel Sigauque
Stephen Tollman
H. Rogier van Doorn
Osman Sankoh
John Kinsman
Heiman F.L. Wertheim
Other Contributor(s)
Oxford University Clinical Research Unit
University of Health and Allied Sciences, Ghana
Njala University
Universidade Eduardo Mondlane
Kintampo Health Research Centre
Hanoi Institute of Mathematics
Hanoi Medical University
Umeå Universitet
University of Oxford
Universität Heidelberg
University of the Witwatersrand, Johannesburg
Wits School of Public Health
Mahidol University
University of KwaZulu-Natal
International Centre for Diarrhoeal Disease Research Bangladesh
Radboud University Medical Center
Statistics Sierra Leone
Manhiça Health Research Center (CISM)
Dodowa Health Research Centre
University of Health and Allied Sciences, Ghana
Njala University
Universidade Eduardo Mondlane
Kintampo Health Research Centre
Hanoi Institute of Mathematics
Hanoi Medical University
Umeå Universitet
University of Oxford
Universität Heidelberg
University of the Witwatersrand, Johannesburg
Wits School of Public Health
Mahidol University
University of KwaZulu-Natal
International Centre for Diarrhoeal Disease Research Bangladesh
Radboud University Medical Center
Statistics Sierra Leone
Manhiça Health Research Center (CISM)
Dodowa Health Research Centre
Abstract
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 health-care 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.