Exploring drivers of self-treatment with antibiotics in three agricultural communities of northern Tanzania.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES Antimicrobial Resistance and Infection Control Pub Date : 2024-08-29 DOI:10.1186/s13756-024-01453-x
Kathrin Loosli, Fortunata Nasuwa, Matayo Melubo, Kunda Mnzava, Louise Matthews, Stephen E Mshana, Blandina T Mmbaga, Adrian Muwonge, Alicia Davis, Tiziana Lembo
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Abstract

Background: Antimicrobial resistance (AMR) poses a significant global health threat, particularly in low- and middle-income countries (LMICs). Self-treatment with antibiotics, the practice of using antibiotics without professional guidance, is often considered an important contributor to the emergence and spread of AMR.

Method: This study investigated the drivers of self-treatment in three common types of agricultural communities in northern Tanzania. The research employed a comprehensive array of methods, including cross-sectional surveys (n = 790), interviews (n = 30) and observations (n = 178) targeting both antibiotic (human and animal) providers and users (patients and farmers). Qualitative interview data were analysed using a coding and association matrix, while descriptive analyses were performed on survey and observation data.

Results: Self-treatment with antibiotics was highly prevalent in all communities. Between 41.0% (self-reported) and 60.3% (observed) of human antibiotics were obtained without a prescription and we observed that veterinary antibiotics were regularly purchased in retail shops without referral by a professional. Structural deficiencies in the healthcare system drove this practice: limited access to healthcare facilities, medication stockouts and prolonged waiting times were identified as key factors. The absence of safety nets like insurance schemes further contributed to self-medication. Retail shops offered a convenient and cost-effective alternative when antibiotics were inaccessible or unaffordable. Notably, informal networks comprising treatment vendors, friends or neighbours, as well as personal experiences played a crucial role in guiding individuals in their self-treatment decisions by providing advice on treatment choice and modalities.

Conclusions: Addressing self-treatment requires a multi-faceted approach. Improving the availability and accessibility of antibiotics, enhancing healthcare services and involving retail vendors in antibiotic stewardship are essential. Structural issues like access to diagnostics and medicines must be tackled, alongside reducing barriers and incentivising individuals to use professional healthcare services. Training retail vendors to sell specific first-line antibiotics over the counter with guidance on appropriate usage should be considered. Such bottom-up interventions will enable sustainable promotion of responsible antibiotic use, mitigating AMR emergence and securing a healthier future for all.

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探索坦桑尼亚北部三个农业社区自我使用抗生素的驱动因素。
背景:抗菌素耐药性(AMR)对全球健康构成严重威胁,尤其是在中低收入国家(LMICs)。使用抗生素进行自我治疗,即在没有专业指导的情况下使用抗生素,通常被认为是导致抗菌素耐药性出现和传播的重要因素:本研究调查了坦桑尼亚北部三种常见农业社区中自我治疗的驱动因素。研究采用了一系列综合方法,包括横截面调查(n = 790)、访谈(n = 30)和观察(n = 178),调查对象包括抗生素(人类和动物)提供者和使用者(患者和农民)。采用编码和关联矩阵对定性访谈数据进行了分析,同时对调查和观察数据进行了描述性分析:结果:抗生素自我治疗在所有社区都非常普遍。41.0%(自我报告)和 60.3%(观察)的人用抗生素是在没有处方的情况下获得的,我们还观察到兽用抗生素经常是在零售店购买的,没有专业人士的介绍。医疗保健系统的结构性缺陷是导致这种做法的原因:医疗保健设施有限、药品缺货和等待时间过长被认为是关键因素。保险计划等安全网的缺失进一步助长了自我药疗。当抗生素无法买到或买不起时,零售商店提供了一种方便且经济实惠的替代品。值得注意的是,由治疗商贩、朋友或邻居组成的非正式网络以及个人经验在指导个人做出自我治疗决定方面发挥了至关重要的作用,他们就治疗选择和方式提供建议:解决自我治疗问题需要多管齐下。改善抗生素的可用性和可及性、加强医疗保健服务以及让零售商参与抗生素管理至关重要。在减少障碍和鼓励个人使用专业医疗服务的同时,还必须解决结构性问题,如诊断和药品的获取。应考虑对零售商进行培训,让他们在柜台上销售特定的一线抗生素,并指导如何正确使用。这种自下而上的干预措施将有助于可持续地促进负责任地使用抗生素,减少急性呼吸道感染的出现,确保所有人拥有更健康的未来。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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