Khine Zaw, Yuzana, Charoenboon, Nutcha, Haenssgen, Marco Johannes and Lubell, Yoel (2018) A comparison of patients’ local conceptions of illness and medicines in the context of C-reactive protein biomarker testing in Chiang Rai and Yangon. The American Journal of Tropical Medicine and Hygiene, 98 (6). pp. 1661-1670. doi:10.4269/ajtmh.17-0906 ISSN 0002-9637.

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Abstract

Antibiotic resistance is not solely a medical but also a social problem, influenced partly by patients’ treatment-seeking behavior and their conceptions of illness and medicines. Situated within the context of a clinical trial of C-reactive protein (CRP) biomarker testing to reduce antibiotic over-prescription at the primary care level, our study explores and compares the narratives of 58 fever patients in Chiang Rai (Thailand) and Yangon (Myanmar). Our objectives are to 1) compare local conceptions of illness and medicines in relation to health-care seeking and antibiotic demand; and to 2) understand how these conceptions could influence CRP point-of-care testing (POCT) at the primary care level in low- and middle-income country settings. We thereby go beyond the current knowledge about antimicrobial resistance and CRP POCT, which consists primarily of clinical research and quantitative data. We find that CRP POCT in Chiang Rai and Yangon interacted with fever patients’ preexisting conceptions of illness and medicines, their treatment-seeking behavior, and their health-care experiences, which has led to new interpretations of the test, potentially unforeseen exclusion patterns, implications for patients’ self-assessed illness severity, and an increase in the status of the formal health-care facilities that provide the test. Although we expected that local conceptions of illness diverge from inbuilt assumptions of clinical interventions, we conclude that this mismatch can undermine the intervention and potentially reproduce problematic equity patterns among CRP POCT users and nonusers. As a partial solution, implementers may consider applying the test after clinical examination to validate rather than direct prescription processes.

Item Type:	Journal Article
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > R Medicine (General)
Divisions:	Faculty of Arts > School for Cross-faculty Studies > Global Sustainable Development
Library of Congress Subject Headings (LCSH):	Drug resistance in microorganisms, Health behavior -- Thailand, C-reactive protein -- Health aspects, Antibiotics, Drugs -- Prescribing
Journal or Publication Title:	The American Journal of Tropical Medicine and Hygiene
Publisher:	American Society of Tropical Medicine and Hygiene
ISSN:	0002-9637
Official Date:	June 2018
Dates:	Date Event June 2018 Published 19 January 2018 Accepted
Volume:	98
Number:	6
Page Range:	pp. 1661-1670
DOI:	10.4269/ajtmh.17-0906
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	15 November 2018
Date of first compliant Open Access:	15 November 2018
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Foundation for Innovative New Diagnostics http://viaf.org/viaf/123746350 105032/Z/14/Z Wellcome Trust http://dx.doi.org/10.13039/100010269 UNSPECIFIED [UO] University Of Oxford http://dx.doi.org/10.13039/501100000769 ES/P00511X/1 [ESRC] Economic and Social Research Council http://dx.doi.org/10.13039/501100000269

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