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Antibiotic knowledge, attitudes, and practices : new insights from cross-sectional rural health behaviour surveys in low- and middle-income Southeast Asia
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(2019) Antibiotic knowledge, attitudes, and practices : new insights from cross-sectional rural health behaviour surveys in low- and middle-income Southeast Asia. BMJ Open, 9 . e028224. doi:10.1136/bmjopen-2018-028224
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Official URL: http://dx.doi.org/10.1136/bmjopen-2018-028224
Abstract
Introduction: Low- and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices, and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains underrepresented in AMR research.
Objective: To (1) describe antibiotic-related knowledge, attitudes, and practices of the general population in two LMICs and to (2) assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers.
Design: Observational study: cross-sectional rural health behaviour survey, representative on the population level.
Setting: General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018.
Participants: 2141 adult members (≥18 years) of the general rural population, representing 712,000 villagers.
Outcome measures: Antibiotic-related knowledge, attitudes, and practices across sites and healthcare access channels.
Findings: Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like “anti-inflammatory medicine” in Chiang Rai (87.6%; 95% confidence interval [CI]: 84.9–90.0) and “ampi” in Salavan (75.6%; 95% CI: 71.4–79.4). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI: 0.01 – 0.23) and 0.53 in Salavan (95% CI: 0.16 – 0.90).
Conclusions: Locally specific conceptions and counter-intuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming “knowledge deficits” alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards “AMR-sensitive interventions” that address context-specific upstream drivers of antimicrobial use (e.g. unemployment insurance) and complement education and awareness campaigns.
Registration: clinicaltrials.gov identifier NCT03241316
| Item Type: | Journal Article | |||||||||
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| Subjects: | H Social Sciences > HM Sociology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
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| Divisions: | Faculty of Arts > School for Cross-faculty Studies > Global Sustainable Development | |||||||||
| Library of Congress Subject Headings (LCSH): | Antibiotics -- Public opinion -- Thailand --Chiang Rai, Antibiotics -- Public opinion -- Laos -- Salavan, Drug resistance in microorganisms, Anti-infective agents, Infection control, Health services accessibility -- Social aspects -- Thailand --Chiang Rai, Health services accessibility -- Social aspects -- -- Laos -- Salavan | |||||||||
| Journal or Publication Title: | BMJ Open | |||||||||
| Publisher: | BMJ | |||||||||
| ISSN: | 2044-6055 | |||||||||
| Official Date: | 2019 | |||||||||
| Dates: |
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| Date of first compliant deposit: | 22 July 2019 | |||||||||
| Volume: | 9 | |||||||||
| Article Number: | e028224 | |||||||||
| DOI: | 10.1136/bmjopen-2018-028224 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access | |||||||||
| RIOXX Funder/Project Grant: |
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