Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe
Background As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-b...
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BMJ Publishing Group
2021-11-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/11/e006920.full |
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| author | Justin Dixon Shunmay Yeung John Bradley Laurie Denyer Willis Susan Nayiga Clare I R Chandler Rashida Abbas Ferrand Sham Lal Miriam Kayendeke Christine Nabirye Sarah G Staedke Eleanor Elizabeth MacPherson Edward Green Salome Manyau Esnart Sanudi Alex Nkaombe Portia Mareke Kenny Sitole Coll de Lima Hutchison Chrissy Roberts |
| author_facet | Justin Dixon Shunmay Yeung John Bradley Laurie Denyer Willis Susan Nayiga Clare I R Chandler Rashida Abbas Ferrand Sham Lal Miriam Kayendeke Christine Nabirye Sarah G Staedke Eleanor Elizabeth MacPherson Edward Green Salome Manyau Esnart Sanudi Alex Nkaombe Portia Mareke Kenny Sitole Coll de Lima Hutchison Chrissy Roberts |
| author_sort | Justin Dixon |
| collection | DOAJ |
| description | Background As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.Design This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.Results The most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.Conclusions Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security. |
| format | Article |
| id | doaj-art-b0f40d557cb1465ca254307ef28bfbb1 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2021-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-b0f40d557cb1465ca254307ef28bfbb12025-08-20T02:19:11ZengBMJ Publishing GroupBMJ Global Health2059-79082021-11-0161110.1136/bmjgh-2021-006920Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and ZimbabweJustin Dixon0Shunmay Yeung1John Bradley2Laurie Denyer Willis3Susan Nayiga4Clare I R Chandler5Rashida Abbas Ferrand6Sham Lal7Miriam Kayendeke8Christine Nabirye9Sarah G Staedke10Eleanor Elizabeth MacPherson11Edward Green12Salome Manyau13Esnart Sanudi14Alex Nkaombe15Portia Mareke16Kenny Sitole17Coll de Lima Hutchison18Chrissy Roberts19Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKDepartment of Clinical Research, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKDepartment of Infection Biology, London School of Hygiene & Tropical Medicine, London, UKSchool of Social and Political Science, University of Edinburgh, Edinburgh, UKDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKBiomedical Research and Training Institute, Harare, ZimbabweDepartment of Clinical Research, London School of Hygiene and Tropical Medicine, London, UKInfectious Diseases Research Collaboration, Kampala, UgandaInfectious Diseases Research Collaboration, Kampala, UgandaInfectious Diseases Research Collaboration, Kampala, UgandaMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi1German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, MalawiMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, MalawiBiomedical Research and Training Institute, Harare, ZimbabweBiomedical Research and Training Institute, Harare, ZimbabweDepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKDepartment of Clinical Research, London School of Hygiene and Tropical Medicine, London, UKBackground As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.Design This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.Results The most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.Conclusions Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.https://gh.bmj.com/content/6/11/e006920.full |
| spellingShingle | Justin Dixon Shunmay Yeung John Bradley Laurie Denyer Willis Susan Nayiga Clare I R Chandler Rashida Abbas Ferrand Sham Lal Miriam Kayendeke Christine Nabirye Sarah G Staedke Eleanor Elizabeth MacPherson Edward Green Salome Manyau Esnart Sanudi Alex Nkaombe Portia Mareke Kenny Sitole Coll de Lima Hutchison Chrissy Roberts Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe BMJ Global Health |
| title | Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe |
| title_full | Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe |
| title_fullStr | Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe |
| title_full_unstemmed | Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe |
| title_short | Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe |
| title_sort | antibiotic stories a mixed methods multi country analysis of household antibiotic use in malawi uganda and zimbabwe |
| url | https://gh.bmj.com/content/6/11/e006920.full |
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