Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach.
Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach.
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DOI：
10.1016/s2214-109x(21)00024-3
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发表时间：
2021-05
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影响因子：
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通讯作者：
Wertheim HFL
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作者：
Do NTT;Vu HTL;Nguyen CTK;Punpuing S;Khan WA;Gyapong M;Asante KP;Munguambe K;Gómez-Olivé FX;John-Langba J;Tran TK;Sunpuwan M;Sevene E;Nguyen HH;Ho PD;Matin MA;Ahmed S;Karim MM;Cambaco O;Afari-Asiedu S;Boamah-Kaali E;Abdulai MA;Williams J;Asiamah S;Amankwah G;Agyekum MP;Wagner F;Ariana P;Sigauque B;Tollman S;van Doorn HR;Sankoh O;Kinsman J;Wertheim HFL
抗生素滥用在低收入和中等收入国家（LMIC）很常见，这种做法是抗生素耐药性的驱动因素。我们比较了中低收入国家各社区基于社区的抗生素获取和使用实践，以确定干预措施的具体目标，以改善抗生素使用实践。我们对非洲（莫桑比克，加纳和南非）和亚洲（孟加拉国，越南和泰国）的六个LMIC的抗生素获取和使用进行了定量和定性评估，为期2年半（2016年7月1日至2018年12月31日）。我们通过供应商地图、客户离职访谈和家庭调查对社区抗生素的获取和使用进行了定量评估。这些定量评估与定性药物供应商和消费者的访谈和讨论进行了三角分析。越南和孟加拉国拥有最大比例的非许可抗生素配药点。对于轻度疾病，药店是大多数国家寻求抗生素时最常见的接触点，但南非和莫桑比克除外，那里的公共设施最常见。使用抗生素的自我用药在越南（55.2%的抗生素是在没有处方的情况下分发的）、孟加拉国（45.7%）和加纳（36.1%）很普遍，但在莫桑比克（8.0%）、南非（1.2%）和泰国（3.9%）较少。人们认为，与通过医疗机构获取药物相比，自我用药耗时更少、更便宜，而且总体上更方便。决定在哪里寻求治疗的因素通常涉及相关政策，对供应商和药物的信任，疾病严重程度以及抗生素是否用于儿童。在非洲和亚洲，人们对如何识别口服抗生素感到困惑。研究揭示了收入、政策框架和文化规范不同的国家之间的背景复杂性和差异。这些背景差异使得单一战略不足以解决问题，而是需要根据具体情况制定综合干预方案，以改善中低收入国家的抗生素使用，作为全球抗击抗生素耐药性努力的一部分。Wellcome Trust和Volkswagen Foundation。
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. 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. 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. 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. Wellcome Trust and Volkswagen Foundation.