Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India
Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India
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DOI：
10.1016/s0277-9536(99)00380-9
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发表时间：
2000-03-01
影响因子：
5.4
通讯作者：
Nichter, M
中科院分区：
文献类型：
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作者：
Saradamma, RD;Higginbotham, N;Nichter, M
我们调查了印度南部喀拉拉邦城郊地区自行使用抗生素的情况以及影响这种做法的因素。首先，在特里凡得琅附近的一个初级卫生中心地区随机抽样调查了 400 个家庭。我们发现 69.3% (95% CI = 64.8-73.8) 的家庭在两周的召回期内至少有一个人使用某种药品；抗生素几乎占所消耗药物的 11%。接下来，我们从该地区 12 家私营药店中的 11 家抽样的 405 名抗生素购买者中收集了基于药房的访谈和观察数据。这 405 名顾客中有 73 名没有处方就购买了抗生素（18%；95% CI = 14.3-21.7）。通过结合家庭调查和药房观察，我们估计在喀拉拉邦，近一半的 1% 人口（0.41%；95% CI = 0.24-1.16），即每 1000 人中有 4 人在任何两周内使用抗生素进行自我药疗。我们的数据显示，最不可能遵循这种做法的人来自较高收入的家庭，拥有更多的教育和更高的职业地位，并享受医疗保险福利。相反，逻辑回归分析表明，购买没有处方的抗生素的风险与中等或以下教育水平、看病费用昂贵以及对医生满意度低的看法有关。喀拉拉邦人的自我药疗模式可以从社会、文化、历史和经济的角度进行广泛的解释。建议从以下几个方面着手解决抗生素滥用问题：药品从业者、供应商和营销人员之间，以及药品消费者本身。 (C) 2000 Elsevier Science Ltd. 保留所有权利。
We investigated the magnitude of self-medication with antibiotics in a peri-urban area of Southern Kerala State, India and factors influencing this practice. First, a random sample of 400 households was surveyed in one primary health centre area near Trivandrum. We found 69.3% (95% CI = 64.8-73.8) of households had at least one person using a pharmaceutical product during the two-week recall period; antibiotics formed almost 11% of the medicines consumed. Next, pharmacy based interview and observation data were collected from 405 antibiotic purchasers sampled from 11 out of the 12 private pharmacies in the area. Seventy-three of these 405 customers purchased antibiotics without a prescription (18%; 95% CI = 14.3-21.7). By combining the household survey and pharmacy observations, we estimate that almost half of 1% (0.41%; 95% CI = 0.24-1.16) of the population, or four people per 1000, is engaged in self-medication using antibiotics in Kerala in any two-week period. Our data show that people least likely to follow this practice are from higher:her income families, having more education and higher status occupations and receiving the benefits of medical insurance. Conversely, logistic regression analysis indicated that risk of buying antibiotics without a script was associated with education at secondary level or below, the perception that it is expensive to consult a doctor and low satisfaction with medical practitioners. Keralites' self-medication patterns are interpreted broadly using social, cultural, historical and economic perspectives. Solutions to the problem of antibiotic misuse are suggested, proceeding on several fronts: among practitioners, suppliers and marketeers of medicines, and among the population of pharmaceutical consumers themselves. (C) 2000 Elsevier Science Ltd. All rights reserved.