Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe.
Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe.
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DOI：
10.1136/bmjgh-2021-006920
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发表时间：
2021-11
影响因子：
8.1
通讯作者：
Chandler CIR
中科院分区：
文献类型：
--
作者：
Dixon J;MacPherson EE;Nayiga S;Manyau S;Nabirye C;Kayendeke M;Sanudi E;Nkaombe A;Mareke P;Sitole K;de Lima Hutchison C;Bradley J;Yeung S;Ferrand RA;Lal S;Roberts C;Green E;Denyer Willis L;Staedke SG;Chandler CIR
随着对现有抗生素耐药感染流行的担忧增加，人们已将注意力转向在正规医疗机构内外使用这些药物。除了正式环境之外，人们所知道的关于使用的大部分信息都是通过基于调查的研究来了解的。到目前为止，很少有研究使用比较、混合的方法来呈现环境内和环境之间的可见使用模式，以及塑造这些模式的更广泛的背景点。本文分析了2018至2020年间津巴布韦、马拉维和乌干达农村和城市地区对抗生素使用的混合方法人类学研究的结果。所有人都使用了一种“药袋”调查工具，以获取1811个家庭使用抗生素的频率和类型。然后，我们在居民环境中与卫生服务提供者和关键利益攸关方进行了观察和采访，以更好地了解使用最多的抗生素背后的故事。自我报告的最常使用的抗生素是阿莫西林、复方新诺明和甲硝唑。它们使用背后的故事因环境而异，反映了卫生系统和抗生素供应配置的不同。与此同时，这些故事揭示了当代全球卫生规划的交叉特征和遗漏，这些规划塑造了国家和地方一级抗生素(过度)使用的轮廓。我们的发现挑战了管理框架对抗生素最终用户实践的主要关注。我们建议，未来的干预措施可以考虑将系统--而不是个人--作为抗生素的管理者，减少对这些药物的依赖，以解决不公平、生产率和安全等其他问题。
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. 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. 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. 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.
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影响因子：
8.1
作者：
Haenssgen, Marco J.;Charoenboon, Nutcha;Ariana, Proochista
通讯作者：
Ariana, Proochista
影响因子：
4
作者：
Chandler, Clare I. R.
通讯作者：
Chandler, Clare I. R.
影响因子：
2.8
作者：
Abiiro GA;Mbera GB;De Allegri M
通讯作者：
De Allegri M
DOI：
10.1016/s2214-109x(21)00024-3
发表时间：
2021-05
期刊：
The Lancet. Global health
影响因子：
--
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
通讯作者：
Wertheim HFL
影响因子：
3.7
作者：
Ewing, Victoria L.;Tolhurst, Rachel;Lalloo, David G.
通讯作者：
Lalloo, David G.