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Who gets what and when? Pathways of antibiotic use among people and animals in Bangladesh

谁在什么时候得到什么？

基本信息

批准号：
ES/P004563/1
负责人：
Emily Rousham
金额：
$ 25.79万
依托单位：
Loughborough University
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2017
资助国家：
英国
起止时间：
2017 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=ES%2FP004563%2F1
关键词：
Who gets what when Pathways

项目摘要

Bangladesh is a low-income country with an estimated 40% of the population living in extreme poverty. Against this background of poverty, Bangladesh is internationally recognised for achieving 'good health at low cost' through community-based interventions to improve the health of the most disadvantaged. However, antibiotic resistant bacteria are known to be present in drinking water, wastewater and in patient samples, and the availability of over-the-counter, inexpensive antibiotics means that there is a high risk of a rapid and uncontrolled spread of antibiotic resistance throughout the population. Studies in Bangladesh suggest that 63% of prescriptions for antibiotics are from practitioners with no qualifications, and antibiotics are prescribed in nearly half (44%) of all consultations in primary health care. Tackling antibiotic resistance is essential for the long term economic development and welfare of the country.In order to slow the spread of antibiotic resistance, there are complexities around balancing the need for access to health for the disadvantaged, at the same time as introducing greater regulation around the prescribing and ready availability of antibiotics. Research is required to better understand the needs of households and individuals for antibiotic treatment for their family and livestock, as well as understanding the prescribing behaviours of qualified and unqualified practitioners. We will study the pathways of antibiotic use 1) from the perspective of lay people who buy or consume antibiotics either for themselves, family members or for livestock and 2) from the perspective of the healthcare practitioners, including qualified and unqualified providers (market sellers, unqualified drug shop owners and untrained 'doctors'). Through in-depth interviews in urban and rural Bangladesh, we will gain a better understanding of behaviours around antibiotic prescribing and consumption as well as establishing whether there is an awareness of antibiotic resistance among healthcare practitioners, or their patients and clients. By interviewing practitioners across the whole range of formal and informal outlets we will assess the potential for practitioners to change prescribing practices or act as agents of change. The third aim of the study is to work with government and non-government agencies to inform the development of interventions to reduce antibiotic use. We will use the formative research from interviews to work with a professional communication team to develop culturally appropriate messages and materials for awareness-raising and communication campaigns on antibiotic resistance. These materials will be pre-tested with lay people, healthcare providers and drug shop owners to establish the acceptability of messages, who should be targeted, and what potential there is for the users and stakeholders in antimicrobial resistance to develop national awareness-raising or behaviour change interventions.The benefits of this research are to shed light on the behaviours around antibiotic treatment seeking behaviour and prescribing, the relationships between lay people and their local healthcare practitioner, motivations for seeking or selling antibiotics for people and animals; who and what the antibiotic treatment is sought for; what happens to antibiotics after prescription or purchase, and on the perceived effects of antibiotics on the resolution of symptoms. The findings will provide formative data on which to identify pathways for behaviour change.Our international partner, the International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR, B), is internationally recognised for the development and delivery of low-cost, scalable solutions to major health problems. Capacity-building in Bangladesh and establishing a leading centre for research on antimicrobial resistance are integral parts of this pump-priming initiative.

孟加拉国是一个低收入国家，估计有40%的人口生活在极端贫困中。在这种贫困背景下，孟加拉国通过以社区为基础的干预措施，改善最弱势群体的健康状况，实现了“低成本的良好健康”，得到了国际公认。然而，已知在饮用水、废水和患者样本中存在抗生素耐药细菌，而且廉价的非处方抗生素的可用性意味着抗生素耐药性在人群中迅速和不受控制地蔓延的风险很高。孟加拉国的研究表明，63%的抗生素处方来自没有资格的开业医生，在初级卫生保健的所有咨询中，有近一半（44%）开具了抗生素处方。应对抗生素耐药性对国家的长期经济发展和福利至关重要。为了减缓抗生素耐药性的传播，在平衡弱势群体获得卫生保健的需要的同时，在抗生素的处方和现成可得性方面引入更大的监管，这是很复杂的。需要进行研究，以便更好地了解家庭和个人对其家庭和牲畜抗生素治疗的需求，以及了解合格和不合格从业人员的处方行为。我们将研究抗生素使用的途径1)从为自己、家庭成员或牲畜购买或使用抗生素的非专业人士的角度出发，2)从医疗从业人员的角度出发，包括合格和不合格的提供者（市场卖家、不合格的药店老板和未经培训的“医生”）。通过在孟加拉国城市和农村进行深入访谈，我们将更好地了解有关抗生素处方和消费的行为，并确定卫生保健从业人员或其患者和客户是否意识到抗生素耐药性。通过采访所有正式和非正式渠道的从业者，我们将评估从业者改变处方实践或作为变革推动者的潜力。这项研究的第三个目标是与政府和非政府机构合作，为减少抗生素使用的干预措施的制定提供信息。我们将利用访谈的形成性研究，与专业沟通团队合作，为提高对抗生素耐药性的认识和沟通活动制定文化上适当的信息和材料。这些材料将在非专业人员、卫生保健提供者和药店老板中进行预先测试，以确定信息的可接受性，应针对哪些人，以及用户和利益攸关方在抗菌素耐药性方面发展国家提高认识或行为改变干预措施的潜力。这项研究的好处是阐明了抗生素治疗寻求行为和处方的行为，非专业人员与当地医疗保健从业者之间的关系，为人和动物寻求或销售抗生素的动机；寻求抗生素治疗的对象和目的；处方或购买抗生素后发生的情况，以及抗生素对症状解决的感知效果。这些发现将为确定行为改变的途径提供形成性数据。我们的国际合作伙伴孟加拉国国际腹泻病研究中心（ICDDR， B）在开发和提供低成本、可扩展的重大卫生问题解决方案方面得到国际认可。孟加拉国的能力建设和建立一个主要的抗微生物药物耐药性研究中心是这一泵启动倡议的组成部分。