What contributes to inappropriate antibiotic dispensing among qualified and unqualified healthcare providers in Bangladesh? A qualitative study (original) (raw)
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What influences antibiotic sales in rural Bangladesh? A drug dispensers’ perspective
Journal of Pharmaceutical Policy and Practice, 2020
BackgroundAntibiotic resistance poses a great threat to global health, especially in low- and middle-income countries with a high infectious disease burden and limited resources. In spite of regulations, antibiotics are sold in many settings as non-prescription medicines, resulting in inappropriate use and resistance.ObjectiveThis study aimed to investigate the current status of access and use of antibiotics in rural Bangladesh, by exploring the perspectives and sales practices of antibiotic drug dispensers.MethodsWe used a mixed methods approach (qualitative and quantitative). We mapped and characterized antibiotic purchasing and dispensing sites in the Matlab Health and Demographic Surveillance System catchment area. Furthermore, we investigated the volume of provision of systemic antibiotics in 10 drug outlets. We held 16 in-depth interviews with randomly selected antibiotics dispensers. Interviews explored factors associated with antibiotic selling. Responses were transcribed, c...
Journal of Pharmaceutical Policy and Practice, 2021
Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence. Methods We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, an...
INDIAN RESEARCH JOURNAL OF PHARMACY AND SCIENCE, 2020
Antimicrobial resistance and irrational use of antibiotics are two concerning issues in the present world especially in lower-and-middle income countries. Bangladesh is one of the worst untrained drug store salespersons are involves with dispensing drug. This aimed to understand the differential perception of trained and untrained pharmacists on role of irrational antibiotics use in emergence of antimicrobial resistance. A qualitative study was designed with in in Dhaka. The participants demonstrated a significant difference in knowledge, awareness, attitude and practice regarding antimicrobial resistance and dispensing practice of antibiotics along with diff and professional training. Grade C and untrained pharmacists working in the local small drug shops were found reluctant and unaware about antimicrobial resistance and rational use of antibiotics influenced by various factors li workplace environment, client demands, marketing by pharmaceutical companies and ignorance about the existing. However, grade A and B pharmacists were found working in bigger corporate and hospital pharmacies confined to managing and dispensing drugs with limited decision multidisciplinary approach with a strong regulatory body is required to control the situation in Bangladesh.
Clinical Infection and Immunity, 2017
Background: Bangladesh is not exempted from the grave dangers of antibiotic resistance and the other problems arising from its misuse. The prevalent aberrations in the practice of using antibiotics in Bangladesh include self-medication, prescription by quacks and nonphysicians, non-registered "village doctors", irrational prescription, etc. The resultant rises in resistant strains of several bacteria are also seen, and probably much is yet unseen and unnoticed. Methods: This observational descriptive study attempted to describe the actual scenario. A total of 155 patients (60% male and 40% female) were included in this study with consecutive purposive sampling who took antibiotics prior to coming to the primary health care facility. Results: Most common problems were common cold symptoms, only fever with or without body ache but without any other specific features and gastrointestinal upset (constipation/diarrhea/abdominal pain) with/without fever. Most (67.9%) of the patients also had taken some antibiotics in the past year for similar reasons, most common of which is "mixed reasons", followed by common cold. Most of the time, the antibiotic was prescribed by drug seller at medicine store (89, 57.4%), followed by quack/village doctor (29, 18.7%). In mere 14.2% of cases, the antibiotic was prescribed by registered Bachelor of Medicine and Bachelor of Surgery (MBBS) doctors (22, 14.2%). Most have no clear idea about the definition of a doctor, and most (137, 89%) consider non-medical as doctors and think them to be qualified enough to prescribe antibiotic. About 80% of the respondents had no idea or flawed idea about importance of regularity in taking antibiotics, or completion of the course or the concept and threat of antibiotic resistance. Most commonly taken antibiotic was ciprofloxacin (38, 24.7%), followed by cefixime (30, 19.5%), and azithromycin (26, 16.9%). Patients had already spent from a minimum of 12 Bangladeshi Taka (BDT) to a maximum of 675 BDT, average being 166.61 BDT and a median of 117 BDT, before they came for consultation. So the economic impact is also not negligible. Conclusion: This study shows that gross misuse of antibiotics is being done in Bangladesh. Most of the responsibilities of gross misuse belong to two parties, non-physicians, illegal medical practitioners, quacks, and lack of awareness among the patients.
BMJ Global Health, 2021
IntroductionOver-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in Nepal, its drivers and implications for policy.MethodsData were collected in and around three tertiary hospitals in eastern, western and central Nepal. Using pre-defined guides, a mix of semi-structured interviews and focus group discussions were conducted with dispensers at drug stores, patients attending a hospital and clinicians. Interviews were audio-recorded, translated and transcribed into English and coded using a combination of an inductive and deductive approach.ResultsDrug shops were the primary location where patients engaged with health services. Interactions were brief and transactional: symptoms were described or explicit requests for specific medicine made, and money was exchanged. There were economic incentives for clients and drug st...
Pathways of antibiotic use in Bangladesh: Qualitative protocol for the PAUSE study
BMJ Open, 2019
Introduction Global actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding of the drivers of antibiotic use from the perspective of providers and consumers. In Bangladesh, there is limited research on household decision-making and healthcare seeking in relation to antibiotic use and consumption for humans and livestock. Knowledge is similarly lacking on factors influencing the supply and demand for antibiotics among qualified and unqualified healthcare providers. The aim of this study is to conduct integrated research on household decision-making for healthcare and antibiotic use, as well as the awareness, behaviours and priorities of healthcare providers and sellers of antibiotics to translate into policy development and implementation. Methods and analysis In-depth interviews will be conducted with (1) household members responsible for decision-making about illness and antibiotic use for family and livestock; (2) qualified and unqualified private and government healthcare providers in human and animal medicine and (3) stakeholders and policy-makers as key informants on the development and implementation of policy around AMR. Participant observation within retail drug shops will also be carried out. Qualitative methods will include a thematic framework analysis. A holistic approach to understanding who makes decisions on the sale and use of antibiotics, and what drives healthcare seeking in Bangladesh will enable identification of routes to behavioural change and the development of effective interventions to reduce the health risks of AMR. Ethics and dissemination Approval for the study has been obtained from the Institutional Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh following review by the Research and Ethics Committees (PR-16100) and from Loughborough University (R17-P081). Information about the study will be provided in a participant information letter in Bangla (to be read verbally and given in writing to participants). A written informed consent form in Bangla will be obtained and participants will be informed of their right to withdraw from the study. Dissemination will take place through a 1 day dissemination workshop with key stakeholders in public health and policy, practitioners and scientists in Bangladesh, and through international conference presentations and peer-review publications. Anonymised transcripts of interviews will be made available through open access via institutional data repositories after an embargo period.
Antibiotics, 2022
Globally, Antibiotic resistance is a major public health concern, with antibiotic use contributing significantly. Targeting informal healthcare providers (IHCPs) is important to achieve universal health coverage and effective antibiotic stewardship in resource-constrained settings. We, therefore, aimed to analyse the internal and external drivers that influence IHCPs’ prescribing behaviour for common illnesses in children under five, with an emphasis on antibiotic use in rural areas of India. A total of 48 IHCPs participated in focus group discussions. Thematic framework analysis with an inductive approach was used, and findings were collated in the theoretical framework based on knowledge, attitude, and practice model which depicted that the decisions made by IHCPs while prescribing antibiotics are complex and influenced by a variety of external and internal drivers. IHCPs’ internal drivers included the misconception that it is impossible to treat a patient without antibiotics and ...
Aims: Antibiotic resistance is one of the widely recognized public health challenges in Bangladesh. The present study was aimed to analyze the current status of irrational use of antibiotics in rural Bangladesh and to explore the views from both physicians’ and patients’ perspective. Study Design: Population based survey. Place and Duration of Study: The survey was conducted among 6,000 patients and 580 physicians in the rural areas of Dhaka and Rajshahi divisions of Bangladesh from July 2012 to December 2012. Methodology: The survey followed a face-to-face interview protocol. 24 Upazila Health Complexes and 112 Union Health Centers of Dhaka and Rajshahi divisions were conveniently surveyed by trained volunteer interviewers. Two separate survey questionnaires were developed for physician and patient survey. Results: From the physician survey it was found that significantly more doctors prescribe antibiotics in suspected infections (P<.0001). Around forty-four (44.1) percent docto...
Patient Preference and Adherence, 2022
The COVID-19 pandemic is thought to have led to increased "inappropriate" or "unjustified" seeking and consumption of antibiotics by individuals in the community. However, little reference has been made to antibiotic seeking and using behaviors from the perspectives of users in Bangladesh during this health crisis. Purpose: This study seeks to document how antibiotic medicines are sought and used during a complex health crisis, and, within different contexts, what are the nuanced reasons why patients may utilize these medicines sub-optimally. Methods: We used an exploratory, qualitative design. Forty semi-structured telephone interviews were conducted with people diagnosed with COVID-19 (n=20), who had symptoms suggestive of COVID-19 (n=20), and who had received care at home in two cities between May and June 2021 in Bangladesh. In this study, an inductive thematic analysis was performed. Results: The analysis highlighted the interlinked relationships of antibiotic seeking and consumption behaviors with the diversity of information disseminated during a health crisis. Antibiotic-seeking behaviors are related to previous experience of use, perceived severity of illness, perceived vulnerability, risk of infection, management of an "unknown" illness and anxiety, distrust of expert advice, and intrinsic agency on antimicrobial resistance (AMR). Suboptimal adherence, such as modifying treatment regimes and using medication prescribed for others, were found to be part of care strategies used when proven therapeutics were unavailable to treat COVID-19. Early cessation of therapy was found to be a rational practice to avoid side effects and unknown risks. Conclusion: Based on the results, we highly recommend the take up of a pandemic specific antimicrobial stewardship (AMS) program in the community. To deliver better outcomes of AMS, incorporating users' perspectives could be a critical strategy. Therefore, a co-produced AMS intervention that is appropriate for a specific cultural context is an essential requirement to reduce the overuse of antibiotics during the COVID-19 pandemic and beyond.