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BMJ Open. 2019 Aug 20;9(8):e028224. doi: 10.1136/bmjopen-2018-028224.

Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia.

Author information

1
Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK marco.haenssgen@warwick.ac.uk.
2
School of Cross Faculty Studies, University of Warwick, Coventry, UK.
3
Green Templeton College, Oxford, United Kingdom.
4
Said Business School, University of Oxford, Oxford, UK.
5
Mathematical/Economic Modelling, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
6
School of Agriculture, Policy and Development, University of Reading, Reading, UK.
7
Leverhulme Centre for Integrative Research on Agriculture and Health, London, London, UK.
8
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Vientiane, Laos.
9
Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos.
10
Institute of Research and Education Development, University of Health Sciences, Vientiane, Laos.
11
Oxford Martin School, University of Oxford, Oxford, UK.
12
Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK.
13
Medical Microbiology Department, Radbuod University, Nijmegen, The Netherlands.
14
Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam.
15
National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
16
Department of Peace and Conflict Studies, University for Peace, Ciudad Colon, Costa Rica.
17
Department of Political Science, Ateneo de Manila University, Quezon City, Philippines.
18
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
19
Chiangrai Clinical Research Unit, Chiangrai Regional Hospital, Chiang Rai, Thailand.
20
Primary Care Department, Chiangrai Regional Hospital, Chiang Rai, Thailand.
21
Microbiology, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
22
UCL Anthropology, University College London, London, UK.
23
Institut de recherche pour le développement, Vientiane, Laos.

Abstract

INTRODUCTION:

Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research.

OBJECTIVE:

To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers.

DESIGN:

Observational study: cross-sectional rural health behaviour survey, representative of the population level.

SETTING:

General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018.

PARTICIPANTS:

2141 adult members (≥18 years) of the general rural population, representing 712 000 villagers.

OUTCOME MEASURES:

Antibiotic-related knowledge, attitudes and practices across sites and healthcare access channels.

FINDINGS:

Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like 'anti-inflammatory medicine' in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and 'ampi' in Salavan (75.6%; 95% CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI 0.01 to 0.23) and 0.53 in Salavan (95% CI 0.16 to 0.90).

CONCLUSIONS:

Locally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming 'knowledge deficits' alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards 'AMR-sensitive interventions' that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns.

TRIAL REGISTRATION NUMBER:

Clinicaltrials.gov identifier NCT03241316.

KEYWORDS:

Lao pdr; Thailand; antibiotics; antimicrobial resistance; awareness; development studies; interdisciplinary research; social sciences; survey; treatment-seeking behaviour

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