Disparity in socio-economic status explains the pattern of self-medication of antibiotics in India: understanding from game-theoretic perspective

Impact of socioeconomic determinants on outcomes of eight select conditions for which self-care is a modality for prevention and treatment: a scoping review

We conducted a scoping review of peer-reviewed literature published between January 1, 1990 and October 31, 2021, to identify socioeconomic determinants that contribute to higher burden and adverse outcomes in diseases for which self-care is an important modality of treatment and prevention. We identified these diseases using over-the-counter medicines sales data sourced from IQVIA. We searched Ovid Medline, PubMed, and EMBASE databases for articles published in English using inclusion/exclusion criteria. We analyzed articles covering 42 diseases that qualified as cardiovascular disorders (219 studies including ischemic heart disease, myocardial infarction, stroke, and related risk factors such as hypertension, dyslipidemia and atrial fibrillation), nutritional disorders (66 studies including malnutrition which encompasses undernutrition and micronutrient deficiencies, and anemia), digestive disorders (40 studies including gastroesophageal reflux disorder, inflammatory bowel disease, and dyspepsia), allergy disorders (40 studies including asthma and allergic rhinitis), pain disorders (14 studies including lower back pain, knee pain, generalized musculoskeletal pain and headaches), dermatological disorders (23 studies including atopic dermatitis [eczema], occupational dermatosis, and facial dermatitis), respiratory disorders (11 studies including chronic cough, pneumonia, chronic bronchitis, wheezing, and influenza), and gynecological disorders (29 studies including bacterial vaginosis and trichomoniasis vaginosis). We found that lifestyle factors were the commonly reported risk factors, and residential segregation, education, and income were the commonly reported socioeconomic determinants. A closer analysis of income within each disorder revealed that it is more often associated with health conditions that are self-limiting. Although we did not find any discernible relationship between the commonly reported socioeconomic factors and the prevalence of self-medication for the health conditions considered, income plays an important role in the burden and outcomes of conditions that require more self-care compared to those that require less self-care.

Trends and geographical variations in outpatient antimicrobial consumption in Ireland in relation to socio-economic deprivation

Background

Different factors have been associated with changes in antimicrobial consumption rates in Ireland, however the relationship between socio-economic deprivation and antimicrobial consumption has not been explored. The presented ecological analysis explores the temporal and geographical variation in outpatient antimicrobial consumption and socio-economic deprivation in Ireland from January 2015 to March 2022.

Method

Deprivation index (DI) was used as a socio-economic proxy. A multilevel mixed model was applied to explore temporal variation and analyse the longitudinal antimicrobial consumption (DID) in relation to DI. Furthermore, maps were generated based on antimicrobial consumption rates, and spatial autocorrelation analyses were carried out to study geographical variation in antimicrobial consumption rates.

Results

The antimicrobial consumption rates per month varied from 26.2 DID (January 2015) to 22.1 DID (March 2022) showing an overall reduction of 16 %. Overall, total antimicrobial consumption in the multilevel model showed a consistent correlation with higher DI score (6.6 (95%CI 3.9 to 9.3)), and winter season (3.6 (95%CI 3.2 to 3.9)). In contrast, before COVID-19 showed significant lower antimicrobial consumption rates compared to during COVID-19 (-4.0 (95%CI -4.7 to -3.23)). No consistent trends were observed for geographical variation between areas.

Conclusion

Antimicrobial consumption rates decreased from 2015 to 2021 in Ireland. No geographical patterns were observed in antimicrobial consumption rates but associations between deprivation and antimicrobial consumption rates were observed.

Systems thinking based approaches to engage with health inequities shaping Antimicrobial Resistance in low and lower-middle-income countries

This paper argues for 'systems thinking' as a conceptual framework to address antimicrobial resistance, especially focusing on the context of low and lower middle-income countries (LLMICs), which are plagued with health inequities that magnify the AMR threat. Systems thinking provides two avenues to enhance these mitigation efforts: i) it helps go beyond a purely biomedical approach to incorporate considerations of the social and informational; ii) particularly relevant as is it helps to understand the role of health inequities in shaping AMR related prevention and care processes.

Use of antibiotics in poultry and poultry farmers- a cross-sectional survey in Pakistan

Background

Antimicrobial resistance (AMR) which has been ascribed to be due to community carriage of antibiotic-resistant bacteria is highly prevalent in the WHO South-East Asia region. One of the major reasons for this is the misuse of antibiotics in animal farming practices and at the community level, which threatens both human and animal health. However, this problem of antibiotic misuse in poultry farms and in respective farmers is not well studied in countries like Pakistan.

Methods

We conducted a cross-sectional study in rural Punjab to explore the current practices of antibiotic use in poultry and poultry farmers, associated factors, their healthcare-seeking behavior and biosecurity practices.

Results

In the context of antibiotic use for poultry, 60% comprised of Colistin sulfate and Amoxicillin trihydrate whereas Colistin is considered as the last resort antibiotic. In addition, the significant consumption of antibiotics in poultry farms (60%) and poultry farmers (50%) was without prescription by either human health physicians or veterinarians. Most of the farms (85%) had no wastewater drainage system, which resulted in the direct shedding of poultry waste and antibiotic residue into the surrounding environment. The lack of farmers' education, professional farm training and farming experience were the most significant factors associated with antibiotic use and knowledge of AMR.

Conclusion

Our study findings show that it is necessary for an integrated AMR policy with the inclusion of all poultry farmers to be educated, a mass awareness program to be undertaken and that strict antibiotic usage guidelines be available to them. Such initiatives are also important to ensure food safety and farm biosecurity practices.

Health-seeking behaviours of young women with sexually transmitted infections: Analysis of the 2014 Ghana Demographic and Health Survey

BACKGROUND

Young people are at a disproportionately higher risk for sexually transmitted infections (STIs) due to biological factors, low awareness and limited access to sexual and reproductive health information and services. Untreated STIs can lead to major complications, including HIV, congenital infections, infertility, permanent disability and mortality. This study aimed to identify the salient factors associated with health-seeking behaviours of young women with a history of STIs in Ghana.

METHODS

We analysed data from the 2014 Ghana Demographic and Health Survey. In all, we analysed data from a weighted sample of 742 young women with a history of STIs. At the univariate level, frequencies and percentages were computed, while Chi-square analysis was computed at the bivariate level. Both crude and adjusted odds ratios were computed at the multivariable level using binary logistic regression.

RESULTS

The findings showed that the majority (72%) of the participants sought treatment for STIs. Among the participants who sought treatment for STIs (n = 532), 26% sought treatment at a public hospital/polyclinic, 34% sought treatment at a chemical/drug store and 10% self-medicated. Seeking treatment for STIs was significantly associated with older age (20-24yrs), and higher socioeconomic and educational status.

CONCLUSION

This study demonstrated that majority of the young women sought treatment for STIs. Seeking treatment for STIs was influenced by socio-demographic factors. These findings have implications for sexual and reproductive health policies and interventions in Ghana.

An evolutionary game model of individual choices and bed net use: elucidating key aspect in malaria elimination strategies

Insecticide-treated net (ITN) is the most applicable and cost-effective malaria intervention measure in sub-Saharan Africa and elsewhere. Although ITNs have been widely distributed to malaria-endemic regions in the past, their success has been threatened by misuses (in fishing, agriculture etc.) and decay in ITN efficacy. Decision-making in using the ITNs depends on multiple coevolving factors: malaria prevalence, mosquito density, ITN availability and its efficacy, and other socio-economic determinants. While ITN misuse increases as the efficacy of ITNs declines, high efficacy also impedes proper use due to free-riding. This irrational usage leads to increased malaria prevalence, thereby worsening malaria control efforts. It also remains unclear if the optimum ITN use for malaria elimination can be achieved under such an adaptive social learning process. Here, we incorporate evolutionary game theory into a disease transmission model to demonstrate these behavioural interactions and their impact on malaria prevalence. We show that social optimum usage is a function of transmission potential, ITN efficacy and mosquito demography. Under specific parameter regimes, our model exhibits patterns of ITN usage similar to observed data from parts of Africa. Our study suggests that the provision of financial incentives as prompt feedback to improper ITN use can reduce misuse and contribute positively towards malaria elimination efforts in Africa and elsewhere.

Disparity in socio-economic status explains the pattern of self-medication of antibiotics in India: understanding from game-theoretic perspective

The emergence of antimicrobial resistance has raised great concern for public health in many lower-income countries including India. Socio-economic determinants like poverty, health expenditure and awareness accelerate this emergence by influencing individuals' attitudes and healthcare practices such as self-medication. This self-medication practice is highly prevalent in many countries, where antibiotics are available without prescriptions. Thus, complex dynamics of drug- resistance driven by economy, human behaviour, and disease epidemiology poses a serious threat to the community, which has been less emphasized in prior studies. Here, we formulate a game-theoretic model of human choices in self-medication integrating economic growth and disease transmission processes. We show that this adaptive behaviour emerges spontaneously in the population through a self-reinforcing process and continual feedback from the economy, resulting in the emergence of resistance as externalities of human choice under resource constraints situations. We identify that the disparity between social-optimum and individual interest in self-medication is primarily driven by the effectiveness of treatment, health awareness and public health interventions. Frequent multiple-peaks of resistant strains are also observed when individuals imitate others more readily and self-medication is more likely. Our model exemplifies that timely public health intervention for financial risk protection, and antibiotic stewardship policies can improve the epidemiological situation and prevent economic collapse.