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Ahmed I, King R, Akter S, Akter R, Aggarwal VR. Determinants of antibiotic self-medication: A systematic review and meta-analysis. Res Social Adm Pharm 2023; 19:1007-1017. [PMID: 37019706 DOI: 10.1016/j.sapharm.2023.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined. OBJECTIVES To identify patient and health system-related determinants of antibiotic self-medication among the public. METHODS A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis. RESULTS Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication. CONCLUSIONS Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.
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Kounnavong S, Yan W, Sihavong A, Sychareun V, Eriksen J, Hanson C, Chaleunvong K, Keohavong B, Vongsouvath M, Mayxay M, Brauner A, Stålsby Lundborg C, Machowska A. Antibiotic knowledge, attitudes and reported practice during pregnancy and six months after birth: a follow- up study in Lao PDR. BMC Pregnancy Childbirth 2022; 22:701. [PMID: 36096811 PMCID: PMC9465860 DOI: 10.1186/s12884-022-05018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Antibiotics are important medicines to prevent maternal and child morbidity and mortality. Women’s knowledge and attitudes towards antibiotic use influence their practice. When they become mothers, this may be mirrored in the use of antibiotics for their newborn children. The current study aimed to assess knowledge, attitudes, and reported practice of pregnant women regarding antibiotic use and antibiotic resistance as well as their approach towards antibiotic use for their newborn babies. Methods This was a follow-up study with data collected via structured interviews between September 2019 and August 2020 in Feuang (rural) and Vangvieng (urban) districts in Vientiane province, Lao PDR. We identified and invited all women attending antenatal care in their third trimester of pregnancy in the selected areas. Using a structured questionnaire at third trimester of pregnancy we captured data on knowledge regarding antibiotic use and resistance. We collected information on attitudes and reported practice at two time points: (i) at third trimester of pregnancy and (ii) 6 months after birth. Univariate analysis and frequency distributions were used to study pattern of responses. Chi-square and Mann-Whitney tests were used to compare categorical and continuous variables respectively. P value < 0.05 was considered statistically significant. Results We surveyed 539 women with a mean age of 25 years. Two oral antibiotics, i) ampicillin and ii) amoxicillin were correctly identified by 68 and 47% of participants respectively. Only 24% of women (19% in Feuang and 29% in Vangvieng) answered correctly that antibiotics are effective against bacterial infections. The most prevalent response was “I don’t know” suggesting the questions were challenging. Significantly less women would use antibiotics from a previous illness for their child than for themselves (16% vs 29%), however they would be more willing to use antibiotics for their baby even in case of mild symptoms (29% vs 17% while pregnant). The majority of antibiotics were prescribed by healthcare providers and 46% of children with the common cold received antibiotics. Conclusions Women’s knowledge was sub-optimal, still, they manifested appropriate attitudes towards antibiotic use during pregnancy and for their child. Nearly half of children received antibiotics for the common cold. There is a need for context adapted programs aiming at improving women’s knowledge, as well as healthcare providers, emphasising rational antibiotic prescribing during pregnancy and for children.
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Affiliation(s)
- Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Weirong Yan
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane, Lao PDR
| | | | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Institute of Research and Education Development, UHS, Ministry of Health, Vientiane, Lao PDR.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Sychareun V, Phounsavath P, Sihavong A, Kounnavong S, Chaleunvong K, Machowska A, Keohavong B, Mayxay M, Eriksen J, Hanson C, Vongsouvath M, Brauner A, Durham J, Stålsby Lundborg C. Perceptions and reported practices of pregnant women and mothers of children under two years of age regarding antibiotic use and resistance in Vientiane province, Lao PDR: a qualitative study. BMC Pregnancy Childbirth 2022; 22:569. [PMID: 35842597 PMCID: PMC9287906 DOI: 10.1186/s12884-022-04894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding pregnant women and mothers' perceptions towards antibiotic use and resistance is essential for appropriate antibiotic use and limiting antibiotic resistance. This study aimed to explore perceptions and reported practices of pregnant women and mothers with children under two years of age regarding correct antibiotic use and antibiotic resistance in Vientiane Province, Lao PDR. METHODS The study employed an exploratory qualitative research design using focus groups discussions (FGDs). Participants were purposively selected based on: being pregnant at third trimester and attending antenatal care and mothers with children under two years of age, attending the health facility for postpartum visit /vaccinations. Six focus group discussions were conducted in September 2019 with a total of 55 women. The FGDs were transcribed verbatim, data were analyzed first by coding then categorizing the data as we looked for patterns and themes by using the qualitative content analysis. RESULTS Most participants had some understanding of antibiotics but wrongly believed antibiotics can be used to treat viral disease. Over half of the participants had heard the term "antibiotic resistance", but often believed it was their bodies, not the bacteria that developed antibiotic resistance. During pregnancy and for their infants, women preferred to use antibiotics only when prescribed by a doctor. Outside of pregnancy however, consuming antibiotics without a prescription was commonly reported. Participants wanted more information about the indications for antibiotic use and antibiotic resistance. CONCLUSIONS More effort is required to increase the level of understanding, and practice of mothers to promote optimal antibiotic use. Mothers' desire to learn more, and their fundamental concern for their children, can be used to promote appropriate antibiotic use. Awareness raising should be complemented by efforts to address other determinants of inappropriate antibiotic use, including educating healthcare workers, and pharmacists and addressing health service determinants that contribute to inappropriate antibiotic use.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane, Lao PDR
| | | | - Amphoy Sihavong
- Vientiane Capital Health Department, MOH, Vientiane, Lao PDR
| | - Sengchanh Kounnavong
- Lao Tropical & Public Health Institute, Ministry of Health (MOH), Vientiane, Lao PDR
| | | | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, MOH, Vientiane, Lao PDR.,Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology. Laboratory, Mahosot Hospital, MOH, Vientiane, Lao PDR.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. .,Department of infectious diseases, Stockholm South General Hospital, Stockholm, Sweden.
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology. Laboratory, Mahosot Hospital, MOH, Vientiane, Lao PDR
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Jo Durham
- Faculty of Health, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Chansamouth V, Mayxay M, Dance DA, Roberts T, Phetsouvanh R, Vannachone B, Vongsouvath M, Davong V, Inthavong P, Khounsy S, Keohavong B, Keoluangkhot V, Choumlivong K, Day NP, Turner P, Ashley EA, van Doorn HR, Newton PN. Antimicrobial use and resistance data in human and animal sectors in the Lao PDR: evidence to inform policy. BMJ Glob Health 2021; 6:e007009. [PMID: 34853032 PMCID: PMC8638151 DOI: 10.1136/bmjgh-2021-007009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To review the scientific evidence base on antimicrobial use (AMU) and antimicrobial resistance (AMR) in human and animal sectors in the Lao PDR (Laos). METHODS We reviewed all publications from July 1994 (the first article describing AMR in Laos) to December 2020. Electronic searches were conducted using Google Scholar and PubMed with specific terms relating to AMR and AMU in Lao, French and English languages. FINDINGS We screened 1,357 peer-reviewed and grey reports by title and abstract and then full articles/reports. Of 80 included, 66 (83%) related to human health, nine (11%) to animal health, four (5%) to both animal and human health and one (1%) to the environment. Sixty-two (78%) were on AMR and 18 (22%) on AMU. Extended spectrum beta lactamase-producing Escherichia coli was the greatest concern identified; the proportion of isolates increased fivefold from 2004 to 2016 (2/28 (7%) to 27/78 (35%)) from blood cultures submitted to the Microbiology Laboratory, Mahosot Hospital, Vientiane. Carbapenem resistant Escherichia coli was first identified in 2015. Methicillin-resistant Staphylococcus aureus (MRSA) was uncommon, with 15 cases of MRSA from blood cultures between its first identification in 2017 and December 2020. AMR patterns of global antimicrobial resistance surveillance system (GLASS) target pathogens from livestock were less well documented. There were few data on AMU in human health and none on AMU in livestock. The first hospital AMU survey in Laos showed that 70% (1,386/1,981) of in-patients in five hospitals from 2017 to 2018 received antimicrobial(s). Antibiotic self-medication was common. CONCLUSION AMR in Laos is occurring at relatively low proportions for some GLASS pathogens, giving the country a window of opportunity to act quickly to implement strategies to protect the population from a worsening situation. Urgent interventions to roll out new guidelines with enhanced one-health antibiotic stewardship, reduce antibiotic use without prescriptions, enhance surveillance and improve understanding of AMU and AMR are needed.
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Affiliation(s)
- Vilada Chansamouth
- Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - David Ab Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Tamalee Roberts
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rattanaxay Phetsouvanh
- Department of Communicable Disease Control, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Bouakham Vannachone
- Department of Communicable Disease Control, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Manivanh Vongsouvath
- Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Viengmon Davong
- Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Phout Inthavong
- Department of Livestock and Fisheries, Ministry of Agriculture, Vientiane, Lao People's Democratic Republic
| | - Syseng Khounsy
- Department of Livestock and Fisheries, Ministry of Agriculture, Vientiane, Lao People's Democratic Republic
| | - Bounxou Keohavong
- Department of Food and Drug, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Valy Keoluangkhot
- Infectious Disease Center, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | | | - Nicholas Pj Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
| | - Elizabeth A Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Hanoi, Viet Nam
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Torres NF, Chibi B, Kuupiel D, Solomon VP, Mashamba-Thompson TP, Middleton LE. The use of non-prescribed antibiotics; prevalence estimates in low-and-middle-income countries. A systematic review and meta-analysis. ACTA ACUST UNITED AC 2021; 79:2. [PMID: 33390176 PMCID: PMC7780654 DOI: 10.1186/s13690-020-00517-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/07/2020] [Indexed: 12/21/2022]
Abstract
Background The global increase in the utilization of non - prescribed antibiotics (NPA), is concerning, with high persistence within the low and middle-income countries (LMICs). With a negative impact on the health of individuals and communities the use of NPA paves the way to the propagation of superbugs that potentially predisposes to changes in bacterial resistance patterns, antibiotic resistance (AR) and antimicrobial resistance (AMR). This study aimed at estimating through a systematic review and meta-analysis, the prevalence of NPA utilisation and describe its primary sources in LMICs. Methods The study is a systematic review and meta-analysis which study protocol was registered in PROSPERO (CRD42017072954). The review used The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The studies searched in databases were deemed eligible if reported evidence of practices of self-medication with antibiotics (SMA) and the prevalence of NPA utilisation within adult participants from LMICs, published between 2007 to 2017. The pooled analyses were carried out using Meta XL statistical software. The pooled prevalence was calculated with a 95% confidence interval (CI). The risk of bias of the included studies was assessed using the Quality in Prognosis Studies (QUIPS) tool. Results The review included a total of 11 cross-sectional studies, involving 5080 participants and conducted in LMICs from Asia (India, Laos, Nepal, Pakistan, Sri Lanka and Yemen), Latin America (Guatemala), Africa (Nigeria). All studies reported existing practices of SMA, with reported prevalence ranging from 50% to 93,8%. The pooled prevalence of SMA was 78% (95% CI: 65–89%). The main sources of NPA were; pharmacies, family and friends, old prescriptions, home cabinet and leftover antibiotics. Conclusion This study revealed a high prevalence of utilisation of NPA in the studied LMICs, these were found to be twice as high in women than men and those participants aged between 18 and 40 years old. The review suggests f considering broader qualitative and comprehensive contextuallized research to better understand the nuances of NPA use. These would be benefitial to uncover uncover gray areas, inform decisions, support the (re) design and implementation of multifaceted interventions towards antibiotic stewardship and conservancy in LMICs.
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Affiliation(s)
- Neusa F Torres
- Instituto Superior de Ciências de Saúde (ISCISA), Maputo, Mozambique. .,Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa.
| | - Buyisile Chibi
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Desmond Kuupiel
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
| | - Vernon P Solomon
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | | | - Lyn E Middleton
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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Brata C, Schneider CR, Marjadi B, Clifford RM. The provision of advice by pharmacy staff in eastern Indonesian community pharmacies. Pharm Pract (Granada) 2019; 17:1452. [PMID: 31275500 PMCID: PMC6594425 DOI: 10.18549/pharmpract.2019.2.1452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background: Indonesian community pharmacies hold a strategic position from which to
promote the rational use of medicines by providing appropriate advice for
patients requesting self-medication. To date, published studies related to
the provision of advice in Indonesian community pharmacies are limited and
have been conducted only in more developed western Indonesia. No studies
have been undertaken in eastern Indonesia, which is less developed than and
culturally different from the western region. Objectives: This paper aims to: (1) describe the types and amount of advice provided by
pharmacy staff for three scenarios in a patient simulation study and for two
scenarios in pharmacy staff interviews; and (2) ascertain the frequency of
appropriate advice given in response to the scenarios. Methods: A patient simulation study was conducted at community pharmacies in an
eastern Indonesian provincial capital. Four weeks after completing a patient
simulation study, structured interviews with pharmacy staff were conducted.
Two cough scenarios and one diarrhoea scenario were developed for the
patient simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced
cough and a common cough and cold) were developed for pharmacy staff
interviews. The types and amount of advice provided by pharmacy staff were
recorded on paper and assessed for its appropriateness. The determination of
appropriate advice was based on the literature and by consensus of two
Indonesian experts. Results: In patient simulation, the most common type of advice provided in all
scenarios was product recommendations. In interviews, medical referrals and
recommending cough and cold medicine were the most common types of advice
provided for ACE inhibitor-induced cough and common cough and cold scenarios
respectively. Appropriate advice was provided in less than 0.5% in
the patient simulation study, but two-third of participants in the
interviews responded to the scenarios appropriately. Conclusions: Pharmacy staff did not provide appropriate advice in practice, although they
may have adequate knowledge. A contributing factor was insufficient
information gathered in patient encounters. Optimising information-gathering
practice by pharmacy staff is needed.
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Affiliation(s)
- Cecilia Brata
- Centre of Medicine Information and Pharmaceutical Care, University of Surabaya, Surabaya (Indonesia).
| | - Carl R Schneider
- Faculty of Pharmacy, University of Sydney. Sydney, NSW (Australia).
| | | | - Rhonda M Clifford
- School of Medicine and Pharmacology, University of Western Australia. Perth, WA (Australia).
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7
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Keohavong B, Vonglokham M, Phoummalaysith B, Louangpradith V, Inthaphatha S, Kariya T, Saw YM, Yamamoto E, Hamajima N. Antibiotic prescription for under-fives with common cold or upper respiratory tract infection in Savannakhet Province, Lao PDR. Trop Med Health 2019; 47:16. [PMID: 30858755 PMCID: PMC6394019 DOI: 10.1186/s41182-019-0143-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background The irrational use of antibiotics has been identified as a major problem in healthcare, and it can lead to antimicrobial resistance, treatment failure, and increased healthcare costs. Although many studies worldwide have focused on the irrational use of drugs, reports on prescription practice in Lao PDR remained limited. This study aimed to examine the patterns of antibiotic prescription for under-fives with common cold or upper respiratory tract infection (URTI) at pediatric outpatient divisions. Methods One provincial hospital (PH) at Kaisone Phomvihane and four district hospitals (DHs) at Songkhone, Champhone, Atsaphangthong, and Xepon in Savannakhet Province were selected. Healthcare providers at these hospitals were interviewed and medical records of under-fives from 2016 were examined. Results Of the 54 healthcare providers interviewed, 85.2% had seen the standard treatment guideline, 77.8% adhered to this guideline, and 90.7% knew about antimicrobial resistance, while 18.5% participated in antimicrobial resistance activities. Medical records of 576 outpatients (311 boys and 265 girls) with common cold or URTI were examined, 154 at the PH and 422 at the DHs. Although antibiotics prescription proportions were similar between facilities at both levels (68.8% and 70.9% at the PH and DHs, respectively), antibiotics were exclusively prescribed for URTIs (96.4%), not for common cold (4.9%). First-line antibiotics recommended by WHO Model List of Essential Medicines for Children the 6th List were prescribed for 81.5% of patients; mainly, beta-lactam antibiotics were prescribed (87.2% of prescribed antibiotics). There were no cases in which two or more antibiotics were prescribed. The correct dose according to the National STG was 31.9% as a whole. The difference in the correct dose between the PH (52.8%) and the DHs (24.4%) was significant (p < 0.001). Conclusions This study demonstrated the patterns of antibiotic prescription for under-fives with common cold or URTI among healthcare providers from two different levels of facilities. Although an appropriate number of generic first-line antibiotics in the essential drug list were prescribed, the dosage and duration of antibiotic use were not appropriate. In order to further improve antibiotic prescription practices, regulation by the government is necessary; this could also decrease antimicrobial resistance and improve treatment outcomes.
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Affiliation(s)
- Bounxou Keohavong
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan.,2Food and Drug Department, Ministry of Health, Simuang road, Vientiane Capital, Lao People's Democratic Republic
| | - Manithong Vonglokham
- 3Lao Tropical and Public Health Institute, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Bounfeng Phoummalaysith
- 4National Health Insurance Bureau, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Viengsakhone Louangpradith
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan.,Mittaphab Hospital, Phonsavang V, Chanthabouly D, Vientiane Capital, Lao People's Democratic Republic
| | - Souphalak Inthaphatha
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Tetsuyoshi Kariya
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Yu Mon Saw
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Eiko Yamamoto
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Nobuyuki Hamajima
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
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8
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Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP. Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review. Public Health 2019; 168:92-101. [PMID: 30716570 DOI: 10.1016/j.puhe.2018.11.018] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Self-medication with antibiotics (SMA) is a practice of global concern with a higher incidence within the low- and middle-income countries (LMICs). Despite worldwide efforts to control and promote the rational use of antibiotics, the continuing practice of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and a host of other antibiotic side-effects. This systematic scoping review maps evidence on the factors influencing SMA in these settings. STUDY DESIGN Systematic scoping review. METHODS The search strategy involved electronic databases including PubMed, Web of science, Science Direct, EBSCOhost, Google Scholar, BioMed Central, and the World Health Organization Library. PRISMA P guidelines and Arksey and O'Malley's framework were used. Thematic analysis was used to identify the factors that influence the practices of SMA in LMICs. The Mixed Method Appraisal Tool (MMAT), version 2011, was used to assess the quality of the included primary studies. RESULTS Fifteen studies met the inclusion criteria. Studies included participants from the following LMICs: Guatemala, India, Indonesia, Kenya, Laos, Nepal, Nigeria, Pakistan, Sri Lanka, and Yemen. The findings of the review emphasized a considerable high prevalence of SMA, ranging from 8.1% to 93%, with an association with the level of education, monthly income, and gender of participants. Accessibility, affordability, and conditions of health facilities, as well as the health-seeking behavior, are factors that influence SMA in LMICs. Health conditions such as a sore throat, common cold, cough, headache, toothache, flu-like symptoms, pain relief, fever, runny nose, toothache, upper respiratory tract infections, and urinary tract infection were the major complaints that led to the practices of SMA. CONCLUSIONS There is a considerable level of research evidence predominantly in some LMICs from Asia, with less evidence from African LMICs. Sociocultural determinants of health associated with the structure and conditions of health system as well as the health-seeking behavior are the main factors influencing SMA. Contextual and comprehensive studies on the factors influencing the non-prescribed use of antibiotics are needed to enable evidence-based strategies to correctly address the utilization of antibiotics and contain the problem of antimicrobial resistance, especially within the LMICs. PROSPERO REGISTRATION CRD42017072954.
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Affiliation(s)
- N F Torres
- Instituto Superior de Ciências de Saúde - ISCISA, Maputo, Mozambique; School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa.
| | - B Chibi
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa; Human Sciences Research Council, Durban, South Africa
| | - L E Middleton
- School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - V P Solomon
- School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - T P Mashamba-Thompson
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
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Stakeholder Analysis of Community Distribution of Misoprostol in Lao PDR: A Qualitative Study. PLoS One 2016; 11:e0162154. [PMID: 27631089 PMCID: PMC5025235 DOI: 10.1371/journal.pone.0162154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/18/2016] [Indexed: 11/19/2022] Open
Abstract
Background Globally, significant progress has been made in reducing maternal mortality, yet in many low-resource contexts it remains unacceptably high. Many of these deaths are due to postpartum haemorrhage and are preventable with access to essential obstetric care. Where there are barriers to access, maternal deaths could be prevented if community-level misoprostol was available. The purpose of this study was to explore perceptions of stakeholders regarding misoprostol use in the Lao People’s Democratic Republic, a setting with high maternal mortality. Methods Semi-structured interviews were conducted with 35 stakeholders in the capital, Vientiane and in one northern province identified as a site for a possible intervention. The sample included international and national stakeholders involved in policy-making and providing maternal and reproductive health services. Findings Most stakeholders supported a pilot program for community distribution of misoprostol but levels of awareness of the drug’s use in preventing postpartum haemorrhage and level of influence over policy direction varied considerably. Some international organizations, all identified as powerful in influencing policy, were ambivalent about the use of community distribution of misoprostol. Concerns related to the capacity of village health workers or lay people to safely administer misoprostol, whether its distribution would undermine efforts to improve access to safe delivery services and active management of the third stage of labour, the ease with which prescription drugs can be bought over the counter, and technical, logistical, and financial constraints. Conclusion Access to appropriate oxytocic drugs is a matter of health equity. In settings without access to essential obstetrical care, misoprostol represents a viable solution for the prevention of postpartum haemorrhage. Understanding stakeholders’ perspectives and their legitimate concerns on misoprostol can inform interventions in order to assuage these concerns and enable disadvantaged women to access misoprostol and its potentially life-saving benefits.
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Bowring AL, Pasomsouk N, Higgs P, Sychareun V, Hellard M, Power R. Factors Influencing Access to Sexual Health Care Among Behaviorally Bisexual Men in Vientiane, Laos: A Qualitative Exploration. Asia Pac J Public Health 2016; 27:820-34. [PMID: 26543164 DOI: 10.1177/1010539515612909] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Laos, men who have sex with men (MSM) are disproportionately affected by HIV, and bisexual behavior among men is common. We conducted a qualitative study to explore access and influences on sexual health care seeking among bisexual men in Vientiane. In 2013, behaviorally bisexual men were recruited from bars, clubs and dormitories for 5 focus group discussions and 11 in-depth interviews. Participants (aged 18-35 years) commonly reported high-risk sexual behaviors, yet most had never been tested for HIV, and none reported testing for sexually transmitted infections. Common barriers to testing were low perception of risk, expectation of symptoms, fear of HIV, shyness, perceived stigma, confidentiality concerns, and waiting times. Many men were unaware of available services. Most clinics cannot provide comprehensive HIV and sexually transmitted infection services. Strategies are needed to generate demand for testing, improve the capacity of sexual health care providers, and promote available services among behaviorally bisexual men in Vientiane.
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Affiliation(s)
- Anna L Bowring
- Burnet Institute, Melbourne, Victoria, Australia School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Victoria, Australia Faculty of Health Sciences, National Drug Research Institute, Curtin University, Fitzroy, Melbourne, Victoria, Australia
| | - Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao PDR
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert Power
- Burnet Institute, Melbourne, Victoria, Australia School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Ocan M, Obuku EA, Bwanga F, Akena D, Richard S, Ogwal-Okeng J, Obua C. Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries. BMC Public Health 2015; 15:742. [PMID: 26231758 PMCID: PMC4522083 DOI: 10.1186/s12889-015-2109-3] [Citation(s) in RCA: 227] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/29/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Antimicrobial self-medication is common in most low and middle income countries (LMICs). However there has been no systematic review on non-prescription antimicrobial use in these settings. This review thus intended to establish the burden, risk factors and effects of antimicrobial self-medication in Low and Middle Income Countries. METHODS In 2012, we registered a systematic review protocol in PROSPERO (CRD42012002508). We searched PubMed, Medline, Scopus, and Embase databases using the following terms; "self-medication", "non-prescription", 'self-treatment', "antimicrobial", "antimalarial", "antibiotic", "antibacterial" "2002-2012" and combining them using Boolean operators. We performed independent and duplicate screening and abstraction of study administrative data, prevalence, determinants, type of antimicrobial agent, source, disease conditions, inappropriate use, drug adverse events and clinical outcomes of antibiotic self-medication where possible. We performed a Random Effects Meta-analysis. RESULTS A total of thirty four (34) studies involving 31,340 participants were included in the review. The overall prevalence of antimicrobial self-medication was 38.8 % (95 % CI: 29.5-48.1). Most studies assessed non-prescription use of antibacterial (17/34: 50 %) and antimalarial (5/34: 14.7 %) agents. The common disease symptoms managed were, respiratory (50 %), fever (47 %) and gastrointestinal (45 %). The major sources of antimicrobials included, pharmacies (65.5 %), leftover drugs (50 %) and drug shops (37.5 %). Twelve (12) studies reported inappropriate drug use; not completing dose (6/12) and sharing of medicines (4/12). The main determinants of antimicrobial self-medication include, level of education, age, gender, past successful use, severity of illness and income. Reported negative outcomes of antimicrobial self-medication included, allergies (2/34: 5.9 %), lack of cure (4/34: 11.8 %) and causing death (2/34: 5.9 %). The commonly reported positive outcome was recovery from illness (4/34: 11.8 %). CONCLUSION The prevalence of antimicrobial self-medication is high and varies in different communities as well as by social determinants of health and is frequently associated with inappropriate drug use.
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Affiliation(s)
- Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Ekwaro A Obuku
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Freddie Bwanga
- Department of Microbiology, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Dickens Akena
- Department of Psychiatry, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Sennono Richard
- Infectious Disease Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda.
| | - Jasper Ogwal-Okeng
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Celestino Obua
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
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Caillet C, Sichanh C, Syhakhang L, Delpierre C, Manithip C, Mayxay M, Lapeyre-Mestre M, Newton PN, Roussin A. Population awareness of risks related to medicinal product use in Vientiane Capital, Lao PDR: a cross-sectional study for public health improvement in low and middle income countries. BMC Public Health 2015; 15:590. [PMID: 26116373 PMCID: PMC4483223 DOI: 10.1186/s12889-015-1948-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 06/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background While essential medicines have been made more available in all but the most remote areas in low and middle income countries (L/MICs) over the past years, inappropriate and incorrect use of good quality medicines remains a key impediment for public health. In addition, as medicines have a potential to cause harm (medicine risks), adequate awareness by medicine users of the risks of adverse reactions is essential, especially as self-medication is common in L/MICs. This study aimed to investigate the awareness of Lao residents regarding medicine risks in Vientiane Capital, Lao People’s Democratic Republic. Methods Face-to-face interviews using structured questionnaires of 144 residents older than 16 years were carried out in 12 randomly selected villages out of the 146 villages of Vientiane Capital with at least one health facility. Results The respondents were mainly (85.0 %) the heads of households or their husband/spouse . The majority of the respondents were unaware (61.8 %) of medicine risks. Compared to residents living in the urban district of Xaysetha, living in peri-urban and even more in rural areas were identified as factors associated with being unaware of medicine risks [adjusted odds ratio (aOR) =3.3, 95 % Confidence Interval (CI) = 1.1–9.4]) and aOR =7.5 (95 % CI = 2.3–24.2), respectively]. In addition, more than half of the respondents had never heard of poor quality medicines, with a higher rate in rural/peri-urban compared to urban districts (55.6 % vs 38.9 %, respectively, p = 0.02). Finally, approximately one third of all respondents thought that traditional medicines could not cause harm. Conclusions Overall, these results suggest a lack of awareness about medicinal product risks. Differences according to the place of residence are apparent and could be partly explained by a lower level of training of healthcare providers in contact with the population in the rural districts in particular. Communication on medicinal product risks to patients through well-trained healthcare providers could probably make a valuable contribution towards the appropriate use of medicines in L/MICs.
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Affiliation(s)
- Céline Caillet
- Faculté de Médecine, Equipe de Pharmacoépidémiologie UMR 1027 INSERM-Université de Toulouse III, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Chanvilay Sichanh
- WorldWide Antimalarial Resistance Network, University of Oxford, Wellington Square, OX1 2JD, Oxford, UK.
| | - Lamphone Syhakhang
- Food and Drug Department, Ministry of Health, Simuang Road, Vientiane Capital, Lao People's Democratic Republic.
| | - Cyrille Delpierre
- Faculté de Médecine, Cancer et maladies chroniques, UMR1027 INSERM- Université de Toulouse III, 37 Allées Jules Gusede, 31000, Toulouse, France.
| | - Chanthanom Manithip
- Faculty of Pharmacy, University of Health Sciences, P.O.Box 7444, Samsenthai Road, Vientiane, Lao People's Democratic Republic.
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, FaNgum Rd, Vientiane, Lao People's Democratic Republic. .,Faculty of Postgraduate Studies, University of Health Sciences, P.O.Box 7444, Samsenthai Road, Vientiane, Lao People's Democratic Republic.
| | - Maryse Lapeyre-Mestre
- Faculté de Médecine, Equipe de Pharmacoépidémiologie UMR 1027 INSERM-Université de Toulouse III, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Paul N Newton
- WorldWide Antimalarial Resistance Network, University of Oxford, Wellington Square, OX1 2JD, Oxford, UK. .,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, FaNgum Rd, Vientiane, Lao People's Democratic Republic. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, University of Oxford, Wellington Square, OX1 2JD, Oxford, UK.
| | - Anne Roussin
- Faculté de Médecine, Equipe de Pharmacoépidémiologie UMR 1027 INSERM-Université de Toulouse III, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000, Toulouse, France.
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Inoue Y, Morita Y, Takikawa M, Takao K, Kanamoto I, Sugibayashi K. Future expectations for Japanese pharmacists as compared to the rest of the world. Res Social Adm Pharm 2015; 11:448-58. [DOI: 10.1016/j.sapharm.2014.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/20/2014] [Indexed: 11/28/2022]
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Esmaily HM, Vahidi R, Fathi NM, Wahlström R. How do physicians and trainers experience outcome-based education in "Rational prescribing"? BMC Res Notes 2014; 7:944. [PMID: 25533194 PMCID: PMC4326339 DOI: 10.1186/1756-0500-7-944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/16/2014] [Indexed: 12/03/2022] Open
Abstract
Background Continuing medical education (CME) is compulsory in Iran, but has shown limitations in terms of educational style and format. Outcome-based education (OBE) has been proposed internationally to create links to physicians’ actual practices. We designed an outcome-based educational intervention for general physicians in primary care (GPs). Positive outcomes on GPs’ knowledge, skills and performance in the field of rational prescribing were found and have been reported. The specific purpose of this study was to explore the perceptions of the GPs and trainers, who participated in the outcome-based education on rational prescribing. Methods All nine trainers in the educational programme and 12 general physicians (out of 58) were invited to individual interviews four months after participation in the CME program. Semi-structured open-ended interviews were carried out. Qualitative content analysis was used to explore the text and to interpret meaning and intention. Results There was a widespread agreement that the programme improved the participants’ knowledge and skills to a higher extent than previously attended programmes. Trainers emphasized the effect of outcome-based education on their educational planning, teaching and assessment methods, while the general physicians’ challenges were how to adapt their learning in the real work environment considering social and economical barriers. Self-described attitudes and reported practice changed towards more rational prescribing. Conclusions Outcome-based CME seems attractive and additionally useful for general physicians in Iran and could be an effective approach when creating CME programmes to improve general physicians’ performance. Similar approaches could be considered in other contexts both regionally and globally.
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Affiliation(s)
- Hamideh M Esmaily
- Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
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Lan PT, Phuc HD, Hoa NQ, Chuc NTK, Lundborg CS. Improved knowledge and reported practice regarding sexually transmitted infections among healthcare providers in rural Vietnam: a cluster randomised controlled educational intervention. BMC Infect Dis 2014; 14:646. [PMID: 25471366 PMCID: PMC4263008 DOI: 10.1186/s12879-014-0646-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare providers (HCPs) play a critical role in controlling the spread of sexually transmitted infections (STI) through early and accurate diagnosis, appropriate treatment and prevention counselling. This study aimed to assess the effectiveness of an educational intervention about STI on knowledge and reported practice among HCPs and to explore which determinants may influence the intervention's effects. METHODS A cluster randomized controlled educational intervention was carried out in a rural district, Vietnam. 32 communes of the district were randomized into two arms, with 160 HCPs in an STI intervention arm and 144 in a control arm. The STI intervention comprised interactive training with basic STI knowledge, case scenarios, and poster distribution. Questionnaires to evaluate knowledge and reported practice were completed three times: before, during and after the intervention. Correct answer was scored as 1; "do not know", incorrect answer was scored as 0. Univariate and multilevel multivariate analyses were applied. RESULTS Of the maximum 56 points, the mean knowledge score increased significantly in the STI intervention arm and in the control arm post-intervention (37.2 to 48.4, and 32.7 to 41.7, respectively). In multivariate regression analysis, knowledge improvement in the intervention arm was significantly higher than that in the control arm (regression coefficient = 2.97, p = 0.008). Other factors which positively influenced the increase in knowledge were being between 35 and 50 years old, having intermediate professional training, being a pharmacist or working at a village level (regression coefficient: 2.81, 4.43, 5.53 and 7.91, respectively). Post-intervention, the mean reported practice score increased significantly in the STI intervention arm (from 17.6 to 21.8) and insignificantly in the control arm (maximum 36 points). Factors which positively influenced the increase in reported practice were being between 35 and 50 years old, having intermediate professional training, or working at a pharmacy/drugstore (regression coefficient: 2.15, 3.33 and 3.22, respectively). CONCLUSIONS This study indicates that an educational intervention including interactive training and multi-faceted interventions may be effective in improving STI knowledge and reported practice of HCPs at grassroots level, particularly among pharmacists, HCPs who work in villages or pharmacies/drugstores, and who initially have low STI knowledge.
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Affiliation(s)
- Pham Thi Lan
- Hanoi Medical University, Hanoi, Vietnam. .,Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | | | - Nguyen Quynh Hoa
- Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. .,National Cancer Hospital, Hanoi, Vietnam.
| | | | - Cecilia Stålsby Lundborg
- Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Nielsen A, Lan PT, Marrone G, Phuc HD, Chuc NTK, Stålsby Lundborg C. Reproductive Tract Infections in Rural Vietnam, Women's Knowledge, and Health-Seeking Behavior: A Cross-Sectional Study. Health Care Women Int 2014; 37:392-411. [PMID: 24850497 DOI: 10.1080/07399332.2014.920021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We interviewed 1,805 women in a rural setting in Vietnam with the aim of investigating women's knowledge regarding reproductive tract infections (RTIs) and their health-seeking behavior. We found that women's overall knowledge was poor. Furthermore, only one-third of the symptomatic women sought health care. RTIs affect millions of women globally each year. Most vulnerable are women in low- and middle-income countries where poverty and gender inequities affect their access to health care services. Findings from our study can be used in similar rural settings worldwide to understand and manage the widespread problem of RTIs.
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Affiliation(s)
- Anna Nielsen
- a Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet , Stockholm , Sweden
| | - Pham Thi Lan
- a Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet , Stockholm , Sweden.,b Hanoi Medical University , Hanoi , Vietnam
| | - Gaetano Marrone
- a Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet , Stockholm , Sweden
| | - Ho Dang Phuc
- c Department of Probability and Mathematical Statistics , Institute of Mathematics, Vietnam Academy of Science and Technology , Hanoi , Vietnam
| | | | - Cecilia Stålsby Lundborg
- a Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet , Stockholm , Sweden
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Stålsby Lundborg C, Tamhankar AJ. Understanding and changing human behaviour--antibiotic mainstreaming as an approach to facilitate modification of provider and consumer behaviour. Ups J Med Sci 2014; 119:125-33. [PMID: 24735112 PMCID: PMC4034549 DOI: 10.3109/03009734.2014.905664] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This paper addresses: 1) Situations where human behaviour is involved in relation to antibiotics, focusing on providers and consumers; 2) Theories about human behaviour and factors influencing behaviour in relation to antibiotics; 3) How behaviour in relation to antibiotics can change; and, 4) Antibiotic mainstreaming as an approach to facilitate changes in human behaviour as regards antibiotics. Influencing human behaviour in relation to antibiotics is a complex process which includes factors like knowledge, attitudes, social norms, socio-economic conditions, peer pressure, experiences, and bio-physical and socio-behavioural environment. Further, key concepts are often perceived in different ways by different individuals. While designing and implementing projects or programmes for behavioural change with respect to antibiotics for professionals or consumers it is helpful to consider theories or models of behaviour change, e.g. the 'stages of change model', including pre-contemplation, contemplation, preparation, action, and maintenance. People in different stages of change are susceptible to different behaviour modification strategies. Application of marketing principles to 'global good', so-called 'social marketing', to improve 'welfare of the individual and society' is gaining increased attention in public health. In conclusion, just providing correct knowledge is not sufficient although it is a pre-requisite for behaviour modification in the desired direction. We can never change the behaviour of any other human, but we can facilitate for others to change their own behaviour. One possibility is to implement 'antibiotic mainstreaming' as a potentially effective way for behaviour modification, i.e. to address consequences for maintaining effective antibiotics in all activities and decisions in society.
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Affiliation(s)
- Cecilia Stålsby Lundborg
- Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ashok J. Tamhankar
- Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Indian Initiative for Management of Antibiotic Resistance (IIMAR), Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain, India
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Brata C, Gudka S, Schneider CR, Everett A, Fisher C, Clifford RM. A review of the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries. Res Social Adm Pharm 2012; 9:370-83. [PMID: 23089294 DOI: 10.1016/j.sapharm.2012.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Currently, no review has been completed regarding the information-gathering process for the provision of medicines for self-medication in community pharmacies in developing countries. OBJECTIVE To review the rate of information gathering and the types of information gathered when patients present for self-medication requests. METHODS Six databases were searched for studies that described the rate of information gathering and/or the types of information gathered in the provision of medicines for self-medication in community pharmacies in developing countries. The types of information reported were classified as: signs and symptoms, patient identity, action taken, medications, medical history, and others. RESULTS Twenty-two studies met the inclusion criteria. Variations in the study populations, types of scenarios, research methods, and data reporting were observed. The reported rate of information gathering varied from 18% to 97%, depending on the research methods used. Information on signs and symptoms and patient identity was more frequently reported to be gathered compared with information on action taken, medications, and medical history. CONCLUSION Evidence showed that the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries is inconsistent. There is a need to determine the barriers to appropriate information-gathering practice as well as to develop strategies to implement effective information-gathering processes. It is also recommended that international and national pharmacy organizations, including pharmacy academics and pharmacy researchers, develop a consensus on the types of information that should be reported in the original studies. This will facilitate comparison across studies so that areas that need improvement can be identified.
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Affiliation(s)
- Cecilia Brata
- Pharmacy, School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia.
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Phrasisombath K, Thomsen S, Sychareun V, Faxelid E. Care seeking behaviour and barriers to accessing services for sexually transmitted infections among female sex workers in Laos: a cross-sectional study. BMC Health Serv Res 2012; 12:37. [PMID: 22333560 PMCID: PMC3347996 DOI: 10.1186/1472-6963-12-37] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 02/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prompt, correct diagnosis and treatment with health information are essential components of reproductive tract infection (RTI) and sexually transmitted infection (STI) services. This study aims to describe care seeking behaviour and barriers to accessing RTI/STI services among female sex workers (FSWs) in Laos. METHODS A cross-sectional survey using closed and open-ended questions was performed in six districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 407 FSWs were interviewed. The data were analyzed and presented descriptively. Multiple logistic regression analysis was applied to assess associations between respondents' background characteristics and care seeking behaviour. RESULTS About half of the respondents (49%) were less than or equal to 19 years of age, and 50% had started or completed secondary school. Fifty-eight percent had been engaged in sex work for less than 1 year. Eighty-six percent of the respondents reported RTI/STI signs or symptoms currently or in the last 3 months but only two-thirds of those with symptoms sought treatment. Source of treatment for the last RTI/STI episode was the drop-in centre (53%) followed by a public hospital (23%), private clinic (12%), private pharmacy (9%), and herbalist (2%). The main barriers to service use were long waiting time, inconvenient location of the clinic, not knowing where to get the services needed, and negative attitudes among healthcare providers. Care seeking behaviour was associated with longer duration of sex work (OR = 2.6, 95%CI 1.52-5.36). Forty-four percent received health information from peer educators, 34% from fellow friends, 26% from a pimp, and 26% had received information from a healthcare provider during the visit. CONCLUSION There were several barriers to accessing RTI/STI services and they were related to both structural and individual factors. Innovative STI service strategies to inform FSWs about the importance of early diagnosis and treatment should be established. Continuous training for STI service providers focusing on counseling skills and awareness of the sexual health care needs for FSWs is recommended in order to minimize the barriers experienced by FSWs in this particular setting.
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Widayati A, Suryawati S, de Crespigny C, Hiller JE. Self medication with antibiotics in Yogyakarta City Indonesia: a cross sectional population-based survey. BMC Res Notes 2011; 4:491. [PMID: 22078122 PMCID: PMC3273454 DOI: 10.1186/1756-0500-4-491] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/11/2011] [Indexed: 12/03/2022] Open
Abstract
Background Self medication with antibiotics has become an important factor driving antibiotic resistance. This study investigated the period prevalence, patterns of use, and socio-demographic factors associated with self medication with antibiotics in Yogyakarta City Indonesia. This cross-sectional population-based survey used a pre-tested questionnaire which was self-administered to randomly selected respondents (over 18 years old) in Yogyakarta City Indonesia in 2010 (N = 625). Descriptive statistics, chi-square and logistic regression were applied. Results A total of 559 questionnaires were analyzed (response rate = 90%). The period prevalence of self medication with antibiotics during the month prior to the study was 7.3%. Amoxicillin was the most popular (77%) antibiotic for self medication besides ampicilline, fradiomisin-gramisidin, tetracycline, and ciprofloxacin to treat the following symptoms: the common-cold including cough and sore throat, headache, and other minor symptoms; with the length of use was mostly less than five days. Doctors or pharmacists were the most common source of information about antibiotics for self medication (52%). Antibiotics were usually purchased without prescription in pharmacies (64%) and the cost of the purchases was commonly less than US $1 (30%). Previous experience was reported to be the main reason for using non-prescribed antibiotics (54%). There were no socio-demographic variables significantly associated with the actual practice of using non-prescribed antibiotics. However, gender, health insurance, and marital status were significantly associated with the intent to self medicate with antibiotics (P < 0.05). Being male (Odds Ratio = 1.7 (1.2 - 2.6)) and having no health insurance (Odds Ratio = 1.5 (1.0 -2.3)) is associated with the intent to self medicate with antibiotics. Conclusions This study is the first population-based study of self-medication with antibiotics among the Indonesian population. Usage of non-prescribed antibiotics as well as intent of doing so is common across socio-demographic categories. Given the findings, factors influencing people's intentions to self medicate with antibiotics are required to be investigated to better understand such behavior. Impact of health insurance coverage on self medication with antibiotics should also be further investigated.
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Affiliation(s)
- Aris Widayati
- Faculty of Pharmacy, Sanata Dharma University, Yogyakarta, Indonesia.
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Khennavong M, Davone V, Vongsouvath M, Phetsouvanh R, Silisouk J, Rattana O, Mayxay M, Castonguay-Vanier J, Moore CE, Strobel M, Newton PN. Urine antibiotic activity in patients presenting to hospitals in Laos: implications for worsening antibiotic resistance. Am J Trop Med Hyg 2011; 85:295-302. [PMID: 21813851 PMCID: PMC3144829 DOI: 10.4269/ajtmh.2011.11-0076] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Widespread use of antibiotics may be important in the spread of antimicrobial resistance. We estimated the proportion of Lao in- and outpatients who had taken antibiotics before medical consultation by detecting antibiotic activity in their urine added to lawns of Bacillus stearothermophilus, Escherichia coli, and Streptococcus pyogenes. In the retrospective (N = 2,058) and prospective studies (N = 1,153), 49.7% (95% confidence interval [CI] = 47.4–52.0) and 36.2% (95% CI = 33.4–38.9), respectively, of Vientiane patients had urinary antibiotic activity detected. The highest frequency of estimated antibiotic pre-treatment was found in patients recruited with suspected central nervous system infections and community-acquired septicemia (both 56.8%). In Vientiane, children had a higher frequency of estimated antibiotic pre-treatment than adults (60.0% versus 46.5%; P < 0.001). Antibiotic use based on patients histories was significantly less frequent than when estimated from urinary antibiotic activity (P < 0.0001).
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Affiliation(s)
- Manisone Khennavong
- Wellcome Trust - Mahosot Hospital - Oxford Tropical Medicine Research Collaboration, Vientiane, Lao PDR.
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Wen Y, Lieber E, Wan D, Hong Y. A qualitative study about self-medication in the community among market vendors in Fuzhou, China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:504-513. [PMID: 21651638 PMCID: PMC3873345 DOI: 10.1111/j.1365-2524.2011.01009.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Despite government efforts to increase healthcare insurance and access in China, many individuals, regardless of insurance status, continue to engage in high levels of self-medication. To understand the factors influencing common self-medication behaviour in a community of food market vendors in Fuzhou China, a total of 30 market vendors were randomly recruited from six food markets in 2007. In-depth interviews were conducted with each participant at their market stalls by trained interviewers using a semi-structured open-ended interview protocol. Participants were asked broad questions about their health-seeking behaviours as well as their past experiences with self-medication and hospital care. ATLAS. ti was used to manage and analyse the interview data. The results showed that hospital-based healthcare services were perceived as better quality. However, self-medication was viewed as more affordable in terms of money and time. Other factors prompting self-medication, included confidence in understanding the health problem, the easy accessibility of local pharmacies and the influences of friends/peers and advertising. Three broad domains, attitude, cost and effectiveness, were all seen to determine past decisions and experiences with self-medication. Interestingly, the effective management of self-medication via pharmacy resources raised particular concern because of perceived variation in quality. In conclusion, self-medication was found to be an important and common health-seeking behaviour driven by multiple factors. A sound and comprehensive public health system should systematically attend to these behaviours and the pharmacies, where much of the behaviour occurs.
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Affiliation(s)
- Yi Wen
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
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Phrasisombath K, Thomsen S, Hagberg J, Sychareun V, Faxelid E. Knowledge about sexually transmitted infections (STIs) and attitudes toward female sex workers with STI symptoms among health care providers in Laos. Asia Pac J Public Health 2011; 24:940-52. [PMID: 21807620 DOI: 10.1177/1010539511416223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to assess the knowledge and attitudes among health care providers (HCPs) providing sexually transmitted infection (STI) service to female sex workers (FSWs). A cross-sectional survey was performed in 6 districts along Road 9, traversing Savannakhet province from Thailand to Vietnam. In total, 244 HCPs providing STI services were interviewed. In all, 54% of respondents had no STI training despite providing STI treatment. Misperceptions of STI causes, transmission routes, and symptoms were common among respondents. Attitudes differed neither between male and female respondents nor between those who had or had not received STI training. A higher proportion of pharmacists/drug sellers (68%) had negative attitudes followed by medical doctors (59%) and nurse/midwives (55%). The proportion of herbalists with negative attitudes (53%) was less in comparison with the other professionals. To improve the quality of STI services and to enhance FSWs' access to health care services, educational improvements of HCPs' knowledge about STIs and their attitudes are needed.
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Community perceptions and treatment-seeking behaviour regarding reproductive tract infections including sexually transmitted infections in Lao PDR: a qualitative study. J Biosoc Sci 2011; 43:285-303. [PMID: 21211093 DOI: 10.1017/s002193201000074x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Creating community awareness of reproductive tract infections (RTI), including sexually transmitted infections (STI), and how to prevent them is essential to minimize their spread. Data on people's views about RTI/STI are entirely lacking in Laos. The aim of this study was thus to explore people's perceptions, treatment-seeking behaviour and understanding of information about RTI/STI, in urban and rural communities in two provinces in Laos. Fourteen focus group discussions and 20 in-depth interviews were held with 76 women and 56 men, selected purposively to provide diversity of socio-demographic backgrounds. Qualitative content analysis was employed for the data analysis. The major finding was that both male and female participants had a variety of misconceptions about the causes and symptoms of RTI/STI and their cure, and a reluctance to seek health care, which could cause delay in appropriate diagnosis and treatment. The most common treatment-seeking behaviour was self-medication through private pharmacies, following advice mostly given by friends and drug sellers. The main reasons for not going to health facilities were fear of social discrimination or shyness of genital examination. Complaints were also made about clinicians' negative attitudes towards 'dirty disease'. Although condom use was mentioned as a way to prevent RTI/STI, an unwillingness to use condoms was commonly expressed. The main media sources of RTI/STI information were radio and television, and access to health information was more difficult in rural areas. The health messages provided were mostly understood, except for some technical terms. The findings indicate that strengthening health education and promotion through interventions at the community level is recommended to improve quality of RTI/STI management. Health education messages should be more accessible in rural areas. There is also an urgent need to improve communication between RTI/STI patients and clinicians.
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Viberg N, Kalala W, Mujinja P, Tomson G, Lundborg CS. "Practical knowledge" and perceptions of antibiotics and antibiotic resistance among drugsellers in Tanzanian private drugstores. BMC Infect Dis 2010; 10:270. [PMID: 20846407 PMCID: PMC2949758 DOI: 10.1186/1471-2334-10-270] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 09/16/2010] [Indexed: 11/10/2022] Open
Abstract
Background Studies indicate that antibiotics are sold against regulation and without prescription in private drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sale and dispensing practices and link it to drugseller knowledge and perceptions of antibiotics and antibiotic resistance. Methods Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics and resistance. Data were analyzed using mixed quantitative and qualitative methods. Results Of 350 interviewed exit customers, 24% had bought antibiotics. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough, stomachache, genital complaints and diarrhea but not for malaria or headache. Dispensed drugs were assessed as relevant for the symptoms or disease presented in 83% of all cases and 51% for antibiotics specifically. Non-prescribed drugs were assessed as more relevant than the prescribed. The knowledge level of the drugseller was ranked as high or very high by 75% of the respondents. Seventy-five drugsellers from three districts participated. Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24% of these also said that antibiotics can be used for treating viral disease. Most (85%) said that STI can be treated with antibiotics while 1% said the same about headache, 4% general weakness and 3% 'all diseases'. Seventy-two percent had heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical point of view with some exceptions. They gave rise to five categories and one theme: Perceiving antibiotic resistance based on practical experience. Conclusions The drugsellers have considerable "practical knowledge" of antibiotics and a perception of antibiotic resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of antibiotics from these outlets in resource-constrained settings, their "practical knowledge" as well as their perceptions must be taken into account in order to attain rational dispensing practices.
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Affiliation(s)
- Nina Viberg
- Division of Global Health IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Dameh M, Green J, Norris P. Over-the-counter sales of antibiotics from community pharmacies in Abu Dhabi. ACTA ACUST UNITED AC 2010; 32:643-50. [DOI: 10.1007/s11096-010-9418-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
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Knowledge and practice among healthcare providers in rural Vietnam regarding sexually transmitted infections. Sex Transm Dis 2009; 36:452-8. [PMID: 19556937 DOI: 10.1097/olq.0b013e31819fe9ae] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess knowledge and reported practice regarding sexually transmitted infections (STI) among healthcare providers in rural Vietnam and to examine background characteristics possibly associated with knowledge and practice. METHODS A cross-sectional study using a self-completed questionnaire was carried out in 2006 among 465 healthcare providers in rural Vietnam. The questionnaire included questions on providers' characteristics, STI knowledge, and case scenarios of 4 common STI syndromes. Correct answer was scored 1, "do not know" or incorrect answer was scored 0. Linear and logistic regressions were applied. RESULTS Diseases considered as STI were gonorrhea and syphilis by 83% of the respondents, 70% believed partner treatment necessary for bacterial vaginosis or candidiasis cases. Sharing clothes/food or kissing was commonly mentioned as transmission routes (60%). Median scores of knowledge and reported practice were 29 (range: 0-50) and 2 (range: 0-20), respectively. Among the respondents, 34% had a knowledge score of less than 25 and 78% had a practice score of less than 10. Characteristics predicting higher level of knowledge were being a medical doctor, assistant medical doctor, midwife, or serving STI patients. Characteristics predicting higher level of practice were serving STI patients, being a midwife or female provider, and having participated in STI or reproductive tract infection training courses. Respondents who reported treating STI patients had a higher level of knowledge and reported practice than the others.
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Oshikoya KA, Senbanjo IO, Njokanma OF. Self-medication for infants with colic in Lagos, Nigeria. BMC Pediatr 2009; 9:9. [PMID: 19193235 PMCID: PMC2645392 DOI: 10.1186/1471-2431-9-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 02/04/2009] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Infantile colic is a self-limiting condition that is distributed worldwide. It is often misdiagnosed as an organic disease for which an infant is admitted to the hospital. Many studies have described the aetiopathogenesis, pharmacologic and non-pharmacologic management of colic but none has evaluated self-medication for infants with colic. The aim of this study was therefore to determine the knowledge of Nigerian mothers about colic, their home-based management, extent of self-medication for the infants with colic and the types of medicines involved. METHODS It is a prospective study conducted at the vaccination clinics of 20 primary health care centres, each from different Local Government Areas in Lagos, Nigeria. Eight hundred mothers that brought their infants for vaccination between April and September, 2006 were interviewed with open-and close-ended questionnaire. RESULTS Six hundred and eighty three (85.4%) mothers claimed they had a good knowledge of colic. Incessant and excessive cry was the main clinical feature of colic identified by 430(62.9%) mothers. Three hundred and seventy eight (67.7%) infants were treated by self-medication, 157 (28.1%) sought medical intervention and 17 (3.1%) were treated at a traditional birth attendant home. Herbal medicines constituted 51.8% of the self-medicated medicines, of which 48 (26.2%) were "Ororo Ogiri". Nospamin (49.5%) and Gripe water (43.0%) were the two frequently prescribed and self-medicated medicines for infants with colic. CONCLUSION Nigerian mothers are deficient in their knowledge of colic. Self-medication was the most frequently used home-based intervention. Health education would appear necessary to improve parental management of this self-limiting condition.
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Affiliation(s)
- Kazeem A Oshikoya
- Pharmacology Department, Lagos State University College of Medicine, P.M.B 21266, Ikeja, Lagos, Nigeria
- Paediatrics and Child Health, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
- Academic Division of Child Health, University of Nottingham, The Medical School, Derbyshire Children's Hospital, Uttoxeter Road, Derby, DE22 3DT, UK
| | - Idowu O Senbanjo
- Paediatrics and Child Health, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Olisamedua F Njokanma
- Paediatrics and Child Health, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Self-Medication Prevalence for Sexually Transmitted Diseases: Meta-Analysis and Meta-Regression of Population Level Determinants. Sex Transm Dis 2009; 36:112-9. [DOI: 10.1097/olq.0b013e31818b2116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sihavong A, Phouthavane T, Lundborg CS, Sayabounthavong K, Syhakhang L, Wahlström R. Reproductive tract infections among women attending a gynecology outpatient department in Vientiane, Lao PDR. Sex Transm Dis 2008; 34:791-5. [PMID: 17507837 DOI: 10.1097/01.olq.0000260918.82625.fd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES AND GOAL To clinically and microbiologically identify reproductive tract infections (RTI), including sexually transmitted infections (STI), and to monitor the antibiotic susceptibility of Neisseria gonorrhoeae among women attending a gynecology outpatient department in Vientiane, Laos. STUDY DESIGN Clinical and laboratory-based cross-sectional study. Women aged 15 to 49 years underwent a pelvic examination, and specimens were taken for laboratory testing. RESULTS Of 1125 study participants, 82% clinically presented with an RTI syndrome. However, only 64% had an etiologically diagnosed RTI, including 11% with an STI. Endogenous infections were most prevalent (candidiasis 40%; bacterial vaginosis 25%), followed by STI [Chlamydia trachomatis 4.1%; N. gonorrhoeae (NG) and Trichomonas vaginalis, both 3.7%]. The 41 NG isolates showed 20% resistance to ciprofloxacin, 98% to penicillin, and complete to tetracycline. CONCLUSIONS High RTI/STI level combined with high NG resistance emphasizes that concurrent with syndromic case management, periodic evaluations of etiological diagnosis should be available to ensure adequacy of treatment algorithms and prescribed medications.
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Affiliation(s)
- Amphoy Sihavong
- Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Lan PT, Faxelid E, Chuc NTK, Mogren I, Lundborg CS. Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam: a qualitative study. Health Policy 2008; 86:308-17. [PMID: 18191494 DOI: 10.1016/j.healthpol.2007.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 11/13/2007] [Accepted: 11/21/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore perceptions, attitudes and health-seeking patterns for reproductive tract infections including sexually transmitted infections (RTI/STI) among men and women in rural Vietnam. METHOD Ten focus group discussions (FGDs) were conducted with 46 women and 27 men aged 15-49 in Bavi district, northern Vietnam. A pre-designed discussion guide was used during the discussions. Content analysis was applied for data analysis. Each sentence/paragraph was coded. Similar codes were clustered and collapsed into sub-categories and categories. Two main themes 'community perceptions of RTI/STI' and 'attitudes towards RTI/STI' were created, based on the relationship between categories. FINDINGS Complex terminology with many different terms was used by participants to describe and discuss RTI/STI. "Inflammation" [RTI], Gonorrhoea, Syphilis was described as three stages of STI. Health-seeking patterns for RTI/STI were reported to differ between men and women: self-medication was mentioned as a common practice among women, while men were more likely to seek health care from private providers. Complaints were voiced about clinicians' negative attitudes towards RTI/STI patients. CONCLUSION Rural dwellers in a district of Vietnam expressed a variety of misconceptions regarding RTI/STI. Designing health education strategies to provide comprehensive RTI/STI information to the community and improving communication between RTI/STI patients and clinicians are urgently needed.
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Affiliation(s)
- Pham Thi Lan
- Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Hanoi Medical University, Hanoi, Viet Nam.
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Jönsson K, Tomson G, Jönsson C, Kounnavong S, Wahlström R. Health systems research in Lao PDR: capacity development for getting research into policy and practice. Health Res Policy Syst 2007; 5:11. [PMID: 17939854 PMCID: PMC2098768 DOI: 10.1186/1478-4505-5-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 10/16/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lao PDR is a low-income country with an urgent need for evidence-informed policymaking in the healthcare sector. During the last decade a number of Health Systems Research (HSR) projects have been conducted in order to meet this need. However, although knowledge about research is increasing among policymakers, the use of research in policymaking is still limited. METHODS This article investigates the relationship between research and policymaking from the perspective of those participating in HSR projects. The study is based on 28 interviews, two group discussions and the responses from 56 questionnaires. RESULTS The interviewees and questionnaire respondents were aware of the barriers to getting research into policy and practice. But while some were optimistic, claiming that there had been a change of attitudes among policymakers in the last two years, others were more pessimistic and did not expect any real changes until years from now. The major barriers to feeding research results into policy and practice included an inability to influence the policy process and to get policymakers and practitioners interested in research results. Another barrier was the lack of continuous capacity development and high-quality research, both of which are related to funding and international support. Many of the interviewees and questionnaire respondents also pointed out that communication between those conducting research and policymakers must be improved. CONCLUSION The results show that in the case of Lao PDR, research capacity development is at a crucial stage for implementing research into policy and practice. If research is going to make a consistent impact on policymaking in the Lao health care sector, the attitude towards research will need to be changed in order to get research prioritised, both among those conducting research, and among policymakers and practitioners. Our findings indicate that there is awareness about the barriers in this process.
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Affiliation(s)
- Kristina Jönsson
- Centre for East and South-East Asian Studies, Lund University, Scheelevägen 15, SE-223 70 Lund, Sweden
| | - Göran Tomson
- Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Medical Management Centre (MMC), Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Christer Jönsson
- Department of Political Science, Lund University, Box 52, SE-221 00 Lund, Sweden
| | - Sengchanh Kounnavong
- National Institute of Public Health (NIOPH), Ministry of Health, Vientiane, Lao PDR
| | - Rolf Wahlström
- Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Nyazema N, Viberg N, Khoza S, Vyas S, Kumaranayake L, Tomson G, Lundborg CS. Low sale of antibiotics without prescription: a cross-sectional study in Zimbabwean private pharmacies. J Antimicrob Chemother 2007; 59:718-26. [PMID: 17337511 DOI: 10.1093/jac/dkm013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the quality of private pharmacy practice with a focus on the extent of antibiotic sales without prescription in private pharmacies in four Zimbabwean cities in relation to two tracer infectious conditions-sexually transmitted infections (STIs) among females and males, and diarrhoea in a child. METHODS A cross-sectional study including pharmacies in Harare and three other towns. Information about each pharmacy was collected through structured interviews. Staff were interviewed using a different structured interview guide and simulated clients were used to assess staff performance. Data were analysed statistically, and step models to evaluate pharmacist performance were developed. RESULTS A majority (69%) stated that they would never sell an antibiotic without a prescription and very few actually did in spite of a high patient demand. Few respondents however performed acceptably regarding provision of information and advice in relation to guidelines: 8% for the STI male, 33% for the STI female and 22% for the diarrhoea scenario. CONCLUSIONS The study revealed low sales of antibiotics without prescription, showing good adherence to the letter of the law. However, few respondents performed acceptably in relation to guidelines when considering information and advice for the tracer conditions.
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Affiliation(s)
- N Nyazema
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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