Social determinants of antibiotic misuse: a qualitative study of community members in Haryana, India
Authors
Anna Barker
Department of Population Health Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, WI USA
Kelli Brown
Department of Population Health Sciences, University of Wisconsin, School of Medicine and Public Health, Madison, WI USA
Muneeb Ahsan
Medanta Institute of Education and Research, Medanta the Medicity Hospital, Gurgaon, Haryana India
Sharmila Sengupta
Department of Clinical Microbiology & Infection Control, Medanta the Medicity Hospital, Gurgaon, Haryana India
Nasia Safdar
Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI USA
Keywords:
Antibiotic resistance, Social determinants, Global health, India, Rural health, Qualitative research
Abstract
Antibiotic resistance is a global public health crisis. In India alone, multi-drug resistant organisms are responsible for over 58,000 infant deaths each year. A major driver of drug resistance is antibiotic misuse, which is a pervasive phenomenon worldwide. Due to a shortage of trained doctors, access to licensed allopathic doctors is limited in India’s villages. Pharmacists and unlicensed medical providers are commonly the primary sources of healthcare. Patients themselves are also key participants in the decision to treat an illness with antibiotics. Thus, better understanding of the patient-provider interactions that may contribute to patients’ inappropriate use of antibiotics is critical to reducing these practices in urban and rural Indian villages.
Methods
We conducted a qualitative study of the social determinants of antibiotic use among twenty community members in Haryana, India. Semi-structured interview questions focused on two domains: typical antibiotic use and the motivation behind these practices. A cross-sectional pilot survey investigated the same twenty participants’ understanding and usage of antibiotics. Interview and open-ended survey responses were translated, transcribed, and coded for themes.
Results
Antibiotics and the implications of their misuse were poorly understood by study participants. No participant was able to correctly define the term antibiotics. Participants with limited access to an allopathic doctor, either for logistic or economic reasons, were more likely to purchase medications directly from a pharmacy without a prescription. Low income participants were also more likely to prematurely stop antibiotics after symptoms subsided. Regardless of income, participants were more likely to seek an allopathic doctor for their children than for themselves.
Conclusions
The prevalent misuse of antibiotics among these community members reinforces the importance of conducting research to develop effective strategies for stemming the tide of antibiotic resistance in India’s villages.
Keywords: Antibiotic resistance, Social determinants, Global health, India, Rural health, Qualitative research
Author Biography
Nasia Safdar, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI USA
William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI USA
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