Pathways to antibiotics in Bangladesh: A qualitative study investigating how and when households access medicine including antibiotics for humans or animals when they are ill


Autoři: Patricia Jane Lucas aff001;  Mohammad Rofi Uddin aff002;  Nirnita Khisa aff002;  S. M. Salim Akter aff002;  Leanne Unicomb aff002;  Papreen Nahar aff003;  Mohammad Aminul Islam aff002;  Fosiul Alam Nizame aff002;  Emily K. Rousham aff005
Působiště autorů: School for Policy Studies, University of Bristol, Bristol, United Kingdom aff001;  International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh aff002;  Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom aff003;  Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America aff004;  Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225270

Souhrn

Background

To understand how to reduce antibiotic use, greater knowledge is needed about the complexities of access in countries with loose regulation or enforcement. This study aimed to explore how households in Bangladesh were accessing antimicrobials for themselves and their domestic animals.

Methods

In-depth interviews were conducted with 48 households in one urban and one rural area. Households were purposively sampled from two lower income strata, prioritising those with under 5-year olds, older adults, household animals and minority groups. Households where someone was currently ill with a suspected infection (13 households) were invited for a follow-up interview. Framework analysis was used to explore access to healthcare and medicines.

Findings

People accessed medicines for themselves through five pathways: drugs shops, private clinics, government/charitable hospitals, community/family planning clinics, and specialised/private hospitals. Drug shops provided direct access to medicines for common, less serious and acute illnesses. For persistent or serious illnesses, the healthcare pathway may include contacts with several of these settings, but often relied on medicines provided by drug shops. In the 13 households with an unwell family member, most received at least one course of antibiotics for this illness. Multiple and incomplete dosing were common even when prescribed by a qualified doctor. Antibiotics were identified by their high cost compared to other medicines. Cost was a reported barrier to purchasing full courses of antibiotics. Few households in the urban area kept household animals. In this rural area, government animal health workers provided most care for large household animals (cows), but drug shops were also important.

Conclusions

In Bangladesh, unregulated drug shops provide an essential route to medicines including those prescribed in the formal sector. Wherever licensed suppliers are scarce and expensive, regulations which prohibit this supply risk removing access entirely for many people.

Klíčová slova:

Antibiotics – Antimicrobial resistance – Bangladesh – Fevers – Livestock – Medical doctors – Rural areas – Drug licensing


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Článek vyšel v časopise

PLOS One


2019 Číslo 11