RT Journal Article
SR Electronic
T1 Antibiotic stories: a mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e006920
DO 10.1136/bmjgh-2021-006920
VO 6
IS 11
A1 Justin Dixon
A1 Eleanor Elizabeth MacPherson
A1 Susan Nayiga
A1 Salome Manyau
A1 Christine Nabirye
A1 Miriam Kayendeke
A1 Esnart Sanudi
A1 Alex Nkaombe
A1 Portia Mareke
A1 Kenny Sitole
A1 Coll de Lima Hutchison
A1 John Bradley
A1 Shunmay Yeung
A1 Rashida Abbas Ferrand
A1 Sham Lal
A1 Chrissy Roberts
A1 Edward Green
A1 Laurie Denyer Willis
A1 Sarah G Staedke
A1 Clare I R Chandler
YR 2021
UL http://gh.bmj.com/content/6/11/e006920.abstract
AB Background As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.Design This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.Results The most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.Conclusions Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.Data are available upon reasonable request. Data are available upon request from the corresponding author.