Instituto Superior de Ciências de Saúde - ISCISA, Maputo, Mozambique; School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa.
School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa; Human Sciences Research Council, Durban, South Africa.
Public Health. 2019 Mar;168:92-101. doi: 10.1016/j.puhe.2018.11.018. Epub 2019 Feb 1.
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.
Systematic scoping review.
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.
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.
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.
CRD42017072954.
自我医疗用抗生素（SMA）是一个全球性关注的问题，在低收入和中等收入国家（LMICs）发生率更高。尽管全球都在努力控制和促进抗生素的合理使用，但 SMA 的持续实践仍使个人和社区面临抗生素耐药性和一系列其他抗生素副作用的风险。本系统范围综述绘制了这些环境中影响 SMA 的因素的证据。
系统范围综述。
搜索策略包括电子数据库，包括 PubMed、Web of science、Science Direct、EBSCOhost、Google Scholar、BioMed Central 和世界卫生组织图书馆。采用 PRISMA P 指南和 Arksey 和 O'Malley 的框架。主题分析用于确定影响 LMICs 中 SMA 实践的因素。使用混合方法评估工具（MMAT），第 2011 版，评估纳入的主要研究的质量。
15 项研究符合纳入标准。研究包括来自以下 LMICs 的参与者：危地马拉、印度、印度尼西亚、肯尼亚、老挝、尼泊尔、尼日利亚、巴基斯坦、斯里兰卡和也门。审查结果强调 SMA 的高患病率相当高，范围从 8.1%到 93%，与参与者的教育水平、月收入和性别有关。可及性、可负担性和卫生设施的条件以及寻求医疗保健的行为是影响 LMICs 中 SMA 的因素。健康状况，如喉咙痛、普通感冒、咳嗽、头痛、牙痛、流感样症状、止痛、发烧、流鼻涕、牙痛、上呼吸道感染和尿路感染，是导致 SMA 实践的主要投诉。
有相当多的研究证据主要来自亚洲的一些 LMICs，来自非洲 LMICs 的证据较少。与卫生系统结构和条件以及寻求医疗保健行为相关的社会文化健康决定因素是影响 SMA 的主要因素。需要对影响非处方使用抗生素的因素进行基于背景和全面的研究，以制定基于证据的策略来正确处理抗生素的使用并遏制抗微生物药物耐药性问题，特别是在 LMICs 中。
PROSPERO 注册：CRD42017072954。
