Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom.
Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Am J Trop Med Hyg. 2019 Jun;100(6):1378-1390. doi: 10.4269/ajtmh.18-0171.
Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque's "Access to Healthcare" framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of "ABR" was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people's understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.
南非农村地区人群对获取和使用抗生素的认知和实践（ABACUS）仍研究不足。通过对该国东北部的四个村庄进行案例研究，我们旨在调查与抗生素相关的大众观念和社会实践，为促进患者合理使用抗生素提供基于社会干预的措施。为此，我们调查了社区成员（村庄居民）在哪里获取和购买药物，以及他们对抗生素和抗生素耐药性（ABR）的理解。这项定性研究是 ABACUS 多国项目的一部分，使用了访谈和焦点小组讨论的方法。我们从位于姆普马兰加省的 Agincourt 健康和人口监测系统中招募了 60 名社区成员作为样本，招募时间为 2017 年 4 月至 8 月。我们使用了 Levesque 的“获取医疗保健”框架中提出的五种获取医疗保健的能力：寻求、到达、支付、感知和参与。受访者报告称从合法来源获得抗生素：在政府初级保健诊所由护士开具处方，或由私人药剂师在私人药店开具处方。没有描述非法购买抗生素的情况。有些人按照指示完成了处方，而有些人则没有。有些人会保留抗生素以备将来感染时使用。由于对结核病和艾滋病治疗方案有所了解，一些社区成员在将“ABR”的概念翻译成相关的茨瓦纳语时能够理解这个概念。我们的研究结果表明，围绕抗生素销售的监管得到了执行。需要加强安全使用抗生素的宣传，让人们了解为什么需要对抗生素耐药性。因此，针对具体情况开展的教育宣传活动，利用人们对抗生素的理解，并借鉴其他疾病的经验，可能是促进安全使用抗生素的一个重要且可行的手段。
