Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh.
BMC Health Serv Res. 2020 Jul 15;20(1):656. doi: 10.1186/s12913-020-05512-y.
Over-prescribing and inappropriate use of antibiotics contributes to the emergence of antimicrobial resistance (AMR). Few studies in low and middle-income settings have employed qualitative approaches to examine the drivers of antibiotic sale and dispensing across the full range of healthcare providers (HCPs). We aimed to explore understandings of the use and functions of antibiotics; awareness of AMR and perceived patient or customer demand and adherence among HCPs for human and animal medicine in Bangladesh.
We used an ethnographic approach to conduct face-to-face, in-depth interviews with 46 community HCPs in one urban and one rural area (Gazipur and Mirzapur districts respectively). We purposefully selected participants from four categories of provider in human and veterinary medicine: qualified; semi-qualified; auxiliary and unqualified. Using a grounded theory approach, thematic analysis was conducted using a framework method.
Antibiotics were considered a medicine of power that gives quick results and works against almost all diseases, including viruses. The price of antibiotics was equated with power such that expensive antibiotics were considered the most powerful medicines. Antibiotics were also seen as preventative medicines. While some providers were well informed about antibiotic resistance and its causes, others were completely unaware. Many providers mistook antibiotic resistance as the side effects of antibiotics, both in human and animal medicine. Despite varied knowledge, providers showed concern about antibiotic resistance but responsibility for inappropriate antibiotic use was shifted to the patients and clients including owners of livestock and animals.
Misconceptions and misinformation led to a wide range of inappropriate uses of antibiotics across the different categories of human and animal healthcare providers. Low awareness of antibiotic action and antibiotic resistance were apparent among healthcare providers, particularly those with little or no training and those in rural areas. Specific and targeted interventions to address AMR in Bangladesh should include educational messages on the rational use of antibiotics and how they work, targeting all types of healthcare providers. While tailored training for providers may increase understanding of antibiotic action and improve practices, more far-reaching structural changes are required to influence and increase responsibility for optimising antibiotic dispensing among all HCPs.
过度处方和不合理使用抗生素导致了抗菌药物耐药性（AMR）的出现。在中低收入国家，很少有研究采用定性方法来研究整个医疗保健提供者（HCP）范围内的抗生素销售和配药的驱动因素。我们旨在探讨 HCP 对人用和兽用抗生素的使用和功能的理解；对抗生素耐药性的认识以及对患者或客户的需求和对人用和兽用药物的依从性的感知。
我们采用人种学方法，在一个城市和一个农村地区（加济布尔和米尔扎布尔区）对 46 名社区 HCP 进行了面对面的深入访谈。我们从人医和兽医的四个提供者类别中有意选择了参与者：合格；半合格；辅助和不合格。使用扎根理论方法，采用框架方法进行主题分析。
抗生素被认为是一种有力量的药物，能迅速产生效果，几乎可以治疗所有疾病，包括病毒。抗生素的价格等同于权力，因此昂贵的抗生素被认为是最有效的药物。抗生素也被视为预防药物。虽然一些提供者对抗生素耐药性及其原因有很好的了解，但其他提供者则完全不知道。许多提供者将抗生素耐药性误认为是抗生素的副作用，无论是在人医还是兽医中。尽管知识各不相同，但提供者对抗生素耐药性表示关注，但将不适当使用抗生素的责任归咎于患者和客户，包括牲畜和动物的主人。
误解和错误信息导致不同类别人医和兽医保健提供者广泛不恰当地使用抗生素。保健提供者对抗生素作用和抗生素耐药性的认识较低，特别是那些接受过很少或没有培训的人和农村地区的提供者。孟加拉国应针对抗生素耐药性采取具体和有针对性的干预措施，包括关于抗生素合理使用及其作用的教育信息，针对所有类型的医疗保健提供者。虽然针对提供者的量身定制培训可能会增加对抗生素作用的理解并改善实践，但需要更广泛的结构性变革来影响和增加所有 HCP 优化抗生素配药的责任。
