Vienna Evaluation Unit, Médecins Sans Frontières, Vienna, Austria.
Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium.
PLoS One. 2021 Nov 19;16(11):e0260096. doi: 10.1371/journal.pone.0260096. eCollection 2021.
Antibiotic resistance is a growing public health threat. In Afghanistan, high levels of indiscriminate antibiotic use exist, and healthcare programmes are not informed by understanding of local attitudes towards rational antibiotic use. Médecins Sans Frontières is an international non-governmental organization providing healthcare services to the Ahmad Shah Baba (ASB) District Hospital in Kabul, Afghanistan, since 2009. This mixed-methods study aimed to explore the perceptions and attitudes toward antibiotics among patients, prescribers, and pharmacists in the ASB District hospital outpatient department.
Knowledge of antibiotics including their purpose and function, how and why they are used, and drivers for choice of antibiotic was examined at patient, prescriber, and provider-level. The first phase of the study, an exploratory qualitative component using an interpretative approach, was used to inform the second phase, a structured survey. Thirty-six interviews were conducted with 39 participants (21 patients or caretakers and 18 hospital health workers). Three hundred and fifty-one (351) patients and caretakers completed the second phase, the structured survey. This study found that poor knowledge of antibiotics and antibiotic resistance is a driving factor for inappropriate use of antibiotics. Participant perceptions of living in a polluted environment drove the high demand and perceived 'need' for antibiotics: patients, doctors and pharmacists alike consider dirty and dusty living conditions as causes of 'disease' in the body, requiring antibiotics to 'clean' and 'strengthen' it.
Findings highlight the need for strategies to improve awareness and knowledge of the general public, improve practice of doctors and pharmacists, regulate antibiotic dispensing in private pharmacies, and implement antibiotic stewardship in hospitals.
抗生素耐药性是日益严重的公共卫生威胁。在阿富汗，存在大量滥用抗生素的情况，而医疗保健计划并未了解当地对抗生素合理使用的态度。无国界医生组织自 2009 年以来一直在阿富汗喀布尔的艾哈迈德沙阿巴巴区医院提供医疗服务。这项混合方法研究旨在探索艾哈迈德沙阿巴巴区医院门诊部门的患者、处方者和药剂师对抗生素的看法和态度。
研究考察了患者、处方者和提供者层面上对抗生素的了解程度，包括其用途和功能、使用方式和原因，以及选择抗生素的驱动因素。该研究的第一阶段是使用解释性方法进行探索性定性部分，旨在为第二阶段，即结构化调查提供信息。共进行了 36 次访谈，涉及 39 名参与者（21 名患者或护理人员和 18 名医院卫生工作者）。351 名患者和护理人员完成了第二阶段，即结构化调查。这项研究发现，对抗生素和抗生素耐药性的知识匮乏是抗生素不当使用的驱动因素。参与者认为生活在污染环境中是导致对抗生素需求高和认为有“需要”使用抗生素的原因：患者、医生和药剂师都认为肮脏和尘土飞扬的生活条件是体内“疾病”的原因，需要抗生素来“清洁”和“增强”身体。
研究结果强调需要采取策略来提高公众的认识和知识水平，改善医生和药剂师的实践，规范私人药店的抗生素配药，并在医院实施抗生素管理。
