一项关于刚果民主共和国金沙萨社区抗生素使用情况的定性研究。
A qualitative study on community use of antibiotics in Kinshasa, Democratic Republic of Congo.
机构信息
Ecole de Santé Publique, Université Catholique de Louvain UCLouvain, Brussels, Belgium.
Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Sakyo-ku, Kyoto, Japan.
出版信息
PLoS One. 2022 Apr 27;17(4):e0267544. doi: 10.1371/journal.pone.0267544. eCollection 2022.
BACKGROUND
Resistance to antibiotics is an increasing and major threat to global health. While the large majority of antimicrobial use occurs in the community where antibiotics are available without prescription, we did not find any studies investigating community-level factors influencing the inappropriate use of antibiotics in the Democratic Republic of Congo (DRC), where non-prescription antibiotic use is prevalent.
METHODS
This qualitative study was conducted from April 1st 2019 to May 5th 2019 and consisting of in-depth semi-structured interviews, utilizing purposive and snowball sampling schemes to recruit adult heads of households in the Pakadjuma slum, in Kinshasa, DRC. Participants with differing medical and educational backgrounds were selected. We employed a thematic analysis approach to explore community knowledge and use of antibiotics in the sampled population.
RESULTS
A total of 18 participants with a median age of 35 years were interviewed. The majority was female (77.7%), had at least a secondary education (83.4%), and unemployed (61.1%). We found that participants were familiar with the term "antibiotics", but had limited knowledge of the indications and risks of antibiotics, including the risk of antibiotic resistance. Inappropriate use of antibiotics was common and there was frequent self-medication of non-prescribed medicines for a range of non-indicated conditions such as menstruation. Having limited income was the most commonly reported reason for not visiting a health facility for appropriate health care.
CONCLUSION
Inappropriate use of antibiotics is a widespread practice and is influenced by lack of adequate knowledge of antibiotic use, indications and risks, prevalent self-medication, and financial barriers to accessing appropriate health care. There is need for both community education as well as structural interventions addressing poverty in order to reduce the inappropriate use of antibiotics in the Pakadjuma slum in Kinshasa.
背景
抗生素耐药性是对全球健康的日益严重和重大威胁。虽然绝大多数抗菌药物的使用发生在社区，在社区中抗生素无需处方即可获得，但我们没有发现任何研究调查影响刚果民主共和国（DRC）社区层面不合理使用抗生素的因素，在那里非处方抗生素的使用很普遍。
方法
这项定性研究于 2019 年 4 月 1 日至 5 月 5 日进行，包括深入的半结构化访谈，利用目的和滚雪球抽样方案在金沙萨 Pakadjuma 贫民窟招募成年户主。选择具有不同医学和教育背景的参与者。我们采用主题分析方法来探索抽样人群中社区对抗生素的知识和使用情况。
结果
共访谈了 18 名中位数年龄为 35 岁的参与者。大多数是女性（77.7%），至少受过中等教育（83.4%），无业（61.1%）。我们发现参与者熟悉“抗生素”一词，但对抗生素的适应症和风险，包括抗生素耐药的风险知之甚少。抗生素的不合理使用很常见，经常自行使用未经处方的药物治疗各种非适应症，例如月经。收入有限是最常报道的不去医疗机构接受适当医疗保健的原因。
结论
抗生素的不合理使用是一种普遍做法，其原因是对抗生素使用、适应症和风险、普遍存在的自我用药以及获得适当医疗保健的经济障碍缺乏足够的了解。需要进行社区教育以及解决贫困问题的结构性干预措施，以减少金沙萨 Pakadjuma 贫民窟中抗生素的不合理使用。
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