坦桑尼亚药店供应抗生素的实践和动机:一项定性研究。

Practices and motives behind antibiotics provision in drug outlets in Tanzania: A qualitative study.

机构信息

Department of Biostatistics, Epidemiology and Behavioral Sciences, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.

Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.

出版信息

PLoS One. 2023 Aug 31;18(8):e0290638. doi: 10.1371/journal.pone.0290638. eCollection 2023.

Abstract

Dispensing antibiotics without prescription is among the major factors leading to antimicrobial resistance. Dispensing of antibiotics without prescription has negative impact at the individual and societal level leading to poor patient outcomes, and increased risks of resistant bacteria facilitated by inappropriate choice of antibiotics doses/courses. Antimicrobial resistance is a global public health threat which is projected to cause 10 million deaths by 2050 if no significant actions are taken to address this problem This study explored the practices and motives behind dispensing of antibiotics without prescription among community drug outlets in Tanzania. Finding of this study provides more strategies to antibiotics stewardship intervention. In-depth interviews with 28 drug dispensers were conducted for three months consecutively between November 2019 and January 2020 in 12 community pharmacies and 16 Accredited Drug Dispensing Outlets (ADDOs) in the Mwanza, Kilimanjaro and Mbeya regions of Tanzania. Transcripts were coded and analyzed thematically using NVivo12 software. Majority of dispensers admitted to providing antibiotics without prescriptions, selling incomplete courses of antibiotics and not giving detailed instructions to customers on how to use the drugs. These practices were motivated by several factors including customers' pressure/customers' demands, business orientation-financial gain of drug dispensers, and low purchasing power of patients/customers. It is important to address the motives behind the unauthorized dispensing antibiotics. On top of the existing regulation and enforcement, we recommend the government to empower customers with education and purchasing power of drugs which can enhance the dispensers adherence to the dispensing regulations. Furthermore, we recommend ethnographic research to inform antibiotic stewardship interventions going beyond awareness raising, education and advocacy campaigns. This will address structural drivers of AMR such as poverty and inadequate government health services, and the disconnect between public messaging and/or policy and the public itself.

摘要

未经处方配药是导致抗菌药物耐药的主要因素之一。未经处方配药会对个人和社会层面产生负面影响,导致患者治疗效果不佳,并因抗生素剂量/疗程选择不当而增加产生耐药菌的风险。抗菌药物耐药性是一个全球性的公共卫生威胁,如果不采取重大行动来解决这个问题,预计到 2050 年将导致 1000 万人死亡。本研究探讨了坦桑尼亚社区药店未经处方配药的做法和动机。这项研究的发现为抗生素管理干预提供了更多策略。2019 年 11 月至 2020 年 1 月,在坦桑尼亚的姆万扎、乞力马扎罗和姆贝亚地区的 12 家社区药店和 16 家认证药品配药处(ADDO),连续三个月对 28 名药品配药师进行了深入访谈。使用 NVivo12 软件对转录本进行编码和主题分析。大多数配药师承认未经处方提供抗生素、出售不完整的抗生素疗程,并且未向顾客详细说明如何使用药物。这些做法受到多种因素的驱动,包括顾客的压力/顾客的需求、以商业为导向-药品配药师的经济利益,以及患者/顾客的购买力低。解决未经授权配药抗生素的动机非常重要。除了现有的监管和执法措施,我们建议政府通过教育和提高患者/顾客的药物购买力来赋予顾客权力,这可以增强配药师遵守配药规定的能力。此外,我们建议进行民族志研究,为抗生素管理干预提供信息,超越提高认识、教育和宣传活动。这将解决贫困和政府卫生服务不足等导致 AMR 的结构性驱动因素,以及公共信息传递和/或政策与公众本身之间的脱节问题。

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