Barasa Violet
Institute of Development Studies, University of Sussex, Brighton, United Kingdom.
Front Glob Womens Health. 2024 Jul 18;5:1429203. doi: 10.3389/fgwh.2024.1429203. eCollection 2024.
Inappropriate use of antimicrobials is a major driver of AMR in low-resource settings, where the regulation of supply for pharmaceuticals is limited. In pastoralist settings in Tanzania, men and women face varying degrees of exposure to antibiotics due to gender relations that shape access and use of antimicrobials. For example, critical limitations in healthcare systems in these settings, including inadequate coverage of health services put people at risk of AMR, as families routinely administer self-treatment at home with antimicrobials. However, approaches to understanding AMR drivers and risk distribution, including the One Health approach, have paid little attention to these gender considerations. Understanding differences in access and use of antimicrobials can inform interventions to reduce AMR risk in community settings. This paper focuses on the gendered risk of AMR through a study of gender and social determinants of access to and use of antimicrobials in low-resource pastoralist settings in Tanzania.
A mixed methods approach involving household surveys, interviews and ethnographic participant observation in homes and sites of healthcare provision was used, to investigate access and administration of antibiotics in 379 adults in Naiti, Monduli district in northern Tanzania. A purposive sampling technique was used to recruit study participants and all data was disaggregated by sex, age and gender.
Gender and age are significantly associated with the use of antibiotics without a prescription in the study population. Young people aged 18-24 are more likely to use unprescribed antibiotics than older people and may be at a higher risk of AMR. Meanwhile, although more men purchase unprescribed antibiotics than women, the administration of these drugs is more common among women. This is because men control how women use drugs at the household level.
AMR interventions must consider the critical importance of adopting and implementing a gender-sensitive One Health approach, as gender interacts with other social determinants of health to shape AMR risk through access to and use of antimicrobials, particularly in resource-limited pastoralist settings.
在药品供应监管有限的资源匮乏地区，抗菌药物的不当使用是抗菌药物耐药性（AMR）的主要驱动因素。在坦桑尼亚的游牧地区，由于性别关系影响了抗菌药物的获取和使用，男性和女性面临着不同程度的抗生素接触风险。例如，这些地区医疗系统存在严重局限性，包括卫生服务覆盖不足，这使人们面临抗菌药物耐药性风险，因为家庭经常在家自行使用抗菌药物进行治疗。然而，包括“同一健康”方法在内的理解抗菌药物耐药性驱动因素和风险分布的方法，很少关注这些性别因素。了解抗菌药物获取和使用的差异可为降低社区环境中抗菌药物耐药性风险的干预措施提供信息。本文通过研究坦桑尼亚资源匮乏的游牧地区获取和使用抗菌药物的性别及社会决定因素，聚焦于抗菌药物耐药性的性别风险。
采用混合方法，包括家庭调查、访谈以及在家庭和医疗服务场所进行人种志参与观察，以调查坦桑尼亚北部蒙杜利区奈蒂的379名成年人抗生素的获取和使用情况。采用目的抽样技术招募研究参与者，所有数据按性别、年龄和社会性别进行分类。
在研究人群中，性别和年龄与无处方使用抗生素显著相关。18至24岁的年轻人比年长者更有可能使用非处方抗生素，可能面临更高的抗菌药物耐药性风险。同时，虽然购买非处方抗生素的男性多于女性，但这些药物的使用在女性中更为普遍。这是因为在家庭层面男性控制着女性如何用药。
抗菌药物耐药性干预措施必须考虑采用和实施对性别问题有敏感认识的“同一健康”方法的至关重要性，因为性别与其他健康社会决定因素相互作用，通过获取和使用抗菌药物来塑造抗菌药物耐药性风险，特别是在资源有限的游牧地区。
