Mutua Edna, Davis A, Laurie E, Lembo T, Melubo M, Mnzava K, Msoka E, Nasua F, Ndibohoye T, Zadoks R, Mmbaga B, Mshana S
School of Social and Political Sciences, School of Health and Wellbeing, University of Glasgow, 11 Chapel Lane, Glasgow, G11 6EW, UK.
School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK.
Monash Bioeth Rev. 2024 Dec;42(Suppl 1):125-149. doi: 10.1007/s40592-024-00208-z. Epub 2024 Oct 17.
Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to "misuse" and "overuse", particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice "proper" use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics.
This reflection is anchored on Jarrett Zigon's morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania's National Action Plans on antimicrobial resistance was conducted.
Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with "inappropriate" behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery.
Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur.
抗菌药物耐药性（AMR）是对人类和牲畜健康的全球性威胁。尽管抗菌药物耐药性是由抗菌药物的使用所驱动，但它通常被归因于“滥用”和“过度使用”，尤其是抗生素。为了遏制耐药性，全球呼吁采用新的道德人格形式，以践行“正确”使用，包括抗菌药物，尤其是抗生素的处方、配药和消费。本文旨在思考一些复杂问题，即道德是如何在关于坦桑尼亚人类和牲畜健康中抗菌药物处方、配药和使用所收集的数据中呈现的AMR话语中得以体现的，主要聚焦于抗生素。
这种思考基于贾勒特·齐贡的道德框架，该框架由话语的三个维度组成；制度性、公共性和体现性倾向。我们在此框架内使用的数据来自一项针对坦桑尼亚北部人类和动物医疗服务提供者及社区成员的定性研究。通过28次深入访谈和10次焦点小组讨论收集数据，并在翻译和转录后通过内容分析进行分析。此外，还对坦桑尼亚国家抗菌药物耐药性行动计划进行了审查。
该框架的应用展示了坦桑尼亚国家行动计划所阐述的制度性道德话语、公共话语以及人类和动物医疗服务提供者及社区成员的体现性倾向/生活经历中的趋同点和分歧点。我们表明，抗菌药物耐药性不仅与药物开处方者、配药者和使用者的“不当”行为有关，还与卫生系统和服务提供方面的缺陷有关。
可能与抗菌药物耐药性发展相关的抗生素配药和使用做法不应脱离其发生的更广泛健康背景来孤立看待。
