Ndaki Pendo M, Mwanga Joseph R, Mushi Martha F, Konje Eveline T, Mwita Stanley M, Mshana Stephen E
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.
BMC Public Health. 2025 Feb 20;25(1):705. doi: 10.1186/s12889-025-21553-6.
The inappropriate use of antibiotics is a major driver of antimicrobial resistance worldwide. Antimicrobial resistance is an alarming public health problem leading to significant morbidity and mortality, particularly in low- and middle-income countries (LMICs). Thus, addressing the inappropriate use of antibiotics is key to reducing the development and spread of antimicrobial resistance. This systematic review aimed to synthesize evidence-based drivers of inappropriate use of antibiotics from qualitative data in low- and middle-income countries.
A search was conducted in Google Scholar, PubMed, Web of Science, and Cochrane Library databases to identify qualitative data from published English qualitative and mixed methods studies conducted in LMICs from 2010 until the first week of September 2023. A total of nine studies that used in-depth interviews and focus group discussions tools were included in the final analysis. The quality and risk of bias assessment of the included studies was conducted using the 10 criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for qualitative studies.
The themes identified in this review included knowledge on diseases symptoms, indications, and use of antibiotics; using previous prescription to purchase and use antibiotics for treating the current disease, fear of buying and using suboptimal antibiotics available in market; limited healthcare access hinders them getting doctor's prescription; economic constraints cause patients not to afford treatment; and perceived severity of illnesses determine when to go to health facility. It was uniformly observed that lack of proper knowledge and misinterpretation of symptoms facilitated unnecessary use of ABs. In addition, use of the previous prescription, recommendations from the drug sellers, unavailability of competent doctors for consultations, low socioeconomic status, mild disease symptoms were found to create an environment of self-medication and inappropriate AB use. Evidence of the findings was presented by active voices of the participants, who supported the explored themes.
It is recommended that health ministries in LMICs invest in providing quality health education in communities for proper use of antibiotics. In addition, improved health systems and economic status are critical for appropriate antibiotic use in LMICs.
抗生素的不当使用是全球抗菌药物耐药性的主要驱动因素。抗菌药物耐药性是一个令人担忧的公共卫生问题，会导致严重的发病率和死亡率，在低收入和中等收入国家（LMICs）尤为如此。因此，解决抗生素的不当使用问题是减少抗菌药物耐药性产生和传播的关键。本系统评价旨在从低收入和中等收入国家的定性数据中综合分析抗生素不当使用的循证驱动因素。
在谷歌学术、PubMed、科学网和考克兰图书馆数据库中进行检索，以识别2010年至2023年9月第一周在低收入和中等收入国家开展并发表的英文定性研究和混合方法研究中的定性数据。最终分析纳入了总共9项使用深入访谈和焦点小组讨论工具的研究。使用乔安娜·布里格斯研究所（JBI）定性研究批判性评价清单的10项标准对纳入研究的质量和偏倚风险进行评估。
本评价确定的主题包括对疾病症状、适应症和抗生素使用的了解；使用以前的处方购买和使用抗生素治疗当前疾病、担心购买和使用市场上效果欠佳的抗生素；医疗服务可及性有限阻碍他们获得医生处方；经济限制导致患者负担不起治疗费用；以及对疾病严重程度的认知决定何时前往医疗机构就诊。一致观察到，缺乏正确知识和对症状的误解助长了抗生素的不必要使用。此外，使用以前的处方、药品销售商的建议、缺乏能提供咨询的合格医生、社会经济地位低、疾病症状轻微，这些因素共同营造了自我用药和抗生素不当使用的环境。参与者的积极声音为这些发现提供了证据支持，他们认可所探讨的主题。
建议低收入和中等收入国家的卫生部投资于在社区提供高质量的健康教育，以促进抗生素的合理使用。此外，改善卫生系统和经济状况对于低收入和中等收入国家合理使用抗生素至关重要。
