Authors

Marco J. Haenssgen, University of Oxford Centre for Tropical Medicine
Nutcha Charoenboon, Mahidol Oxford Tropical Medicine Research Unit, Thailand
Giacomo Zanello, University of Reading
Mayfong Mayxay, Mahidol Oxford Tropical Medicine Research Unit, Laos
Felix Reed-Tsochas, Green Templeton College
Yoel Lubell, University of Oxford Centre for Tropical Medicine
Heiman Wertheim, Radbuod University
Jeffrey Lienert, Green Templeton College
Thipphaphone Xayavong, Ateneo de Manila University
Yuzana Khine Zaw, London School of Hygiene and Tropical Medicine
Amphayvone Thepkhamkong, Mahidol Oxford Tropical Medicine Research Unit, Laos
Nicksan Sithongdeng, Mahidol Oxford Tropical Medicine Research Unit, Laos
Nid Khamsoukthavong, Mahidol Oxford Tropical Medicine Research Unit, Laos
Chanthasone Phanthavong, Mahidol Oxford Tropical Medicine Research Unit, Laos
Somsanith Boualaiseng, Mahidol Oxford Tropical Medicine Research Unit, Laos
Souksakhone Vongsavang, Mahidol Oxford Tropical Medicine Research Unit, Laos
Kanokporn Kanokporn, Mahidol Oxford Tropical Medicine Research Unit, Thailand
Poowadon Chai-in, Mahidol Oxford Tropical Medicine Research Unit, Thailand
Patthanan Thavethanutthanawin, Mahidol Oxford Tropical Medicine Research Unit, Thailand
Thomas Althaus, University of Oxford Centre for Tropical Medicine
Rachel Claire Greer, Mahidol Oxford Tropical Medicine Research Unit, Thailand
Supalert Nedsuwan,, Chiangrai Regional Hospital
Tri Wangrangsimakul, Chiangrai Regional Hospital
Direk Limmathurotsakul, Mahidol Oxford Tropical Medicine Research Unit, Thailand
Elizabeth Elliott, University College London
Proochista Ariana, University of Oxford Centre for Tropical Medicine

Document Type

Article

Publication Date

8-20-2019

Abstract

Introduction Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research.

Objective To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers.

Design Observational study: cross-sectional rural health behaviour survey, representative of the population level.

Setting General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018.

Participants 2141 adult members (≥18 years) of the general rural population, representing 712 000 villagers.

Outcome measures Antibiotic-related knowledge, attitudes and practices across sites and healthcare access channels.

Findings Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like ‘anti-inflammatory medicine’ in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and ‘ampi’ in Salavan (75.6%; 95% CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI 0.01 to 0.23) and 0.53 in Salavan (95% CI 0.16 to 0.90).

Conclusions Locally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming ‘knowledge deficits’ alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards ‘AMR-sensitive interventions’ that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns.

Trial registration number Clinicaltrials.gov identifier NCT03241316.

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