1921
Volume 100, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque’s “Access to Healthcare” framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of “ABR” was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people’s understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. Brink AJ, van den Bergh D, Mendelson M, Richards GA, , 2016. Passing the baton to pharmacists and nurses: new models of antibiotic stewardship for South Africa? S Afr Med J 106: 947948. [Google Scholar]
  2. Tadesse BT, Ashley EA, Ongarello S, Havumaki J, Wijegoonewardena M, González IJ, Dittrich S, , 2017. Antimicrobial resistance in Africa: a systematic review. BMC Infect Dis 17: 616. [Google Scholar]
  3. O’Neill J, , 2016. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. The Review on Antimicrobial Resistance. London, United Kingdom: HM Government and Welcome Trust. [Google Scholar]
  4. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, Vlieghe E, Hara GL, Gould IM, Goossens H, , 2013. Antibiotic resistance - the need for global solutions. Lancet Infect Dis 13: 10571098. [Google Scholar]
  5. NICE, 2015. Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use. London, United Kingdom: The National Institute for Health and Care Excellence. [Google Scholar]
  6. Papoutsi C, Mattick K, Pearson M, Brennan N, Briscoe S, Wong G, , 2017. Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review. J Antimicrob Chemother 72: 24182430. [Google Scholar]
  7. Apalata T, 2011. Global antibiotic resistance partnership - situation analysis: antibiotic use and resistance in South Africa. S Afr Med J 101: 549596. [Google Scholar]
  8. Agyepong IA, 2017. The path to longer and healthier lives for all Africans by 2030: the Lancet Commission on the future of health in sub-Saharan Africa. Lancet 390: 28032859. [Google Scholar]
  9. Leopold SJ, van Leth F, Tarekegn H, Schultsz C, , 2014. Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa: a systematic review. J Antimicrob Chemother 69: 23372353. [Google Scholar]
  10. Leung E, Weil DE, Raviglione M, Nakatani K, , 2011. The WHO Policy Package to Combat Antimicrobial Resistance. Available at: http://www.who.int/bulletin/volumes/89/5/11-088435/en/. Accessed February 20, 2018. [Google Scholar]
  11. CDDEP, 2018. Resistance Map. Available at: https://resistancemap.cddep.org/AntibioticResistance.php. Accessed December 10, 2018. [Google Scholar]
  12. Essack S, Desta A, Abotsi R, Agoba E, , 2017. Antimicrobial resistance in the WHO African region: current status and roadmap for action. J Public Health 39: 813. [Google Scholar]
  13. Chandler C, Hutchinson E, Hutchison C, , 2016. Addressing Antimicrobial Resistance through Social Theory: An Anthropologically Oriented Report. Technical Report. London, United Kingdom: London School of Hygiene & Tropical Medicine, 142. [Google Scholar]
  14. Wood F, , 2016. Antimicrobial Resistance and Medical Sociology: Research Brief. Cardiff, Wales: ESRC AMR Research Champion/University of Bristol, Cardiff University, 115. [Google Scholar]
  15. Haak H, Radyowijati A, Sosa ADJ, Byarugaba DK, Amabile-Cuevas CF, Hsueh PR, Kariuki S, Okeke IN, , 2010. Determinants of antimicrobial use: poorly understood, poorly researched. , eds. Antimicrobial Resistance in Developing Countries. New York, NY: Springer, 283300. [Google Scholar]
  16. Broom A, Kirby E, Gibson AF, Post JJ, Broom J, , 2017. Myth, manners, and medical ritual: defensive medicine and the fetish of antibiotics. Qual Health Res 27: 19942005. [Google Scholar]
  17. Bledsoe CH, Goubaud MF, , 1985. The reinterpretation of western pharmaceuticals among the Mende of Sierra Leone. Soc Sci Med 21: 275282. [Google Scholar]
  18. van der Geest S, , 1987. Self-care and the informal sale of drugs in South Cameroon. Soc Sci Med 25: 293305. [Google Scholar]
  19. van der Geest S, , 1982. Part 1: the illegal distribution of western medicines in developing countries: pharmacists, drug pedlars, injection doctors and others. A bibliographic exploration. Med Anthropol 6: 197219. [Google Scholar]
  20. van der Geest S, Whyte SR, , 1989. The charm of medicines: metaphors and metonyms. Med Anthropol Q 3: 345367. [Google Scholar]
  21. Whyte SR, van der Geest S, Hardon A, , 2002. Social Lives of Medicines. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]
  22. Vuckovic N, , 1999. Fast relief: buying time with medications. Med Anthropol Q 13: 5168. [Google Scholar]
  23. Goudge J, Gilson L, Russell S, Gumede T, Mills A, , 2009. The household costs of illness in rural South Africa with free public primary care and hospital exemptions for the poor. J Trop Med Int Health 14: 458467. [Google Scholar]
  24. Cunnama L, Honda A, , 2016. A mother’s choice: a qualitative study of mothers’ health seeking behaviour for their children with acute diarrhoea. BMC Health Serv Res 16: 669. [Google Scholar]
  25. Goudge J, Russell S, Gilson L, Gumede T, Tollman S, Mills A, , 2009. Illness related impoverishment in rural South Africa: why does social protection work for some households but not others? J Int Dev 21: 231251. [Google Scholar]
  26. Goudge J, Gilson L, Russell S, Gumede T, Mills A, , 2009. Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa. BMC Health Serv Res 9: 75. [Google Scholar]
  27. Jewkes R, Abrahams N, Mvo Z, , 1998. Why do nurses abuse patients? Reflections from South African obstetric services. Soc Sci Med 47: 17811795. [Google Scholar]
  28. van Heerden A, Harris DM, van Rooyen H, Barnabas RV, Ramanathan N, Ngcobo N, Mpiyakhe Z, Comulada WS, , 2017. Perceived mHealth barriers and benefits for home-based HIV testing and counseling and other care: qualitative findings from health officials, community health workers, and persons living with HIV in South Africa. Soc Sci Med 183: 97105. [Google Scholar]
  29. Ameh S, Gomez-Olive FX, Kahn K, Tollman SM, Klipstein-Grobusch K, , 2014. Predictors of health care use by adults 50 years and over in a rural South African setting. Glob Health Action 7: 24771. [Google Scholar]
  30. NDOH, 2017. Essential Drugs Programme (EDP). Available at: http://www.health.gov.za/index.php/essential-drugs-programme-edp . Accessed October 30, 2017. [Google Scholar]
  31. GARP, 2010. The Global Antibiotic Resistance Partnership Report: South Africa. Available at: https://cddep.org/partners/global-antibiotic-resistance-partnership/garp-network/garp-south-africa/. Accessed Febraury 9, 2018. [Google Scholar]
  32. NDOH, 2015. Antimicrobial Resistance - Background Document. Pretoria, South Africa: National Department of Health. [Google Scholar]
  33. Abera Abaerei A, Ncayiyana J, Levin J, , 2017. Health-care utilization and associated factors in Gauteng province, South Africa. Glob Health Action 10: 1305765. [Google Scholar]
  34. Wertheim HFL, 2017. Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: finding targets for social interventions to improve appropriate antimicrobial use—an observational multi-centre study. Wellcome Open Res 2: 58. [Google Scholar]
  35. Sen AK, , 1990. Development as Capability Expansion. Oxford, United Kingdom: Oxford University Press. [Google Scholar]
  36. Sen A, , 1999. Development as Freedom. Oxford, United Kingdom: Oxford University Press. [Google Scholar]
  37. Levesque J-F, Harris MF, Russell G, , 2013. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 12: 18. [Google Scholar]
  38. Shengelia B, Murray CJ, Adams OB, Murray CJL, Evans DB, , 2003. Beyond access and utilization: defining and measuring health system coverage. , eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, Switzerland: World Health Organization, 221234. [Google Scholar]
  39. Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Hafizur Rahman M, , 2008. Poverty and access to health care in developing countries. Ann N Y Acad Sci 1136: 161171. [Google Scholar]
  40. Aday LA, Andersen R, , 1974. A framework for the study of access to medical care. Health Serv Res 9: 208220. [Google Scholar]
  41. Sankoh O, Byass P, , 2012. The INDEPTH Network: Filling Vital Gaps in Global Epidemiology. Oxford, United Kingdom: Oxford University Press. [Google Scholar]
  42. Kinsman J, Norris SA, Kahn K, Twine R, Riggle K, Edin K, Mathebula J, Ngobeni S, Monareng N, Micklesfield LK, , 2015. A model for promoting physical activity among rural South African adolescent girls. Glob Health Action 8: 28790. [Google Scholar]
  43. Kahn K, 2012. Profile: agincourt health and socio-demographic surveillance system. Int J Epidemiol 41: 9881001. [Google Scholar]
  44. Sartorius B, , 2013. Modelling determinants, impact, and space-time risk of age-specific mortality in rural South Africa: integrating methods to enhance policy relevance. Glob Health Action 6: 19239. [Google Scholar]
  45. Agincourt, 2014. Agincourt Village Fact Sheet. Acornhoek, South Africa: MRC/Wits Agincourt HDSS. [Google Scholar]
  46. Twine R, Hundt GL, Kahn K, , 2017. The ‘experimental public’ in longitudinal health research: views of local leaders and service providers in rural South Africa. Glob Health Res Policy 2: 26. [Google Scholar]
  47. Kahn K, Tollman SM, Collinson MA, Clark SJ, Twine R, Clark BD, Shabangu M, Gómez-Olivé FX, Mokoena O, Garenne ML, , 2007. Research into health, population and social transitions in rural South Africa: data and methods of the Agincourt Health and Demographic Surveillance System. Scand J Public Health 35: 820. [Google Scholar]
  48. Anstey Watkins JOT, , 2016. The Vutivi Study: Understanding the Potential Role for Appropriate Digital Technological Solutions in the Innovation of Health System Design, Implementation and Normalisation in Rural South Africa for both Patients and Health-Workers: A Critical Exploratory Analysis. PhD Thesis, Warwick Medical School, The University of Warwick, Coventry, United Kingdom, 54139. [Google Scholar]
  49. Kitzinger J, , 1994. The methodology of focus groups: the importance of interaction between research participants. Soc Health Illness 16: 103121. [Google Scholar]
  50. Braun V, Clarke V, , 2006. Using thematic analysis in psychology. Qual Res Psychol 3: 77101. [Google Scholar]
  51. Crowe S, Brugha R, Clarke N, , 2017. ‘You do not cross them’: hierarchy and emotion in doctors’ narratives of power relations in specialist training. Soc Sci Med 186: 7077. [Google Scholar]
  52. Kabudula CW, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Clark SJ, Tollman S, , 2017. Progression of the epidemiological transition in a rural South African setting: findings from population surveillance in Agincourt, 1993–2013. BMC Public Health 17: 424. [Google Scholar]
  53. Tong A, Sainsbury P, Craig J, , 2007. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19: 349357. [Google Scholar]
  54. Friend-du Preez N, Cameron N, Griffiths P, , 2013. “So they believe that if the baby is sick you must give drugs...” the importance of medicines in health-seeking behaviour for childhood illnesses in urban South Africa. Soc Sci Med 92: 4352. [Google Scholar]
  55. Bogart LM, Chetty S, Giddy J, Sypek A, Sticklor L, Walensky RP, Losina E, Katz JN, Bassett IV, , 2013. Barriers to care among people living with HIV in South Africa: contrasts between patient and healthcare provider perspectives. AIDS Care 25: 843853. [Google Scholar]
  56. van der Hoeven M, Kruger A, Greeff M, , 2012. Differences in health care seeking behaviour between rural and urban communities in South Africa. Int J Equity Health 11: 31. [Google Scholar]
  57. Semenya SS, Potgieter MJ, , 2014. Bapedi traditional healers in the Limpopo Province, South Africa: their socio-cultural profile and traditional healing practice. J Ethnobiol Ethnomed 10: 4. [Google Scholar]
  58. Maimela E, Geertruyden J-P, Alberts M, Modjadji SE, Meulemans H, Fraeyman J, Bastiaens H, , 2015. The perceptions and perspectives of patients and health care providers on chronic diseases management in rural South Africa: a qualitative study. BMC Health Serv Res 15: 143. [Google Scholar]
  59. Dillip A, Embrey M, Shekalaghe E, Ross-Degnan D, Vialle-Valentin C, Kimatta S, Liana J, Rutta E, Valimba R, Chalker J, , 2015. What motivates antibiotic dispensing in accredited drug dispensing outlets in Tanzania? A qualitative study. Antimicrob Resist Infect Control 4: 30. [Google Scholar]
  60. Kalungia AC, Burger J, Godman B, Costa JO, Simuwelu C, , 2016. Non-prescription sale and dispensing of antibiotics in community pharmacies in Zambia. Expert Rev Anti Infect Ther 14: 12151223. [Google Scholar]
  61. Yu M, Zhao G, Lundborg CS, Zhu Y, Zhao Q, Xu B, , 2014. Knowledge, attitudes, and practices of parents in rural China on the use of antibiotics in children: a cross-sectional study. BMC Infect Dis 14: 112. [Google Scholar]
  62. Luque-Fernandez MA, Van Cutsem G, Goemaere E, Hilderbrand K, Schomaker M, Mantangana N, Mathee S, Dubula V, Ford N, Hernán M, , 2013. Effectiveness of patient adherence groups as a model of care for stable patients on antiretroviral therapy in Khayelitsha, Cape Town, South Africa. PLoS One 8: e56088. [Google Scholar]
  63. Llewelyn MJ, Fitzpatrick JM, Darwin E, Gorton C, Paul J, Peto TE, Yardley L, Hopkins S, Walker AS, , 2017. The antibiotic course has had its day. BMJ 358: j3418. [Google Scholar]
  64. Peltzer K, Naidoo P, Matseke G, Louw J, Mchunu G, Tutshana B, , 2012. Prevalence of psychological distress and associated factors in tuberculosis patients in public primary care clinics in South Africa. BMC Psychiatry 12: 89. [Google Scholar]
  65. Sherr L, Cluver LD, Betancourt TS, Kellerman SE, Richter LM, Desmond C, , 2014. Evidence of impact: health, psychological and social effects of adult HIV on children. AIDS 28: S251S259. [Google Scholar]
  66. Tariq S, Hoffman S, Ramjee G, Mantell JE, Phillip JL, Blanchard K, Lince-Deroche N, Exner TM, , 2018. “I did not see a need to get tested before, everything was going well with my health”: a qualitative study of HIV-testing decision-making in Kwazulu-Natal, South Africa. AIDS Care 30: 3239. [Google Scholar]
  67. Karim SSA, Churchyard GJ, Karim QA, Lawn SD, , 2009. HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet 374: 921933. [Google Scholar]
  68. Naidoo P, Simbayi L, Labadarios D, Ntsepe Y, Bikitsha N, Khan G, Sewpaul R, Moyo S, Rehle T, , 2016. Predictors of knowledge about tuberculosis: results from SANHANES I, a national, cross-sectional household survey in South Africa. BMC Public Health 16: 276. [Google Scholar]
  69. Gilgun J, , 2010. Reflexivity and qualitative research. Curr Issues Qual Res 1: 18. [Google Scholar]
  70. Norris P, Churchward M, Fa’alau F, Va’ai C, , 2009. Understanding and use of antibiotics amongst Samoan people in New Zealand. J Prim Health Care 1: 3035. [Google Scholar]
  71. Kesten JM, Bhattacharya A, Ashiru-Oredope D, Gobin M, Audrey S, , 2018. The Antibiotic Guardian campaign: a qualitative evaluation of an online pledge-based system focused on making better use of antibiotics. BMC Public Health 18: 5. [Google Scholar]
  72. DOH, 2018. Become an Antibiotic Guardian. Available at: http://antibioticguardian.com/south-africa/. Accessed December 7, 2018. [Google Scholar]
  73. Cox J, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas M, Gould I, Hara GL, , 2017. Antibiotic stewardship in low- and middle-income countries: the same but different? Clin Microbiol Infect 23: 812818. [Google Scholar]
  74. Mendelson M, Matsoso M, , 2015. The South African Antimicrobial Resistance Strategy Framework. Monitoring, Surveillance and National Plans. Cape Town, South Africa: AMR Control, 5461. [Google Scholar]
  75. NDOH, 2017. Guidelines on Implementation of the Antimicrobial Strategy in South Africa: One Health Approach & Governance. Pretoria, South Africa: Ministerial Advisory Committee on Antimicrobial Resistance, South African National Department of Health. [Google Scholar]
  76. Gelband H, Molly Miller P, Pant S, Gandra S, Levinson J, Barter D, White A, Laxminarayan R, , 2015. The state of the world’s antibiotics 2015. Wound Healing South Afr 8: 3034. [Google Scholar]
  77. NHS, 2017. Treating Your Infection without Antibiotics. Available at: https://www.nhs.uk/video/Pages/treating-your-infection-without-antibiotics.aspx. Accessed October 31, 2017. [Google Scholar]
  78. Charoenboon N, Haenssgen MJ, Warapikuptanun P, Xayavong T, Zaw YK, , 2019. Translating antimicrobial resistance: a case study of context and consequences of antibiotic-related communication in three northern Thai villages. Palgrave Commun 5: 23. [Google Scholar]
  79. WHO, 2017. World Antibiotic Awareness Week. Available at: http://www.who.int/campaigns/world-antibiotic-awareness-week/en/. Accessed November 20, 2017. [Google Scholar]
  80. Cooper RJ, Tsoneva J, , 2017. Benefits and tensions in delivering public health in community pharmacies—a qualitative study of healthy living pharmacy staff champions. Int J Pharm Pract 25: 351357. [Google Scholar]
  81. Sumpradit N, 2012. Antibiotics smart use: a workable model for promoting the rational use of medicines in Thailand. Bull World Health Organ 90: 905913. [Google Scholar]
  82. Haenssgen MJ, Xayavong T, Charoenboon N, Warapikuptanun P, Khine Zaw Y, , 2018. The consequences of AMR education and awareness raising: outputs, outcomes, and behavioural impacts of an antibiotic-related educational activity in Lao PDR. Antibiotics 7: 95. [Google Scholar]
  83. Edgar T, Boyd SD, Palamé MJ, , 2008. Sustainability for behaviour change in the fight against antibiotic resistance: a social marketing framework. J Antimicrob Chemother 63: 230237. [Google Scholar]
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Supplemental appendices

  • Received : 27 Feb 2018
  • Accepted : 26 Jan 2019
  • Published online : 05 Jun 2019

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