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The Role of Multidimensional Poverty in Antibiotic Misuse: A Study of Self-Medication and Non-Adherence in Kenya, Tanzania, and Uganda

26 Pages Posted: 8 Oct 2021

See all articles by Dominique L. Green

Dominique L. Green

University of St Andrews

Katherine Keenan

University of St. Andrews and ESRC Centre for Population Change

Sarah I. Huque

University of St Andrews

Mike Kesby

University of St Andrews

Martha F. Mushi

Catholic University of Health & Allied Sciences

Catherine Kansiime

Makerere University

Benon Asiimwe

Makerere University

John Kiiru

Kenya Medical Research Institute (KEMRI)

Stephen E. Mshana

Catholic University of Health & Allied Sciences

Stella Neema

Makerere University

Joseph R. Mwanga

Catholic University Of Health And Allied Sciences

Kathryn J. Fredricks

University of St Andrews

Andy G. Lynch

University of St Andrews

Hannah Worthington

University of St Andrews

Emmanuel Olamijuwon

University of St Andrews

Mary Abed Al Ahad

University of St Andrews

Annette Aduda

Kenya Medical Research Institute (KEMRI)

Blandina T. Mmbaga

Kilimanjaro Christian Medical University College - Kilimanjaro Clinical Research Institute

Joel Bazira

Mbarara University of Science and Technology

Alison Sandeman

University of St Andrews

John Stelling

Harvard University - Harvard Medical School

Stephen Henry Gillespie

St. Andrews University - Division of Infection and Global Health Research

Gibson Kibiki

East African Health Commission

Wilber Sabiti

University of St. Andrews - Division of Infection and Global Health

Derek J. Sloan

University of St Andrews

Matthew T. G. Holden

University of St Andrews

HATUA Consortium

University of St Andrews

More...

Abstract

Background: Poverty is a proposed driver of antimicrobial resistance (AMR), influencing inappropriate antibiotic (AB) use in low and middle-income countries (LMICs). However, at sub-national levels, studies investigating poverty and AB use are sparse and the results inconsistent.

Methods: The Holistic Approach to Unravelling Antimicrobial Resistance (HATUA) Consortium collected data from 6,827 patients presenting with urinary tract infection (UTI) symptoms in Kenya, Uganda, and Tanzania. Using Bayesian hierarchical modelling, we investigated the association between multidimensional poverty and self-reported AB self-medication and treatment non-adherence (skipping a dose and not completing the course). We also analysed linked qualitative in-depth patient interviews (IDIs) (n = 82) and unlinked focus group discussions (FGDs) with community members (n = 44 groups).

Findings: AB self-medication and non-adherence to treatment courses was significantly more common in the least deprived group compared with those in severe poverty. Adjustment for AB ‘knowledge’, attitudes and socio-demographics diminished the association with self-medication, but not non-adherence. IDIs and FGDs suggested that self-medication and non-adherence are driven by perceived inconvenience of the healthcare system, financial barriers, and ease of unregulated AB access.

Interpretation: Structural barriers to optimal AB use exist at all levels of the socioeconomic hierarchy. Inefficiencies in public healthcare may be fuelling alternative antibiotic access points, for those who can afford it. In designing interventions to tackle AMR and reduce AB misuse, the behaviours and needs of wealthier population groups should not be neglected.

Funding Information: UK National Institute for Health Research, Medical Research Council and the Department of Health and Social Care.

Declaration of Interests: None.

Ethics Approval Statement: Ethical approval for this project was obtained from the University of St Andrews, UK (No. MD14548, 10/09/19); National Institute for Medical Research, Tanzania (No. 2831, updated 26/07/19), CUHAS/BMC research ethics and review committee (No. CREC/266/2018, updated on 02/2019), Mbeya Medical Research and Ethics Committee (No. SZEC-2439/R. A/V.1/303030), Kilimanjaro Christian Medical College, Tanzania (No. 2293, updated 14/08/19). Uganda National Council for Science and Technology (number HS2406, 18/06/18); Makerere University, Uganda (number 514, 25/04/18); and Kenya Medical Research Institute (04/06/19, Scientific and Ethics Review Committee (SERU) number KEMRI/SERU/CMR/P00112/3865 V.1.2). For Uganda, administrative letters of support were obtained from the district health officers to allow the research to be conducted in the respective hospitals and health centres.

Keywords: Multidimensional poverty, antibiotic misuse, AMR, LMICs

Suggested Citation

Green, Dominique L. and Keenan, Katherine and Huque, Sarah I. and Kesby, Mike and Mushi, Martha F. and Kansiime, Catherine and Asiimwe, Benon and Kiiru, John and Mshana, Stephen E. and Neema, Stella and Mwanga, Joseph R. and Fredricks, Kathryn J. and Lynch, Andy G. and Worthington, Hannah and Olamijuwon, Emmanuel and Ahad, Mary Abed Al and Aduda, Annette and Mmbaga, Blandina T. and Bazira, Joel and Sandeman, Alison and Stelling, John and Gillespie, Stephen Henry and Kibiki, Gibson and Sabiti, Wilber and Sloan, Derek J. and Holden, Matthew T. G. and Consortium, HATUA, The Role of Multidimensional Poverty in Antibiotic Misuse: A Study of Self-Medication and Non-Adherence in Kenya, Tanzania, and Uganda. Available at SSRN: https://ssrn.com/abstract=3938836 or http://dx.doi.org/10.2139/ssrn.3938836

Dominique L. Green (Contact Author)

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Katherine Keenan

University of St. Andrews and ESRC Centre for Population Change ( email )

The Gateway
North Haugh
St Andrews, Fife KY16 9RJ
United Kingdom

Sarah I. Huque

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Mike Kesby

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Martha F. Mushi

Catholic University of Health & Allied Sciences ( email )

Catherine Kansiime

Makerere University ( email )

P.O Box 7062
P.O BOX 7062
Kampala, 256
Uganda

Benon Asiimwe

Makerere University ( email )

P.O Box 7062
P.O BOX 7062
Kampala, 256
Uganda

John Kiiru

Kenya Medical Research Institute (KEMRI) ( email )

Nairobi
Kenya

Stephen E. Mshana

Catholic University of Health & Allied Sciences ( email )

Stella Neema

Makerere University ( email )

P.O Box 7062
P.O BOX 7062
Kampala, 256
Uganda

Joseph R. Mwanga

Catholic University Of Health And Allied Sciences ( email )

Tanzania

Kathryn J. Fredricks

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Andy G. Lynch

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Hannah Worthington

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Emmanuel Olamijuwon

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Mary Abed Al Ahad

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Annette Aduda

Kenya Medical Research Institute (KEMRI) ( email )

Nairobi
Kenya

Blandina T. Mmbaga

Kilimanjaro Christian Medical University College - Kilimanjaro Clinical Research Institute

Joel Bazira

Mbarara University of Science and Technology ( email )

Uganda

Alison Sandeman

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

John Stelling

Harvard University - Harvard Medical School ( email )

United States

Stephen Henry Gillespie

St. Andrews University - Division of Infection and Global Health Research

Gibson Kibiki

East African Health Commission ( email )

Burundi

Wilber Sabiti

University of St. Andrews - Division of Infection and Global Health ( email )

Derek J. Sloan

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

Matthew T. G. Holden

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom

HATUA Consortium

University of St Andrews ( email )

St Andrews, KY16 9AL
United Kingdom