TY  - BOOK
AU  - Dominique L Green
AU  - Matthew TG Holden
AU  -  Derek J Sloan
AU  - Wilber Sabiti
AU  -  Gibson Kibiki
AU  - Stephen Henry Gillespie
AU  -  John Stelling
AU  -  Katherine Keenan
AU  -  Alison Sandeman
AU  -  Joel Bazira
AU  -  Blandina T Mmbaga
AU  - Annette Aduda
AU  -  Mary Abed Al Ahad
AU  - Emmanuel Olamijuwon
AU  -  Hannah Worthington
AU  - Andy G Lynch
AU  -  Kathryn J Fredricks
AU  - Joseph R Mwanga
AU  -  Stella Neema
AU  - Stephen E Mshana
AU  - John Kiiru
AU  -  Benon Asiimwe
AU  - Catherine Kansiime
AU  - Martha F Mushi
AU  - Mike Kesby
AU  -  Sarah I Huque
TI  - The Role of Multidimensional Poverty in Antibiotic Misuse: A Study of Self-Medication and Non-Adherence in Kenya, Tanzania, and Uganda
PY  - 0000///82021///
CY  - Mwanza, Tanzania
PB  - The Lancet &,   Catholic University of Health and Allied Sciences [CUHAS – Bugando]  
N2  - 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
UR  - http://dx.doi.org/10.2139/ssrn.3938836 
ER  -