The role of multidimensional poverty in antibiotic misuse: a study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

Dominique L. Green; Katherine Keenan; Sarah I. Huque; Mike Kesby; Martha F. Mushi; Catherine Kansiime; Benon Asiimwe; John Kiiru; Stephen E. Mshana; Stella Neema; Joseph R. Mwanga; Kathryn J. Fredricks; Andy G. Lynch; Hannah Worthington; Emmanuel Olamijuwon; Mary Abed Al Ahad; Annette Aduda; Blandina T. Mmbaga; Joel Bazira; Alison Sandeman; John Stelling; Stephen Henry Gillespie; Gibson Kibiki; Wilber Sabiti; Derek J. Sloan; Matthew T. G. Holden; HATUA Consortium

doi:10.2139/ssrn.3938836

The role of multidimensional poverty in antibiotic misuse: a study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

Dominique L. Green^*, Katherine Keenan, Sarah I. Huque, Mike Kesby, Martha F. Mushi, Catherine Kansiime, Benon Asiimwe, John Kiiru, Stephen E. Mshana, Stella Neema, Joseph R. Mwanga, Kathryn J. Fredricks, Andy G. Lynch, Hannah Worthington, Emmanuel Olamijuwon, Mary Abed Al Ahad, Annette Aduda, Blandina T. Mmbaga, Joel Bazira, Alison SandemanJohn Stelling, Stephen Henry Gillespie, Gibson Kibiki, Wilber Sabiti, Derek J. Sloan, Matthew T. G. Holden, HATUA Consortium

^*Corresponding author for this work

Research output: Working paper › Preprint

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.

Original language	English
Publisher	SSRN
Number of pages	26
DOIs	https://doi.org/10.2139/ssrn.3938836
Publication status	Published - 8 Oct 2021

Publication series

Name	Preprints with The Lancet

Keywords

Multidimensional poverty
Antibiotic misuse
AMR
LMICs

Access to Document

10.2139/ssrn.3938836

2 Finished

Prof M Holden MRC: Holistic approach to unravel antibacterial resistance in East Africa (HATUA)
Holden, M. (PI), Gillespie, S. (CoI), Keenan, K. (CoI), Kesby, M. (CoI), Lynch, A. (CoI), Sabiiti, W. (CoI), Sloan, D. (CoI) & Smith, V. A. (CoI)
Medical Research Council
1/05/18 → 30/04/21
Project: Standard
Kesby/Keenan HATUA: Holistic Approach to Unravel Antibacterial resistance in East Africa (HATUA)
Kesby, M. (PI) & Keenan, K. (CoI)
Medical Research Council
1/05/18 → 31/03/22
Project: Standard

1 Article

The role of multidimensional poverty in antibiotic misuse: a mixed-methods study of self-medication and non-adherence in Kenya, Tanzania, and Uganda
Green, D. L., Keenan, K., Fredricks, K. J., Huque, S. I., Mushi, M. F., Kansiime, C., Asiimwe, B., Kiiru, J., Mshana, S. E., Neema, S., Mwanga, J. R., Kesby, M., Lynch, A. G., Worthington, H., Abed Al Ahad, M., Olamijuwon, E., Aduda, A., Njeru, J. M., Mmbaga, B. T. & Bazira, J. & 8 others, Sandeman, A., Stelling, J., Gillespie, S. H., Kibiki, G., Sabiiti, W., Sloan, D. J., Holden, M. T. G. & HATUA Consortium, 1 Jan 2023, In: The Lancet Global Health. 11, 1, p. e59-e68 10 p.
Research output: Contribution to journal › Article › peer-review

Open Access
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Green, D. L., Keenan, K., Huque, S. I., Kesby, M., Mushi, M. F., Kansiime, C., Asiimwe, B., Kiiru, J., Mshana, S. E., Neema, S., Mwanga, J. R., Fredricks, K. J., Lynch, A. G., Worthington, H., Olamijuwon, E., Ahad, M. A. A., Aduda, A., Mmbaga, B. T., Bazira, J., ... HATUA Consortium (2021). The role of multidimensional poverty in antibiotic misuse: a study of self-medication and non-adherence in Kenya, Tanzania, and Uganda. (Preprints with The Lancet). SSRN. https://doi.org/10.2139/ssrn.3938836

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title = "The role of multidimensional poverty in antibiotic misuse: a study of self-medication and non-adherence in Kenya, Tanzania, and Uganda",

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 {\textquoteleft}knowledge{\textquoteright}, 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.",

keywords = "Multidimensional poverty, Antibiotic misuse, AMR, LMICs",

author = "Green, {Dominique L.} and Katherine Keenan and Huque, {Sarah I.} and Mike Kesby and Mushi, {Martha F.} and Catherine Kansiime and Benon Asiimwe and John Kiiru and Mshana, {Stephen E.} and Stella Neema and Mwanga, {Joseph R.} and Fredricks, {Kathryn J.} and Lynch, {Andy G.} and Hannah Worthington and Emmanuel Olamijuwon and Ahad, {Mary Abed Al} and Annette Aduda and Mmbaga, {Blandina T.} and Joel Bazira and Alison Sandeman and John Stelling and Gillespie, {Stephen Henry} and Gibson Kibiki and Wilber Sabiti and Sloan, {Derek J.} and Holden, {Matthew T. G.} and {HATUA Consortium}",

note = "Funding: The Holistic Approach to Unravel Antibacterial Resistance in East Africa is a 3-year Global Context Consortia Award (MR/S004785/1) funded by the National Institute for Health Research, Medical Research Council, and the Department of Health and Social Care. This work is supported in part by the Makerere University-Uganda Virus Research Institute Centre of Excellence for Infection and Immunity Research and Training (MUII). This paper was funded in part by a grant from the National Institutes of Health (grant number U01CA207167), and a Scottish Funding Council GCRF Consolidator Award.",

year = "2021",

month = oct,

day = "8",

doi = "10.2139/ssrn.3938836",

language = "English",

series = "Preprints with The Lancet",

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Green, DL, Keenan, K, Huque, SI, Kesby, M, Mushi, MF, Kansiime, C, Asiimwe, B, Kiiru, J, Mshana, SE, Neema, S, Mwanga, JR, Fredricks, KJ , Lynch, AG , Worthington, H , Olamijuwon, E , Ahad, MAA, Aduda, A, Mmbaga, BT, Bazira, J, Sandeman, A, Stelling, J, Gillespie, SH, Kibiki, G, Sabiti, W , Sloan, DJ , Holden, MTG & HATUA Consortium 2021 'The role of multidimensional poverty in antibiotic misuse: a study of self-medication and non-adherence in Kenya, Tanzania, and Uganda' Preprints with The Lancet, SSRN. https://doi.org/10.2139/ssrn.3938836

TY - UNPB

T1 - The role of multidimensional poverty in antibiotic misuse

T2 - a study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

AU - Green, Dominique L.

AU - Keenan, Katherine

AU - Huque, Sarah I.

AU - Kesby, Mike

AU - Mushi, Martha F.

AU - Kansiime, Catherine

AU - Asiimwe, Benon

AU - Kiiru, John

AU - Mshana, Stephen E.

AU - Neema, Stella

AU - Mwanga, Joseph R.

AU - Fredricks, Kathryn J.

AU - Lynch, Andy G.

AU - Worthington, Hannah

AU - Olamijuwon, Emmanuel

AU - Ahad, Mary Abed Al

AU - Aduda, Annette

AU - Mmbaga, Blandina T.

AU - Bazira, Joel

AU - Sandeman, Alison

AU - Stelling, John

AU - Gillespie, Stephen Henry

AU - Kibiki, Gibson

AU - Sabiti, Wilber

AU - Sloan, Derek J.

AU - Holden, Matthew T. G.

AU - HATUA Consortium

N1 - Funding: The Holistic Approach to Unravel Antibacterial Resistance in East Africa is a 3-year Global Context Consortia Award (MR/S004785/1) funded by the National Institute for Health Research, Medical Research Council, and the Department of Health and Social Care. This work is supported in part by the Makerere University-Uganda Virus Research Institute Centre of Excellence for Infection and Immunity Research and Training (MUII). This paper was funded in part by a grant from the National Institutes of Health (grant number U01CA207167), and a Scottish Funding Council GCRF Consolidator Award.

PY - 2021/10/8

Y1 - 2021/10/8

N2 - 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.

AB - 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.

KW - Multidimensional poverty

KW - Antibiotic misuse

KW - AMR

KW - LMICs

U2 - 10.2139/ssrn.3938836

DO - 10.2139/ssrn.3938836

M3 - Preprint

T3 - Preprints with The Lancet

BT - The role of multidimensional poverty in antibiotic misuse

PB - SSRN

ER -

The role of multidimensional poverty in antibiotic misuse: a study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

Abstract

Publication series

Keywords

Access to Document

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Projects

Prof M Holden MRC: Holistic approach to unravel antibacterial resistance in East Africa (HATUA)

Kesby/Keenan HATUA: Holistic Approach to Unravel Antibacterial resistance in East Africa (HATUA)

Research output

The role of multidimensional poverty in antibiotic misuse: a mixed-methods study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

Cite this