Pathways to optimising antibiotic use in rural China: identifying key determinants in community and clinical settings, a mixed methods study protocol
Helen Lambert,
Rui Feng,
Jing Chai,
Caroline Coope,
Jing Cheng,
Isabel Oliver,
DeBin Wang,
Alasdair MacGowan,
Matthew Hickman,
Christie Cabral,
Linhai Zhao,
Rachel Marie Kwiatkowska,
Meixuan Chen,
Karen Bowker,
Jilu Shen,
XingRong Shen,
Paul Kadetz
Affiliations
Helen Lambert
Population Health Sciences, University of Bristol, Bristol, UK
Rui Feng
2University of Pennsylvania, Philadelphia, United States of America
Jing Chai
School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
Caroline Coope
3 NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol Medical School, School of Population Health Sciences, Bristol, UK
Jing Cheng
Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
Isabel Oliver
UK Health Security Agency South of England, Bristol, UK
DeBin Wang
1 School of Health Services Management, Anhui Medical University, Hefei, China
Alasdair MacGowan
Antimicrobial Reference Laboratory, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
Matthew Hickman
National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation (BSE), Bristol Medical School, University of Bristol, Bristol, UK
Christie Cabral
Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
Linhai Zhao
School of Health Service and Management, Anhui Medical University, Hefei, Anhui, China
Rachel Marie Kwiatkowska
3 NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol Medical School, School of Population Health Sciences, Bristol, UK
Meixuan Chen
5 School of Population Health Sciences, University of Bristol Medical School, Bristol, UK
Karen Bowker
6 Severn Pathology, North Bristol NHS Trust, Bristol, UK
Jilu Shen
7 First Affiliated Hospital of Anhui Medical University, Hefei, China
XingRong Shen
School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
Introduction This study aims to investigate patterns of antibiotic treatment-seeking, describe current levels of and drivers for antibiotic use for common infections (respiratory tract and urinary tract infections) and test the feasibility of determining the prevalence and epidemiology of antimicrobial resistance (AMR) in rural areas of Anhui province, in order to identify potential interventions to promote antibiotic stewardship and reduce the burden of AMR in China.Methods and analysis We will conduct direct observations, structured and semistructured interviews in retail pharmacies, village clinics and township health centres to investigate treatment-seeking and antibiotic use. Clinical isolates from 1550 sputum, throat swab and urine samples taken from consenting patients at village and township health centres will be analysed to identify bacterial pathogens and ascertain antibiotic susceptibilities. Healthcare records will be surveyed for a subsample of those recruited to the study to assess their completeness and accuracy.Ethics and dissemination The full research protocol has been reviewed and approved by the Biomedical Ethics Committee of Anhui Medical University (reference number: 20170271). Participation of patients and doctors is voluntary and written informed consent is sought from all participants. Findings from the study will be disseminated through academic routes including peer-reviewed publications and conference presentations, via tailored research summaries for health professionals, health service managers and policymakers and through an end of project impact workshop with local and regional stakeholders to identify key messages and priorities for action.
