Patient Preference and Adherence (Jan 2022)
Antibiotics in the Community During the COVID-19 Pandemic: A Qualitative Study to Understand Users’ Perspectives of Antibiotic Seeking and Consumption Behaviors in Bangladesh
Abstract
Md Abul Kalam,1 Shahanaj Shano,2,3 Sharmin Afrose,4 Md Nasir Uddin,2 Nafis Rahman,5 Faruk Ahmed Jalal,6 Samira Akter,7 Ariful Islam,3,8 Md Mujibul Anam,7 Mohammad Mahmudul Hassan9 1Bangladesh Country Office, Helen Keller International, Dhaka, 1212, Bangladesh; 2Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, 1212, Bangladesh; 3EcoHealth Alliance, New York, NY, USA; 4World Food Programme, Dhaka, 1207, Bangladesh; 5Department of Public Health, American International University of Bangladesh, Dhaka, 1212, Bangladesh; 6Handicap International - Humanity & Inclusion, Dhaka, 1212, Bangladesh; 7Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1243, Bangladesh; 8Centre for Integrative Ecology, School of Life and Environmental Science, Deakin University, Geelong Campus, Warrnambool, VIC, 3216, Australia; 9Chattogram Veterinary and Animal Science University, Chattogram, 4225, BangladeshCorrespondence: Md Abul KalamHelen Keller International, Bangladesh Country Office, Dhaka, 1215, Bangladesh, Tel +8801912408148, Email [email protected]: The COVID-19 pandemic is thought to have led to increased “inappropriate” or “unjustified” seeking and consumption of antibiotics by individuals in the community. However, little reference has been made to antibiotic seeking and using behaviors from the perspectives of users in Bangladesh during this health crisis.Purpose: This study seeks to document how antibiotic medicines are sought and used during a complex health crisis, and, within different contexts, what are the nuanced reasons why patients may utilize these medicines sub-optimally.Methods: We used an exploratory, qualitative design. Forty semi-structured telephone interviews were conducted with people diagnosed with COVID-19 (n=20), who had symptoms suggestive of COVID-19 (n=20), and who had received care at home in two cities between May and June 2021 in Bangladesh. In this study, an inductive thematic analysis was performed.Results: The analysis highlighted the interlinked relationships of antibiotic seeking and consumption behaviors with the diversity of information disseminated during a health crisis. Antibiotic-seeking behaviors are related to previous experience of use, perceived severity of illness, perceived vulnerability, risk of infection, management of an “unknown” illness and anxiety, distrust of expert advice, and intrinsic agency on antimicrobial resistance (AMR). Suboptimal adherence, such as modifying treatment regimes and using medication prescribed for others, were found to be part of care strategies used when proven therapeutics were unavailable to treat COVID-19. Early cessation of therapy was found to be a rational practice to avoid side effects and unknown risks.Conclusion: Based on the results, we highly recommend the take up of a pandemic specific antimicrobial stewardship (AMS) program in the community. To deliver better outcomes of AMS, incorporating users’ perspectives could be a critical strategy. Therefore, a co-produced AMS intervention that is appropriate for a specific cultural context is an essential requirement to reduce the overuse of antibiotics during the COVID-19 pandemic and beyond.Keywords: COVID-19, antimicrobial resistance, consumption behavior, antimicrobial stewardships, community engagement, Bangladesh
