Understanding Southeast Asians’ Attitudes Towards Antibiotics

UK scientists report that awareness of drug resistance in Thailand and Laos is similar to that of many industrialized countries, but this does not translate to more stringent antibiotic use.

AsianScientist (Sep. 17, 2019) – Basic understanding of antibiotic resistance is widespread in Southeast Asia, but higher levels of awareness are linked to higher antibiotic use in the general population. These were the findings of researchers at the University of Warwick, UK, published in the journal BMJ Open.

In recent years, clinicians and researchers around the world have sounded the alarm over the rise of drug resistant bacteria. The widespread and inappropriate use of antibiotics is known to be driving the evolution of these superbugs.

It is often assumed that people use antibiotics inappropriately because they do not understand enough about the spread of drug-resistant superbugs. However, research by Warwick University Assistant Professor Marco J. Haenssgen challenges this view.

The researchers conducted a large-scale survey among a representative sample of the rural population of 69 villages in northern Thailand and 65 villages in southern Lao PDR. The two territories were selected for this study because of their traditionally high rates of antibiotic use and busy international travel patterns, which predispose them to the development and spread of drug resistance. The survey involved 2,141 adults from more than 130 villages who represent a rural population of 712,000 villagers.

The team reported that people’s awareness of drug resistance in the two countries was similar to that of many industrialized countries—three in four villagers in Thailand, and six in ten in Laos, had heard about drug resistance, although the term was usually interpreted as a change in the human body rather than as the evolution of bacteria to withstand antibiotic medicine.

People’s attitudes in rural Thailand and Laos were often consistent with recommendations from the World Health Organization to not buy antibiotics without prescription. However, such attitudes were linked to disproportionately and potentially problematically high rates of prescribed antibiotics from public clinics and hospitals—up to 0.5 additional antibiotic courses per illness on average when controlling for other drivers of antibiotic use.

The survey also revealed that people who obtained antibiotics from informal sources, such as the village shop, were just as aware of drug resistance as people who relied on public healthcare channels. Moreover, patients receiving antibiotics from informal sources had no less wealth or formal education than users of public healthcare. Indeed, wealthier and more educated individuals in Chiang Rai were significantly associated with receiving antibiotics from informal sources.

Haenssgen interprets these results as a sign that the conventional public health model of behavior change is failing.

“Too many arguments in public health behavior change rest on a model of ‘information deficits.’ This idea that people behave irrationally because they don’t have the right information finds little support in our research,” he said.

“Basic awareness about drug resistance and antibiotics is widespread but does not contribute to better behavior. New information can be empowering in principle, but people themselves decide how they will use this new ‘power’ in their daily lives. Unnecessary antibiotic use may then rather reflect privilege, resistance to patronizing norms, or interference between local and Western ideas of what good care ought to be,” he added.

The article can be found at: Haenssgen et al. (2019) Antibiotic Knowledge, Attitudes and Practices: New Insights From Cross-sectional Rural Health Behaviour Surveys in Low-income and Middle-income South-east Asia.


Source: Warwick University; Photo: Shutterstock.
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