Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.

Drug resistant infections are increasing across the world and urgent action is required to preserve current classes of antibiotics. Antibiotic use practices in low-and-middle-income countries have gained international attention, especially as antibiotics are often accessed beyond the formal health s...

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Main Authors: Eleanor E MacPherson, Joanna Reynolds, Esnart Sanudi, Alexander Nkaombe, John Mankhomwa, Justin Dixon, Clare I R Chandler
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2022-01-01
Series:PLOS Global Public Health
Online Access:https://doi.org/10.1371/journal.pgph.0000314
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author Eleanor E MacPherson
Joanna Reynolds
Esnart Sanudi
Alexander Nkaombe
John Mankhomwa
Justin Dixon
Clare I R Chandler
author_facet Eleanor E MacPherson
Joanna Reynolds
Esnart Sanudi
Alexander Nkaombe
John Mankhomwa
Justin Dixon
Clare I R Chandler
author_sort Eleanor E MacPherson
collection DOAJ
description Drug resistant infections are increasing across the world and urgent action is required to preserve current classes of antibiotics. Antibiotic use practices in low-and-middle-income countries have gained international attention, especially as antibiotics are often accessed beyond the formal health system. Public awareness campaigns have gained popularity, often conceptualising antimicrobial resistance (AMR) as a problem of excess, precipitated by irrational behaviour. Insufficient attention has been paid to people's lived experiences of accessing medicines in low-income contexts. In Chikwawa District, Malawi, a place of extreme scarcity, our study aimed to understand the care and medicine use practices of households dependent on subsistence farming. Adopting an anthropological approach, we undertook medicine interviews (100), ethnographic fieldwork (six-month period) and key informant interviews (33) with a range of participants in two villages in rural Chikwawa. The most frequently used drugs were cotrimoxazole and amoxicillin, not considered to be of critical importance to human health. Participants recognised that keeping, sharing, and buying medicines informally was not the "right thing." However, they described using antibiotics and other medicines in these ways due to conditions of extreme precarity, the costs and limitations of seeking formal care in the public sector, and the inevitability of future illness. Our findings emphasise the need in contexts of extreme scarcity to equip policy actors with interventions to address AMR through strengthening health systems, rather than public awareness campaigns that foreground overuse and the dangers of using antibiotics beyond the formal sector.
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spelling doaj.art-754ba92bbd5d41f6b0a8746ffe68556b2023-09-03T14:21:27ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752022-01-0126e000031410.1371/journal.pgph.0000314Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.Eleanor E MacPhersonJoanna ReynoldsEsnart SanudiAlexander NkaombeJohn MankhomwaJustin DixonClare I R ChandlerDrug resistant infections are increasing across the world and urgent action is required to preserve current classes of antibiotics. Antibiotic use practices in low-and-middle-income countries have gained international attention, especially as antibiotics are often accessed beyond the formal health system. Public awareness campaigns have gained popularity, often conceptualising antimicrobial resistance (AMR) as a problem of excess, precipitated by irrational behaviour. Insufficient attention has been paid to people's lived experiences of accessing medicines in low-income contexts. In Chikwawa District, Malawi, a place of extreme scarcity, our study aimed to understand the care and medicine use practices of households dependent on subsistence farming. Adopting an anthropological approach, we undertook medicine interviews (100), ethnographic fieldwork (six-month period) and key informant interviews (33) with a range of participants in two villages in rural Chikwawa. The most frequently used drugs were cotrimoxazole and amoxicillin, not considered to be of critical importance to human health. Participants recognised that keeping, sharing, and buying medicines informally was not the "right thing." However, they described using antibiotics and other medicines in these ways due to conditions of extreme precarity, the costs and limitations of seeking formal care in the public sector, and the inevitability of future illness. Our findings emphasise the need in contexts of extreme scarcity to equip policy actors with interventions to address AMR through strengthening health systems, rather than public awareness campaigns that foreground overuse and the dangers of using antibiotics beyond the formal sector.https://doi.org/10.1371/journal.pgph.0000314
spellingShingle Eleanor E MacPherson
Joanna Reynolds
Esnart Sanudi
Alexander Nkaombe
John Mankhomwa
Justin Dixon
Clare I R Chandler
Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.
PLOS Global Public Health
title Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.
title_full Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.
title_fullStr Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.
title_full_unstemmed Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.
title_short Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns.
title_sort understanding antimicrobial use in subsistence farmers in chikwawa district malawi implications for public awareness campaigns
url https://doi.org/10.1371/journal.pgph.0000314
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