‘Cash and carry’ identified as a cause of inappropriate antibiotics use in rural communities - KHRC Research

The inappropriate use of antimicrobial medicines, including antibiotics is leading to the increase in antimicrobial resistance (AMR). Globally, the continuous rise in AMR is a growing threat to public health and achievements in the fight against infectious diseases.

Research conducted by the Kintampo Health Research Centre (KHRC) has identified out-of-pocket payment for healthcare as a key determinant of inappropriate antibiotics use in rural communities.

The study, conducted in the Kintampo North and South districts in the Bono East region between 2016 and 2018 focused on “determinants of inappropriate antibiotics use in rural central Ghana”.

The results revealed that inappropriate antibiotic use was high in rural communities, with a percentage of 86.6 and was mainly influenced by factors including out-of-pocket payment for healthcare, seeking for healthcare outside health centres and pharmacies and distance to health facilities.

AMR occurs when disease causing microorganism including bacteria, viruses, fungi and parasites change overtime and no longer respond to antimicrobial medicines making infections harder to treat, increasing the risk of disease spread, severe illness and death.

The World Health Organisation has identified AMR as one of the top 10 threats to global health and it is estimated that AMR including antibiotic resistance could cause 10 million deaths a year by 2050 if the necessary action is not taken soon.

The study, conducted by Dr. Afari-Asiedu and colleagues revealed that antibiotics users with low socioeconomic status purchased antibiotics in instalments due to cost.

As part of the key findings, the study established that antibiotic users who do not pay for healthcare through the National Health Insurance Scheme were largely inclined to buy antibiotics from over the counter medicine sellers and drug peddlers who could sell incomplete courses to them if they cannot afford the full course, which predisposes them to inappropriate antibiotic use.

The researchers recommend that health ministries and healthcare agencies in Ghana and low- and middle-income (LMIC) enhance access to approved health services to improve use at community level especially in rural settings.

Additionally, expanding the subscription for national health insurance, paying claims to accredited health facilities without delays, intensifying public awareness campaign about the harmful effects of antibiotic resistance and improving the standard of living of citizens were recommended as key to enhancing appropriate antibiotic access and use.

Furthermore, the Ministry of Health was charged to also consider training, recruiting and providing incentives to pharmacist to establish pharmacies in rural communities to help reduce the over the counter sales of antibiotics.

The study further recommended that, the Ministry of Health and other relevant regulatory agencies such as the pharmacy council should consider training over the counter medicine sellers and equip CHPS facilities to dispense some categories of antibiotics.

Dr Afari-Asiedu has presented this findings to the Ghana AMR platform which is made up multisectoral professionals and stakeholders who are implementing various activities within the AMR national policy and national action plan.

Findings from the study has therefore fed into the implementation of the Ghana AMR national action plan by providing information on the context of antibiotic access and use for improved strategies to address the challenge of AMR especially at the community level.