Lancet Global Health: Access to antibiotics: not a problem in some LMICs

28 March, 2021

Citation, extracts and comment from me below.

CITATION: Access to antibiotics: not a problem in some LMICs

Giorgia Sulis, Sumanth Gandra

Lancet Global Health

Published: March 10, 2021DOI:

Poor access to antibiotics is estimated to cause substantial morbidity and mortality due to pneumonia and acute febrile illness among children younger than 5 years, with most of these events happening in low-income and middle-income countries (LMICs). However, a study set in eight LMICs showed that children received around 25 antibiotic prescriptions for respiratory tract infection or fever during their first 5 years of life, and most of these prescriptions were deemed inappropriate. This conflicting finding calls for better understanding of issues surrounding antibiotic access and use in LMICs, because these countries simultaneously face high burdens of antimicrobial resistance.

In The Lancet Global Health, Thi Thuy Nga Do and colleagues elucidate the complexities of community-based antibiotic use through a combination of individual interviews, focus group discussions, household surveys, and customer exit questionnaires involving both community members and suppliers. This mixed-method study was done in seven communities in six LMICs in Asia (Bangladesh, Thailand, and Vietnam) and Africa (Ghana, Mozambique, and South Africa), thus allowing identification of key differences across contexts.

The study findings provide novel insights into access to antibiotics among mainly rural communities in six LMICs. As Do and colleagues point out, access to medically necessary antibiotics is not a problem across rural and urban or suburban communities in Asia where their study took place. Moreover, the liberal dispensation of Watch-group antibiotics in rural communities in Bangladesh and Vietnam is concerning.

The study findings indicate the urgent need for interventions focused on antibiotic dispensing in drug stores for mild conditions. Most research efforts in LMICs to date have been devoted to the evaluation of stewardship programmes in health-care settings.7 Drug stores continue to be only marginally affected (if at all) by interventions aimed at promoting rational antibiotic use. Depending on the context, a multi-pronged approach combining education programmes with regular feedback mechanisms and more incisive law enforcement could have a substantial effect on over-the-counter sale of antibiotics... Community-based interventions improving public awareness on the importance of preserving antibiotics will also be crucial.

For the full study see: Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach. Nga T T Do et al.

COMMENT: I would add that access to reliable information on medicines - for prescribers, dispensers and users - is *essential* for rational prescribing in general, and antibiotics in particular. Back in 2011, the WHO's World Medicines Report noted: ‘Globally, most prescribers receive most of their prescribing information from the pharmaceutical industry and in many countries this is the only information they receive.’ There is little if any evidence that this situation has improved. In 2020 HIFA published a systemic review with the London School of Hygiene and Tropical Medicine, and Nagasaki University, which confirmed 'a lack of up-to-date and relevant medicine information in low and lower middle-income settings'.

Best wishes, Neil

Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: