Self-medication with antibiotics in Maputo, Mozambique: practices, rationales and relationships

Carla F Rodrigues

doi:10.1057/s41599-019-0385-8

Abstract

Self-medication, as a form of self-care, is a common practice worldwide, and often involves the use of both over-the-counter and prescription-only medicines, including antibiotics, anti-malarials and others. Increasing concerns over the global emergence and spread of antimicrobial resistance point to the need to reduce and optimise the use of antimicrobial medicines, both in human and animal health. Over the past few decades, numerous studies on self-medication with antibiotics have sought to determine the prevalence, risks and/or factors related to ‘inappropriate’ use in different parts of the world. Yet much of this literature tends to follow a rather normative approach, which regards such practices as problematic and often irrational, frequently overlooking structural aspects, situated circumstances and individuals’ own reasoning. Based on a mixed methods social science research project in Maputo, which included a household survey, observations in pharmacies and interviews with users and healthcare providers, this paper aims to discuss self-medication in light of local users’ everyday practical reasoning. While situating self-medication within local contextual contingencies, the analysis highlights the ways in which personal and socially shared experiences, articulated with forms of knowledge and information provided by different sources, shape and inform practices of and attitudes towards self-medication with antibiotics. By looking at self-medication beyond (non-)prescription use, and by examining individuals’ decisions within their socioeconomic and therapeutic landscapes in Maputo, this study sheds light on the structural and relational factors that contribute to certain consumption practices that do not always follow biomedical recommendations of ‘rational’ or ‘appropriate’ use, helping to deconstruct and further problematise the various legitimate meanings and understandings of ‘responsible’ use.

Highlights

Practices of self-medication, as a form of self-care, have always triggered controversy
In framing antibiotic use and antimicrobial resistance (AMR) as an ‘individual behaviour’ problem— which needs to be ‘corrected’ through regulatory restrictions and educational campaigns—such approaches neglect broader contextual and relational processes in which antibiotics and other medicines are embedded, which contrasts with the recognised ‘connectedness’ as promoted by the rhetoric of the ‘One Health’ approach (Chandler, 2019). Adding to this broader discussion on antimicrobial medicines (AMs) use, and drawing on a social science research project on medicine use in Maputo, Mozambique, this paper aims to analyse and problematise antibiotic consumption practices beyondprescription use
A brief statistical overview of reported self-medication practices is followed by a thorough analysis of the more in-depth qualitative data, which explores how antibiotics are managed at home; the importance of the standardisation of medical prescriptions; the significance of experiential knowledge and the role of different sources of information; and, the contextual contingencies and realities of healthcare provision and therapeutic encounters, which contribute to self-medication practices

Summary

Introduction

Practices of self-medication, as a form of self-care, have always triggered controversy. Self-medication often involves a combination of therapeutic resources and the use of both over-the-counter (OTC) and prescription-only medicines, including antibiotics. Increasing concerns with the global emergence and spread of antimicrobial resistance (AMR) have pointed to the need to reduce and optimise the use of antimicrobial medicines (AMs), both in human and animal health (WHO, 2015a). This includes tackling the use of AMs without a prescription, which is considered a form of AM ‘misuse’ that can potentially accelerate the emergence of resistant microorganisms (WHO, 2015b). Tracking OTC sales is challenging in most countries (WHO, 2015b), according to a review of Alhomoud et al (2017, p. 4), “it has been estimated that more than 50% of antibiotics are purchased without a prescription and used over-the-counter in most parts of the world”

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Conclusion