Abstract
ABSTRACT Understanding the prevalence and types of antibiotics used in a given human and/or animal population is important for informing stewardship strategies. Methods used to capture such data often rely on verbal elicitation of reported use that tend to assume shared medical terminology. Studies have shown the category ‘antibiotic’ does not translate well linguistically or conceptually, which limits the accuracy of these reports. This article presents a ‘Drug Bag’ method to study antibiotic use (ABU) in households and on farms, which involves using physical samples of all the antibiotics available within a given study site. We present the conceptual underpinnings of the method, and our experiences of using this method to produce data about antibiotic recognition, use and accessibility in the context of anthropological research in Africa and South-East Asia. We illustrate the kinds of qualitative and quantitative data the method can produce, comparing and contrasting our experiences in different settings. The Drug Bag method can produce accurate antibiotic use data as well as provide a talking point for participants to discuss antibiotic experiences. We propose it can help improve our understanding of antibiotic use in peoples’ everyday lives across different contexts, and our reflections add to a growing conversation around methods to study ABU beyond prescriber settings, where data gaps are currently substantial.
Highlights
In response to rising concerns around antimicrobial resistance (AMR), the WHO’s [1] Global Action Plan has called for improved understanding and surveillance of antibiotic use (ABU) in human and animal populations
In low- and middle-income countries (LMICs), where much of the recent growth in ABU has occurred, the most cited methods and metrics to shed light on ABU come from macro-level consumption data from sales and imports [2,3] and from prescriber settings, especially hospitals [4]
In a recent review of ABU data collection methods, Queenan, Chandler and Goodman [5] found that most household surveys relied upon respondent recall and inventories of antibiotics kept at home – sometimes aided by the use of show-cards – while farm surveys utilised various combinations of recall, treatment logs and packaging-bin searches
Summary
In response to rising concerns around antimicrobial resistance (AMR), the WHO’s [1] Global Action Plan has called for improved understanding and surveillance of antibiotic use (ABU) in human and animal populations. In a recent review of ABU data collection methods, Queenan, Chandler and Goodman [5] found that most household surveys relied upon respondent recall and inventories of antibiotics kept at home – sometimes aided by the use of show-cards – while farm surveys utilised various combinations of recall, treatment logs and packaging-bin searches. It is often assumed in surveys that respondents recognise antibiotics according to biomedical concepts and categories [10] when they may not use notions such as ‘bacteria’, ‘antibiotic’ or ‘infectious disease’ at all [11]. Together, these challenges significantly limit the reliability of data that ask verbally about ABU in a one-off interaction
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