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Multidimensional poverty, antibiotic misuse and AMR

Spotlight prepared by Saffiatou Darboe, PhD Student Representative at the AMR Centre.

Poverty is a multidimensional problem and a proposed driver of antimicrobial misuse and resistance. In the past few years, we have seen an increase in the use of antimicrobials in low-income and middle-income countries (LMICs). However, detailed information on the link between poverty and misuse is sparse. A new paper published in The Lancet Global Health investigates the association between multidimensional poverty and antibiotic use in three east African countries, Kenya, Tanzania, and Uganda.

Using standardised mixed methods, the study highlighted an interesting association between poverty and antibiotic misuse (defined as antibiotic self-medication, skipping a dose, or not completing the course). The study found that social inequalities, including not only financial struggles, but time and inconvenience of access to healthcare, played a role in antibiotic misuse and adherence. However, self-medication and non-adherence to treatment were most common among those not living in multidimensional poverty, and least common in those living in the most deprived conditions. 

Additionally, improved awareness of antibiotics reduced levels of self-medication, but not adherence. The qualitative analysis suggested that self-medication and non-adherence were driven by the barriers in the healthcare system, financial constraints, and the accessibility to unregulated antibiotics.

The Lancet Global Health Figure
Source: The Lancet Global Health Figure 1 - Evidence-based conceptual framework that guided the mixed-method study design.

In conclusion, although poverty has a pivotal role in AMR, we shouldn’t assume it is the sole source of an tibiotic misuse nor that the relationship between antibiotic use is directly correlated. To optimize antibiotic use it’s crucial to acknowledge the socioeconomic hierarchy. Therefore, when designing AMR and antibiotic use interventions, we need to take into consideration the behaviours of the wealthier population.
 

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