HIGHLIGHTING ANTIBIOTIC RESISTANCE

9 January 2012

QUALITATIVE STUDY ON ANTIBIOTIC KNOWLEDGE AMONG VILLAGERS IN CHINA

In order to better understand the perceptions and practices around antibiotics and their use among consumers in China, a qualitative study was undertaken in four villages in two different provinces, Hubei and Shandong in 2008.

Antibiotics are the most commonly prescribed drugs in China, accounting for 30-50% of all drug consumption. Antibiotic resistance, ABR, is a very serious problem in China, and since 2004 antibiotics cannot be sold without a prescription, although the enforcement of this law is incomplete. The majority of the village doctors in China are bare foot doctors with no formal education but usually with a very long experience and a high reputation among the villagers.

In-depth interviews and focus group discussions took place with 28 members (8 women and 20 men) from wealthier and poorer households as well as with the village committees. At the time of the intervention there were no pharmacies in the four villages.

Some villagers had never heard of antibiotics, nor had members from poorer families heard of ABR. Those who knew about resistance thought that the human body developed resistance, not the bacteria. The knowledge about antibiotics was usually based on their own experience. Villagers seem to be particularly keen on intravenous infusions, which they actively requested, also for common colds. Children were very often given i.v. antibiotics as soon as they arrived at the doctor’s spot. The price of the drug was assessed as a kind of quality control, and for children, “good”, expensive antibiotics were requested. Villagers reported that they could buy antibiotics at any time at the village clinic and were surprised to find they were now prescription-only-medicines. They were aware of the incentives for the doctors, who earn their whole income from selling drugs and sometimes overprescribe to maximize profit.

There was a widespread and strong belief that there is a never ending line of new antibiotics and that there would always be another antibiotic to overcome the problem with resistance.

Although small in size and geographically limited, the study gives an interesting but worrying picture about people’s knowledge and beliefs about antibiotics and ABR in rural China. This bottom-up perspective is crucial for politicians and administrators to take into account, when educational and legal measures are being planned and implemented.   Influencing patient behaviour/consumer demand is likely to be one of the more important measures to improve rational use. This requires significant efforts to communicate antibiotic resistance in a way that is comprehensible and compelling to lay people often without any biomedical knowledge. Here health professionals need to explore new ways to make messages less technical and employ new means of reaching out.

Source:
Framing a global health risk from the bottom-up: User perceptions and practices around antibiotics in four villages in China

Chenggang Jin, Adrian Ely, Lijie Fang & Xiaoyun Liang. Health, Risk & Society, Volume 13, Issue 5, 2011, pages 433 - 449.

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