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The role of multidimensional poverty in antibiotic misuse: A study of self-medication and non-adherence in Kenya, Tanzania, and Uganda

Dominique Green, University of St Andrews
Sarah Huque, University of St Andrews
Katherine Keenan, University of St Andrews
Stella Neema, Department of Sociology and Anthropology, Makerere University
Joseph Mwanga, Catholic University of Applied Health Sciences
Annette Aduda, Kenya Medical Research Institute (KEMRI)
Derek Sloan, University of St Andrews
Mike Kesby, University of St Andrews
Mary Abed al Ahad, University of St Andrews
Martha Mushi, Catholic University of Applied Health Sciences
Stephen Gillespie, University of St Andrews
Wilber Sabiiti, University of St Andrews
Alison Sandeman, University of St Andrews
Andy Lynch, University of St Andrews
John Kiiru, Kenya Medical Research Institute (KEMRI)
Stephen Mshana, Catholic University of Applied Health Sciences
Benon Asiimwe, Makerere University
Matthew Holden, University of St Andrews

Poverty is a proposed driver of antimicrobial resistance (AMR), influencing inappropriate antibiotic (AB) use in low and middle-income countries (LMICs). However, we know little about how population-level socioeconomic inequalities relate to AB use. The Holistic Approach to Unravelling Antimicrobial Resistance Consortium collected data from 6,827 patients presenting with urinary tract infection symptoms in Kenya, Uganda, and Tanzania. Using Bayesian hierarchical modelling, we investigated the association between multidimensional poverty and self-reported AB use. We also analysed linked qualitative in-depth patient interviews (n = 82) and focus group discussions with community members (n = 44 groups). AB self-medication and non-adherence to treatment was significantly more common in the least deprived group. Adjustment for AB ‘knowledge’, attitudes and socio-demographics diminished the association with self-medication, but not non-adherence. Qualitative analysis suggested that self-medication and non-adherence are driven by perceived inconvenience of the healthcare system, financial barriers, and ease of unregulated AB access. Structural barriers to optimal AB use exist at all levels of the socioeconomic hierarchy. Inefficiencies in public healthcare may be fuelling alternative antibiotic access, for those who can afford it. In designing interventions to tackle AMR and reduce AB misuse, the behaviours and needs of wealthier population groups should not be neglected.

Keywords: Health and morbidity, Inequality

See paper.

  Presented in Session 130. Use and Misuse of Preventive and Curative Treatments: The Role of Socioeconomic Factors