A Thai villager studying a herbal medicine formula. Photo credit: Patthanan Thavethanutthanawin

Patients living in precarious circumstances are less likely to use antibiotics appropriately, according to a new study from the University of Warwick, suggesting that efforts to improve conditions for people with low livelihoods have an unexpected benefit in combating antibiotic resistance around the world could.

The results help demonstrate that the focus should be shifted from influencing individual efforts to combat antibiotic resistance to supporting sustainable development policies that take into account the factors involved.

The study, published in the journal BMJ Global Health and funded by the Economic and Social Research Council (ESRC), part of UK Research and Innovation, provides a comprehensive analysis of patient access to and use of health care and is the first to be quantitative examines the relationship between precariousness and antibiotic use.

Precariousness refers to personal circumstances that are characterized by insecurity, be it about employment, your personal life, or your social status. People in precarious circumstances are limited in their ability to plan and do not have safety nets, social support, economic security and flexibility. It’s not necessarily about being poor: although this study looked at low- to middle-income countries, precariousness can also be a problem in higher-income countries.

Using statistical analysis, researchers were able to study the impact of socio-economic factors such as precariousness, poverty and marginalization on the use of antibiotics to treat their disease. They found that patients in precarious circumstances had a chance of up to 51% using antibiotics without medical advice or because of inappropriate illness – compared to 17% in the average patient.

The lead author Dr. Marco Haenssgen of the Warwick Institute of Advanced Study and the Department of Global Sustainable Development argues that this behavior is understandable when people are involved in a constant balancing act in precarious circumstances.

Dr. Haenssgen, Assistant Professor of Global Sustainable Development, said, “You have to balance your health, your economic life, feed your family, go to school; all of these are competing priorities.

Insecure livelihoods hinder efforts to combat antimicrobial resistance around the world

Pills and capsules of medicine. Photo credit: Patthanan Thavethanutthanawin

“Antibiotics have become such an important part of health care that they have become what some people see as a” quick fix. “If people are in precarious circumstances and are not receiving social support, they will find a quick fix, to keep them going. ” use it, and then it could get problematic. “

In many low- to middle-income countries, patients often have to travel long distances to access health services, which they may not be able to easily arrange or afford. Even in economically more developed areas, employment can be less secure and social networks can be eroded.

Antimicrobial resistance occurs when microbes become resistant to antibiotics and compromise their effectiveness. It is known that the use of antibiotics in humans is a major driver of this process. Hence, antimicrobial resistance policies have typically focused on clinical factors and encouraging individual accountability. However, the researchers argue that the impact of socio-economic factors such as precariousness is underestimated.

Dr. Haenssgen said, “You cannot always blame individuals for antibiotic abuse. Often times we find ourselves in living conditions that create problematic behaviors. So if you want to improve the use of antibiotics you need to improve those living conditions.

“If we can improve precarious situations, we will have a good start for future intervention. We have a very substantial facet of the problem that is constantly being ignored and on which we may have many gains to realize.

“Antimicrobial resistance is a massive global health problem. It can potentially turn global health upside down. Many of the past successes in controlling and preventing infectious diseases may be undone by antimicrobial resistance.”

The study focused on five local communities in rural Thailand and the Lao People’s Democratic Republic, interviewing 2,066 residents about the recent illnesses they had experienced and how they sought medical assistance for them. This provided researchers with an extensive data set of 1,421 episodes of illness that they could analyze to determine which healthcare patients, if any, are seeking, whether they have access to appropriate health care, and when they occur in their illness timeline.

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More information:
BMJ Global Health, DOI: 10.1136 / bmjgh-2020-003779

The study data are publicly available from the UK data service:

MJ Haenssgen, P. Ariana, HFL Wertheim, RC Greer, C. Jones, Y. Lubell et al. (2019). Antibiotics and Activity Spaces: Survey on Rural Health Behavior in Northern Thailand and Southern Laos 2017-2018 [data set]. Colchester: UK Data Service. DOI: 10.5255 / UKDA-SN-853658. Available at reshare.ukdataservice.ac.uk/853658/

Provided by the University of Warwick

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