A Study of Self-Medication Practices and Antibiotic Misuse Among Urban and Rural Populations in India
Keywords:
self-medication, antibiotic misuse, antimicrobial resistance, urban-rural, India and community survey.Abstract
Antimicrobial resistance is emerging as a problem in Indian society due to self-medication with antibiotics; however, there is a lack of direct urban–rural comparative studies. This study aimed to find out how the prevalence, patterns and predictors of self-medication and misuse of antibiotics are different between urban and rural adult populations. The present study was conducted through multi-stage random sampling, and it was a community-based comparative cross-sectional study which included 800 adults (400 rural and 400 urban) from one district of Maharashtra. Self-medication in the last 3 months, antibiotic use and behaviours, and antibiotic knowledge were collected in a questionnaire administered to the children by an interviewer, which was pre-tested. Chi-Square tests and Multivariable Logistic regression: Results: Self-medication was reported by 56.6% (95% CI 53.2–60.0) of participants, more in urban than rural areas (64.2% vs 49.0%; p < 0.001). There was no difference in antibiotic self-medication (22.2% vs 23.0%); however, rural self-medicators were more likely to take an antibiotic (46.9% vs 34.6%, P value= 0.008). Amoxicillin and azithromycin were most commonly used, with 57.5% of episodes being prescribed in the WHO Watch-group class of drugs. Testing for rural antibiotics revealed that 30.4% of these were supplied by informal providers. Rural users more often did not complete the course (79.3% vs 60.7%) or know the dose (56.5% vs 32.6%). The distance to the doctor was also an independent predictor of self-medication with antibiotics (AOR 1.74; 95% CI 1.16–2.60) when living more than 5 km from a doctor. Conclusion: Although overall about 1 in 4 adults do this, those who do take antibiotics without a prescription do so less safely in rural areas, as a result of lower levels of doctor access. Strategies to reduce the availability of antibiotics that do not require a prescription need to be given greater importance, as well as ensuring qualified prescription sales are strong in rural areas.References
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