Nearly half of antibiotic access practices at community level in eastern Ethiopia inappropriate: Study

Nearly half of antibiotic access practices at the community level in eastern Ethiopia were inappropriate and differed significantly between urban and rural areas according to a new study published in Scientific Reports August 1, 2024.

Between July and September 2023, 45.6 per cent of antibiotics were accessed without authorisation, either without a prescription or through unlicensed sales.

The researchers surveyed 2,256 household representatives in the sub-districts of Haramaya and Harar town in eastern Ethiopia. Among the 1,245 household members who received antibiotics, 45.6 per cent obtained them improperly.

In urban regions, antibiotics were commonly accessible without a prescription because of lenient dispensing practices by pharmacies. In contrast, rural areas saw a higher prevalence of antibiotics being obtained from unlicensed drug sellers. Women in rural areas frequently consumed sub-optimal doses of antibiotics, mainly sourced from informal channels.

Community members have turned to unofficial and non-prescribed sources for antibiotics due to personal behaviors and healthcare-related issues like the absence of health insurance, inconvenience, and unavailability of medications. Addressing these behavioral and institutional factors can improve access to prescribed antibiotics, thereby decreasing antibiotic resistance.

Antibiotic access practices

The study's findings contribute to the understanding of contextual factors influencing inappropriate antibiotic access practices within various domains, allowing for targeted interventions to prevent antibiotic resistance.

Additionally, the research highlighted the extent of improper antibiotic use, including obtaining antibiotics without prescriptions and from unlicensed providers and informal sources.

It was found that non-prescribed antibiotic access was more prevalent among urban residents and those not covered by health insurance. This suggests that concerns about distance, drug availability and the convenience of public healthcare facilities were significant factors for these individuals.

In addition, women and rural individuals were more likely to get antibiotics from unauthorised sources. The study conducted by Dumessa Edessa from Haramaya University, Ethiopia established that unrestricted antibiotic sales in urban regions allowed for non-prescribed access, whereas in rural areas, unlicensed providers commonly facilitated this practice.

Of 1,245 individuals who received antibiotics, the majority were females (61 per cent), under-five children (30.3 per cent) and young adults (29.8 per cent). Though official drug suppliers (hospitals, health centers, pharmacies, or drugstores) provided 69 per cent of recent antibiotic access, primary clinics (22.2 per cent) and kiosks (8 per cent) also played significant roles. 

Antibiotics were obtained inappropriately in 45.6 per cent of access practices, with 15.1 per cent not prescribed, 21.8 per cent unlicensed providers, and 8.7 per cent informal sellers.

Inappropriate antibiotic access practices can impend their efficacy and lead to bacterial antimicrobial resistance, which has emerged as one of the biggest threats to human survival, contributing to up to 7.7 million estimated deaths worldwide in 2019.

A study published in Journal of Global Antimicrobial Resistance September 2021 indicated a high prevalence of multidrug-resistant bacteria in Ethiopia. The "overall pooled prevalence of multidrug resistance in Ethiopia was 70.5 per cent".

Non-prescribed and informal sources are implicated as the most common causes of inappropriate antibiotic access practices, resulting in untargeted therapy, which leads to antibiotic resistance. Knowing antibiotic access practices at the community level is essential to target misuse sources.