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Original research
Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo
  1. Tonka Eibs1,
  2. Alena Koscalova1,
  3. Mohit Nair1,
  4. Paul Grohma2,
  5. Gisa Kohler1,
  6. Rawa Gafar Bakhit1,
  7. Mzia Thurashvili1,
  8. Estrella Lasry3,
  9. Sandra Wagner Bauer1,
  10. Carolina Jimenez3
  1. 1Vienna Evaluation Unit, Medecins Sans Frontieres, Vienna, Austria
  2. 2Infectious diseases departement, Slovak Medical University, Bratislava, Slovakia
  3. 3Medical departement, Medecins Sans Frontieres, Barcelona, Spain
  1. Correspondence to Dr Alena Koscalova; alena.koscalova{at}


Objectives The objective of this study was to address the knowledge gap regarding antibiotic use in Medecins Sans Frontiéres (MSF) projects located in Africa by exploring antibiotic prescription and consumption habits and their drivers at different healthcare levels.

Design This study used an exploratory study design through thematic analysis of semistructured, in-depth interviews, focus group discussions (FGDs) and field observations in order to understand the main drivers influencing current antibiotics prescription habits and consumption habits of patients in different geographical settings.

Setting The study took place in MSF centres and towns across four countries: Guinea-Bissau, Central African Republic (CAR), Democratic Republic of Congo (DRC) and Sudan.

Participants 384 respondents participated in the study, which includes project staff, prescribers, community members, patients, among other groups.

Results Treatment protocols were physically present in all countries except DRC, but compliance to protocols varied across contexts. A failing health system and barriers to accessing healthcare were perceived as major drivers of overuse and inconsistent prescription practices. Patient demands influenced prescription decisions, and self-medication was commonly reported in the context of failing health systems. Additionally, there was a strong demand for quick cures and communities preferred injections over pills. Patients tended to stop antibiotic treatment once symptoms abated and had major gaps in understanding antibiotic intake instructions and functions.

Conclusions While there were specific findings in each context, the larger trend from these four MSF projects in Africa indicates widespread use of antibiotics based on unclear assumptions, which are often influenced by patient demands. There needs to be a broader focus on the balance between access and excess, especially in such fragile contexts where access to healthcare is a real challenge.

  • public health
  • infection control
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors TE, AK, MN and SWB wrote the manuscript. AK, TE, CJ and EL designed the research. PG, RGB, GK, MT, TE and AK performed the research and analysed the data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the Medecins Sans Frontieres Ethics Review Board (ID 1823).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from Alena Koscalova, Director of Vienna Evaluation Unit, but restrictions apply to the availability of these data, which are under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Alena Koscalova.

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