PT  - JOURNAL ARTICLE
AU  - Tonka Eibs
AU  - Alena Koscalova
AU  - Mohit Nair
AU  - Paul Grohma
AU  - Gisa Kohler
AU  - Rawa Gafar Bakhit
AU  - Mzia Thurashvili
AU  - Estrella Lasry
AU  - Sandra Wagner Bauer
AU  - Carolina Jimenez
TI  - Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo
AID  - 10.1136/bmjopen-2019-036530
DP  - 2020 Sep 01
TA  - BMJ Open
PG  - e036530
VI  - 10
IP  - 9
4099  - http://bmjopen.bmj.com/content/10/9/e036530.short
4100  - http://bmjopen.bmj.com/content/10/9/e036530.full
SO  - BMJ Open2020 Sep 01; 10
AB  - 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.