Table 4.
Household antibiotic use
| Variable | Malawi | Zimbabwe | Uganda | ||||
| MR1 | MR2 | ZU1 | ZU2 | UU | UR | ||
| Denominator: antibiotics in drug bags | 27 | 27 | 30 | 30 | 37 | 16 | |
| Pile sorting exercises—median drugs selected (range) | Recognised | 6 (0–27) | 5.5 (0–19) | 5 (0–23) | 7.5 (3–25) | 7 (1–17) | 4 (0–11) |
| Used | 3 (0–15) | 5 (0–15) | 2 (0–12) | 5 (0–24) | 5 (1–14) | – | |
| Frequently used | 1 (0–6) | 2 (0–9) | 1 (0–7) | 2 (0–13) | 2 (0–10) | 2 (0–7) | |
| Needed but inaccessible | 0 (0–7) | 0 (0–1) | 0 (0–3) | 1 (0–20) | 1 (0–12) | 2 (0–6) | |
| Denominator: total households | 825 | 100 | 336 | 100 | 350 | 100 | |
| Last antibiotic used, n (%) |
≤1 month | 467 (56.7) | 53 (53.0) | 104 (31.0) | – | 144 (41.1) | 71 (71.0) |
| >1 month | 352 (42.7) | 38 (38.0) | 224 (66.7) | 206 (58.9) | 24 (24.0) | ||
| Top 3 most frequently used antibiotics—antibiotic, n (%) | Amoxicillin, 395 (47.9) | Cotrimoxazole, 68 (68.0) | Amoxicillin, 192 (57.1) | Amoxicillin, 64 (64.0) | Metronidazole, 208 (59.4) | Amoxicillin, 58 (58.0) | |
| Cotrimoxazole, 311 (37.7) | Amoxicillin, 39 (39.0) | Cotrimoxazole, 88 (26.2) | Cotrimoxazole, 51 (51.0) | Ampicillin/cloxacillin, 106 (30.3) | Cotrimoxazole, 42 (42.0) | ||
| Metronidazole, 62 (7.5) | Erythromycin, 19 (19.0) | Metronidazole, 37 (11.0) | Metronidazole, 36 (36.0) | Amoxicillin, 97 (27.7) | Metronidazole, 40 (40.0) | ||
| Frequent use of ≥1 antibiotic in AWaRe classification, n (%): | Access | 608 (73.7) | 80 (80.0) | 231 (68.8) | 74 (74.0) | 291 (83.1) | 94 (94.0) |
| Watch | 82 (9.9) | 21 (21.0) | 28 (8.3) | 25 (25.0) | 85 (24.3) | 15 (15.0) | |
| Denominator: subset of households* | 173 | 100 | 101 | 100 | 350 | 100 | |
| Source of antibiotics, n (%) | Public clinic | 5 (2.9) | 3 (3.0) | 38 (37.6) | Respondents asked qualitatively about where antibiotics were generally obtained and why† | 55 (15.7)‡ | 84 (84.0)‡ |
| Public hospital | 111 (64.2) | 63 (63.0) | 8 (7.9) | ||||
| Private facility | 8 (4.6) | 16 (16.0) | 7 (6.9) | 165 (47.1) | 79 (79.0) | ||
| Research clinic/NGO | 0 (0.0) | 0 (0.0) | 0 (0.0) | 8 (2.3) | 1 (1.0) | ||
| Retail pharmacy | 7 (4.0) | 1 (1.0) | 37 (36.6) | 107 (30.6) | 2 (2.0) | ||
| Other shop | 7 (4.0) | 1 (1.0) | 0 (0.0) | 8 (2.3) | 14 (14.0) | ||
| Informal vendor | 6 (3.5) | 2 (2.0) | 2 (2.0) | 0 (0.0) | 0 (0.0) | ||
| Someone else | 29 (16.8) | 4 (4.0) | 9 (8.9) | 0 (0.0) | 0 (0.0) | ||
| Other | 0.0 | 10 (0.0) | 4 (4.0) | 4 (1.1) | 2 (2.0) | ||
M, Malawi, Z, Zimbabwe, U, Uganda; 1larger, semi-random survey, 2smaller, purposively sampled survey; R, rural, U, urban.
*In MR1 and ZU1, a smaller subset of households who reported using an antibiotic during a prior fever episode were asked where the antibiotic was obtained from. In MR2, all respondents were asked about where the last antibiotic used in the household was obtained from. In UU and UR, respondents were asked to list the sources from which they generally obtain medicines, including antibiotics.
†A common theme among respondents was that the clinic shelves were perceived as often being empty, and so they felt pushed towards retail pharmacies and the informal sector to obtain antibiotics—discussed in section ‘Amoxicillin and the gaps in public sector healthcare’.
‡In Uganda, both public clinics and public hospitals were grouped together under public facilities.
AWaRe, Access, Watch, Reserve; NGO, non-governmental organisation.