학술논문
Understanding antimicrobial resistance through the lens of antibiotic vulnerabilities in primary health care in rural Malawi.
Document Type
Article
Author
Source
Subject
*ANTIMICROBIAL stewardship
*MEDICAL quality control
*HEALTH facilities
*RURAL conditions
*NEGOTIATION
*RESEARCH methodology
*CRITICISM
*ANTI-infective agents
*INTERVIEWING
*CLINICS
*MEDICAL personnel
*LABOR demand
*FEAR
*PRIMARY health care
*FIELDWORK (Educational method)
*SURVEYS
*ETHNOLOGY research
*DOCUMENTATION
*AVOIDANCE (Psychology)
*DRUG prescribing
*MEDICAL referrals
*GOVERNMENT policy
*FIELD notes (Science)
*PSYCHOSOCIAL factors
*COMMUNICATION
*RESEARCH funding
*DRUG resistance in microorganisms
*PHYSICIAN practice patterns
*PATIENT-professional relations
*PATIENT care
*PARTICIPANT observation
*DATA analysis software
*OUTPATIENT services in hospitals
*HEALTH care rationing
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Language
ISSN
1744-1692
Abstract
The diminishing effectiveness of antimicrobials raises serious concerns for human health. While policy makers grapple to reduce the overuse of antimicrobial medicines to stem the rise of antimicrobial resistance, insufficient attention has been paid to how this applies to low-resource contexts. We provide an in-depth portrayal of antimicrobial prescribing at primary health care level in rural Chikwawa District, Malawi. Ethnographic fieldwork took place over 18 months (2018–2020). We surveyed 22 health facilities in the district, observed 1348 health worker-patient consultations, and carried out 49 in-depth interviews with staff and patients. Care was centred around provision of an antimicrobial. Amid chronic lack of essential medicines and other resources, clinic interactions were tightly scripted, providing patients little time to question or negotiate their treatment. We develop the concept of 'antibiotic vulnerabilities' to reveal multiple ways in which provision of antimicrobials in rural Malawi impacts care in conditions of extreme scarcity. Antibiotics are central and essential to primary care. As targets for optimal antimicrobial prescribing take a more central role in global policy, close attention is required of the ramifications for the delivery of care to ensure that efforts to stem resistance do not undermine the goal of improved health for all. [ABSTRACT FROM AUTHOR]