Exploring confusion with antibiotic identification at the community level in six low-and-middle-income countries across Asia and Africa

Abstract

BACKGROUND: Antimicrobial resistance (AMR) is largely attributable to inappropriate antibiotic use particularly in low-and-middle-income countries (LMICs). Misidentification of antibiotics could contribute to inappropriate use, as people may use the wrong drugs for their conditions. Misidentification and inappropriate use are worsened by self medication and easy access to antibiotics that are obtained from unapproved sources, including over-the-counter medicine sellers. This study explored community perceptions of confusion with antibiotics identification and pathways to improve the identification through physical or visual appearance. METHODS: A qualitative exploratory study was conducted from June 2021 and December 2022. A total of 140 In-depth interviews (IDIs) with medicine suppliers and 76 focus group discussions (FGDs) with community members were conducted in six countries spanning Africa (Ghana, Mozambique, South Africa) and Asia (Bangladesh, Thailand, Vietnam). Data was thematically analysed, and results presented as narratives with excerpts to support the findings. RESULTS: Identification of antibiotics through physical and visual appearance emerged as a complex issue influenced by a variety of factors including colours, shapes, sizes, packaging, local terminologies, and cultural beliefs. Visual cues serve as a primary means of antibiotic identification across all studied countries. This is especially significant in contexts where language barriers or low literacy hinder identification by written labels. While there are common trends across the studied countries, such as the importance of colour in identification, there are also significant regional and local variations that should be considered. DISCUSSION: The study highlights visual cues a primary means of antibiotic identification, providing valuable insights for developing targeted health literacy and antibiotic awareness interventions. Ultimately, enhancing the ability of community members to accurately identify antibiotics is a key step in promoting responsible antibiotic use practices and improving global health outcomes.