Pilot study to evaluate the feasibility of a patient questionnaire for the purpose of investigating the extent of purchasing antibiotics without a prescription in a rural province in South Africa : rationale and implications

Sono, Tiyani Milta and Maluleke, Morgan Tiyiselani and Ramdas, Nishana and Jelić, Ana Golić and Campbell, Stephen and Marković-Peković, Vanda and Schellack, Natalie and Kumar, Santosh and Godman, Brian and Meyer, Johanna C. (2024) Pilot study to evaluate the feasibility of a patient questionnaire for the purpose of investigating the extent of purchasing antibiotics without a prescription in a rural province in South Africa : rationale and implications. Advances in Human Biology, 14 (2). pp. 138-147. ISSN 2321-8568 (https://doi.org/10.4103/aihb.aihb_140_23)

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Abstract

Introduction: There are concerns with rising rates of antimicrobial resistance (AMR) across countries with appreciable impact on morbidity, mortality and costs. Amongst low- and middle-income countries, a key driver of AMR is the excessive use of antibiotics in ambulatory care, with a critical area being the appreciable selling of antibiotics without a prescription often driven by patient demand and limited knowledge. There is currently conflicting evidence in South Africa regarding this practice. Consequently, there is a need to explore these critical issues amongst patients, especially in more rural areas of South Africa. A pilot study was undertaken to address this. Methods: A two-step descriptive approach was undertaken. This involved two questionnaires amongst patients exiting chain and independent community pharmacies followed by cognitive interviews. Results: Overall, 21 patients were approached for an interview, including 11 for Part 1 of the questionnaire with 3 declining, and 10 for Part 2, with 2 declining. Subsequently 8 patients completed each part of the questionnaire. On average, it took 2 min 13 s to complete both parts. 3 of the 5 patients being dispensed an antibiotic were dispensed one without a prescription, with all 3 patients exiting from independent pharmacies. Key reasons for self-purchasing included money and convenience. There was mixed knowledge regarding antibiotics and AMR amongst the 8 patients interviewed with Part 2. Overall, there was a satisfactory understanding of the Part 1 questions, although some modifications were suggested. Some participants had difficulty with fully understanding the questions in Part 2, with a number of suggestions made to improve this for the main study. Conclusion: There were concerns with the extent of purchasing antibiotics without a prescription in this pilot study as well as the knowledge of patients regarding antibiotics and AMR. Both areas need addressing and will be explored further in the main study.

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