https://orcid.org/0000-0002-7706-7305
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ABSTRACT
Understanding the prevalence and types of antibiotics used in a given human and/or animal population is important for informing stewardship strategies. Methods used to capture such data often rely on verbal elicitation of reported use that tend to assume shared medical terminology. Studies have shown the category ‘antibiotic’ does not translate well linguistically or conceptually, which limits the accuracy of these reports. This article presents a ‘Drug Bag’ method to study antibiotic use (ABU) in households and on farms, which involves using physical samples of all the antibiotics available within a given study site. We present the conceptual underpinnings of the method, and our experiences of using this method to produce data about antibiotic recognition, use and accessibility in the context of anthropological research in Africa and South-East Asia. We illustrate the kinds of qualitative and quantitative data the method can produce, comparing and contrasting our experiences in different settings. The Drug Bag method can produce accurate antibiotic use data as well as provide a talking point for participants to discuss antibiotic experiences. We propose it can help improve our understanding of antibiotic use in peoples’ everyday lives across different contexts, and our reflections add to a growing conversation around methods to study ABU beyond prescriber settings, where data gaps are currently substantial.
SPECIAL ISSUE:
Responsible Editor Stig Wall, Umeå University, Sweden
Responsible Editor Stig Wall, Umeå University, Sweden
Acknowledgments
We are grateful to all staff and study participants who contributed to this article. Particular thanks go to Chrissy Roberts and Sham Lal for their insights, guidance and support with using ODK and R to develop the Drug Bag method.
Author contributions
The Drug Bag Method was conceived and designed by CC, JD, EM, LDW and CH. Data were collected by SM, YKZ, SN, CN and MK. Quantitative analysis was carried out by JD, EM, SN, CN and MK. Qualitative data were analysed by SM, YKZ, EM, SN, CN, MK and LDW. The manuscript was written by JD and CC, with input from all other authors.
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics and consent
The surveys on which this article is based were approved by the London School of Hygiene and Tropical Medicine ethics board. Additionally, local ethical approval was granted by the Biomedical Research and Training Institute, Zimbabwe; The College of Medicine Research Ethics Committee, Malawi, and the School of Biomedical Sciences Higher Degrees Research and Ethics Committee, Uganda. All participants in the surveys provided written informed consent.
Paper context
Valid and reliable community-level antibiotic use data are difficult to collect through established survey methods because of the limitations of respondent recall and translatability of the concept of ‘antibiotic’. The ‘Drug Bag’ method was designed to overcome these difficulties by presenting physical specimens of antibiotics to respondents. This paper presents experiences of using drug bags in Africa and South-East Asia.
