The ‘Drug Bag’ method: lessons from anthropological studies of antibiotic use in Africa and South-East Asia

Figures & data

Box 1. Drug Bag Research Objectives

To establish how many, and which, different antibiotics were recognisable by members of households and/or farmers in a given study context To capture which antibiotics household members/farmers said they used, and the approximate frequency of use To capture the symptoms and illnesses that frequently-used antibiotics were used to treat. To capture which antibiotics were easier and harder to access

Table 1. Drug Bag participants

Study Site (Region, Country)	Human/animal sector	Sample Size	Mean Household Size	Sex of main respondent (% female)	Mean age and range of main respondent
Harare, Zimbabwe	Human	100	6	96	43 (18–81)
Chikwawa, Malawi	Human	101	4.5	90	27 (17–71)
Yangon, Myanmar	Human	50	5	92	47 (21–83)
Kampala, Uganda	Human	174	-	79	-
Tororo and Wakiso, Uganda	Animal	115	-	52	18–87

Figure 1. Steps taken to operationalise drug bags

Figure 2. Flow diagram showing the progression of pile sorting exercises

Figure 3. Field team in Malawi practicing the pile sorting exercises

Figure 4. Percentage (%) of respondents that recognised antibiotics available in Chikwawa District, Malawi (n = 101)

*Includes 34 antibiotics classified by generic name and mode of administration (and reclassified retrospectively by class). Tablets and capsules are both labelled ‘tablet’.

Figure 5. The ‘jeep-car medicine’ in Yangon, Myanmar

Figure 6. Proportional reported use (%) of frequently-used antibiotics by class among households in Malawi (n = 101), Myanmar (n = 50), Uganda (n = 174) and Zimbabwe (n = 100)

Table 2. Observed strengths and limitations

	Strengths	Limitations
Data	Establishing patterns of recognition in settings with a relatively small and stable range of antibiotics Capturing ABU and approx. frequency of use Capturing symptoms and illnesses that freq. used antibiotics were used to treat	Unreliable data on recognition (and thus use/frequent use) in settings with wide and shifting range of antibiotics Directly identifying antibiotics that are difficult to access Demonstration effects on ABU practices
Logistical	Establishing relationships with providers for ongoing fieldwork Engaging and fun method, contributing to high recruitment rates	Time and resource intensive
Ethical	Takes seriously the importance of local categories, contexts and concerns	Generated expectations for medicines and care