Antibiotic knowledge, attitudes, and practices: new insights from cross-sectional rural health behaviour surveys in low- and middle-income South-East Asia

Introduction: Low- and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices, and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains underrepresented in AMR research. Objective: To (1) describe antibiotic-related knowledge, attitudes, and practices of the general population in two LMICs and to (2) assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers. Design: Observational study: cross-sectional rural health behaviour survey, representative on the population level. Setting: General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018. Participants: 2141 adult members (≥18 years) of the general rural population, representing 712,000 villagers. Outcome measures: Antibiotic-related knowledge, attitudes, and practices across sites and healthcare access channels. Findings: Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p<0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p<0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like “anti-inflammatory medicine” in Chiang Rai (87.6%; 95% confidence interval [CI]: 84.9–90.0) and “ampi” in Salavan (75.6%; 95% CI: 71.4–79.4). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI: 0.01 – 0.23) and 0.53 in Salavan (95% CI: 0.16 – 0.90). Conclusions: Locally specific conceptions and counter-intuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming “knowledge deficits” alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards “AMR-sensitive interventions” that address context-specific upstream drivers of antimicrobial use (e.g. unemployment insurance) and complement education and awareness campaigns

First report of apple stem grooving virus in Lao PDR, detected in citrus

Apple stem grooving virus, the causal agent of citrus tatterleaf disease, was detected for the first time in the Lao People’s Democratic Republic. Samples were collected from citrus trees across the southern provinces for testing in Australia. RNA was extracted and tested using conventional and real-time reverse transcription polymerase chain reactions with the virus detected in 1 of 59 samples tested. Viral identity was confirmed by Sanger sequencing and high throughput sequencing

First report of citrus tristeza virus in Lao PDR

Citrus tristeza virus was detected for the first time in the Lao People’s Democratic Republic. Samples were collected from citrus trees across the southern provinces for testing in Australia. RNA was extracted and tested using conventional and real-time reverse transcription polymerase chain reactions with the virus detected in 12 of 59 samples tested. Viral identities were confirmed by sequencing. Additional confirmation was obtained by an enzyme-linked immunosorbent assay. The implications of the presence of this virus for citrus production in Lao are discussed briefly

Species of Diaspididae (Hemiptera: Coccomorpha) on citrus in southern Lao PDR, new records for Viet Nam, and revised records for Indochina

The Diaspididae (Hemiptera: Coccomorpha), also known as armoured scale insects, is a diverse family of obligate, phytophagous parasites that include major economic pests of terrestrial plants. There are over 2,700 diaspidid species, about 116 of which have been recorded worldwide feeding on species and hybrids of citrus. Citrus is widely cultivated in the Lao People's Democratic Republic (Lao PDR) and has been promoted by the country's government as a poverty alleviation crop. However, little is known about the pest and disease issues faced by farmers of this crop. To help address this, in 2018 we conducted surveys of diaspidids on citrus in southern Lao PDR and found 14 species infesting citrus growing in orchards and home gardens. Identifications were based on morphological features of adult females and 28S, COI and COII DNA sequences. An identification key to the species based on morphological characters is provided. Records of diaspidid species on citrus in Myanmar, Thailand and Cambodia are updated, and records from Peninsular Malaysia provided. The first record on citrus of a Pseudaulacaspis species in Indochina is reported from Viet Nam, and an undescribed species of Pseudaonidia is recorded on citrus in Lao PDR

Antibiotic knowledge, attitudes and practices: new insights from cross-sectional rural health behaviour surveys in low-income and middle-income South-East Asia

Introduction: Low-income and middle-income countries (LMICs) are crucial in the global response to antimicrobial resistance (AMR), but diverse health systems, healthcare practices and cultural conceptions of medicine can complicate global education and awareness-raising campaigns. Social research can help understand LMIC contexts but remains under-represented in AMR research. Objective: To (1) Describe antibiotic-related knowledge, attitudes and practices of the general population in two LMICs. (2) Assess the role of antibiotic-related knowledge and attitudes on antibiotic access from different types of healthcare providers. Design: Observational study: cross-sectional rural health behaviour survey, representative of the population level. Setting: General rural population in Chiang Rai (Thailand) and Salavan (Lao PDR), surveyed between November 2017 and May 2018. Participants: 2141 adult members (≥18 years) of the general rural population, representing 712,000 villagers. Outcome measures: Antibiotic-related knowledge, attitudes and practices across sites and healthcare access channels. Findings: Villagers were aware of antibiotics (Chiang Rai: 95.7%; Salavan: 86.4%; p&lt;0.001) and drug resistance (Chiang Rai: 74.8%; Salavan: 62.5%; p&lt;0.001), but the usage of technical concepts for antibiotics was dwarfed by local expressions like ‘anti-inflammatory medicine’ in Chiang Rai (87.6%; 95% CI 84.9% to 90.0%) and ‘ampi’ in Salavan (75.6%; 95% CI 71.4% to 79.4%). Multivariate linear regression suggested that attitudes against over-the-counter antibiotics were linked to 0.12 additional antibiotic use episodes from public healthcare providers in Chiang Rai (95% CI 0.01 to 0.23) and 0.53 in Salavan (95% CI 0.16 to 0.90). Conclusions: Locally specific conceptions and counterintuitive practices around antimicrobials can complicate AMR communication efforts and entail unforeseen consequences. Overcoming ‘knowledge deficits’ alone will therefore be insufficient for global AMR behaviour change. We call for an expansion of behavioural AMR strategies towards ‘AMR-sensitive interventions’ that address context-specific upstream drivers of antimicrobial use (eg, unemployment insurance) and complement education and awareness campaigns. Trial Registration Number: clinicaltrials.gov identifier NCT03241316.</p