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

Abstract

Introduction: There are concern with rising rates of antimicrobial resistance (AMR) across countries with the appreciable impact on morbidity, mortality and costs. Among low- and middle-income countries (LMICs), a key driver of AMR is 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 among patients especially in more rural areas of South Africa. A pilot study was undertaken to address this. Methodology: A two-step descriptive approach was undertaken. This involved two questionnaires among patients exiting chain and independent community pharmacies followed by cognitive interviews. Results: Overall, 21 patients were approached for an interview, 11 for the first questionnaire (Part 1) and 10 for the second (Part 2). 3 patients declined participation in Part 1 and 2 for Part 2, leaving 8 patients completing each questionnaire. On average, it took 2 minutes 13 seconds 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 among the 8 patients interviewed with Part 2. Overall, there was 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 of 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