Every medicine is medicine; exploring inappropriate antibiotic use at the community level in rural Ghana

• Published in: BMC public health 2020-07, Vol.20 (1), p.1-1103, Article 1103
• Main Authors: Afari-Asiedu, Samuel, Hulscher, Marlies, Abdulai, Martha Ali, Boamah-Kaali, Ellen, Asante, Kwaku Poku, Wertheim, Heiman F. L
• Format: Article
• Language: English
• Subjects: Antibiotic resistance; Antibiotic use; Antibiotics; Bacterial infections; Community; Community health services; Data collection; Dispensers; Drug stores; Ethnomethodology; Ghana; Hernia; Hospitals; Inappropriate antibiotic use; Infections; Management; Medical personnel; Medicine; Metronidazole; Pain; Pharmacy; Physicians; Public health; Qualitative analysis; Qualitative research; Rural areas; Rural health services; Standardization; Stomach; Television
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-020-09204-4

Background Inappropriate antibiotic use is an important driver of antibiotic resistance. This study sought to explore inappropriate antibiotic use and confusing antibiotics with other medicines in Ghana using ethnomethodology research approach. Methods This was an explorative study involving 15 in-depth interviews among health professionals and private dispensers and eight focus group discussions among 55 community members. Qualitative data were coded using Nvivo 12, thematically analysed and presented as narratives with quotes to support the findings. Results Self-medication was common and antibiotics were used to treat specific diseases but respondents were not aware these were 'antibiotics'. Various antibiotics were used for indications that in principle do not require systemic antibiotics, like stomach ache and sores on the body. Antibiotics, in particular tetracycline and metronidazole, were poured into "akpeteshie" (local gin) to treat hernia and perceived stomach sores (stomach ulcer). These practices were copied/learnt from various sources like over-the-counter medicine sellers, family, friends, radio/television, drug peddlers, pharmacies and doctors. Medicines in capsules were referred to as 'topaye' or 'abombelt' in Twi (local dialect) and perceived to treat pain associated with diseases. Antibiotics in capsules were described with colours which appeared confusing as some capsules with different drugs in them have similar colours. Conclusion Inappropriate antibiotic use were influenced by general lack of knowledge on antibiotics and identification of antibiotics by colours of capsules which leads to confusion and could lead to inappropriate antibiotic use. There is the need for public health education on appropriate antibiotic use and standardization of appearance of antibiotics and other drugs to optimize use. Keywords: Antibiotics, Antibiotic use, Antibiotic resistance, Inappropriate antibiotic use, Ghana