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“Antibiotics heal all diseases”; the factors influencing the pratices of self-medication with antibiotics in Maputo City, Mozambique

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Abstract

Background

Antibiotic consumption is the primary driver of antimicrobial resistance (AMR). The non-prescribed use for self-perceived diseases is one of the chief contributing factors to the unwise use of antibiotics as it paves the way to the development, growth, and spread of AMR. We aimed at describing the underlying factors influencing self-medication with antibiotics (SMA) in Maputo city, Mozambique.

Methodology

A qualitative cross sectional study was conducted between October 2018 and March 2019 with 32 participants. Using purposeful sampling, participants were recruited and interviewed after purchasing antibiotics without prescriptions from nine pharmacies in Maputo city. Out of 32 participants, 20 enrolled for individual in-depth interviews and 12 for focus group discussions that were audio-recorded, transcribed, coded, and analyzed using latent content analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist by (Tong et al. Int J Qual Health Care 19:349–357, 2007) was performed.

Results

The participants declared recurrent practices of SMA to treat self-perceived illnesses. The private pharmacies were the main platform to access the non-prescribed antibiotics (NPA). The main factors driving the pratices of SMA were the easy availability of antibiotics, previous experience with antibiotics, easy access to pharmacist’s advice, long wait to access health care facilities, perceived poor quality of assistance at health care facilities, considering minor illness that do not need to seek professional health care, influencing role of the people from the social circle, cultural beliefs on the healing power of antibiotics, and time and financial constraints.

Conclusion

The practices of SMA are influenced by various factors that flow from the health care system, to the participant’s health-seeking behavior. These are reinforced by the public’s cultural belief that “antibiotics heal all diseases,” which determines the social representations of medicines shape the attitudes and behaviors of SMA. The culturally rooted behavior, the social representations of the health care system, and the therapeutic itineraries the public adopt are to be considered as having an ever-present effect on all different stages of the disease and healing process. Understanding the phenomenon of SMA to better address the promotion of rational use of antibiotics is urgently needed in Mozambique.

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Data availability

The raw data was attained in the local language, the datasets analyzed were transcribed, and translated into English. The data are not publicly available as it contains information that could compromise research participant privacy/consent. Therefore, the datasets analyzed for this paper will be assessed from the corresponding author upon reasonable request.

Abbreviations

AMR:

Antimicrobial resistance

LMICs:

Low and middle-income countries

NHS:

National Health System

NPA:

Non-prescribed antibiotics

NDP:

National Department of Pharmacy

POM:

Prescription only medicine

SMA:

Self-medication of antibiotic

UKZN:

University of KwaZulu Natal

WHO:

World Health Organization

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Acknowledgments

The Instituto Superior de Ciências de Saúde (SCISA), the NORHED Project, and the UKZN (College of Health Sciences) are acknowledged for the incentive and provision of resources for this review. The research assistants and the study participants are acknowledged for their support and participation. The authors acknowledge the valuable contributions and suggestions provided during the peer review process.

Funding

The study was partially funded by grants received at ISCISA (Higher Institute for Health Sciences) from the NORHED Project (Norway High Education and Development) and by the College of Health Sciences, University of KwaZulu Natal (UKZN). The authors declare that the sponsors did not influence the study.

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Authors and Affiliations

  1. Instituto Superior de Ciências de Saúde «ISCISA, Higher Institute for Health Sciences», Maputo, Mozambique

    Neusa F. Torres

  2. Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa

    Neusa F. Torres

  3. Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu Natal, Durban, South Africa

    Vernon P. Solomon & Lyn E. Middleton

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  1. Neusa F. Torres
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Contributions

NFT was the principal investigator and the lead author of the manuscript. NFT conceptualized and prepared the draft proposal of the study under the supervision of LEM and VS. Both LEM and VS assisted with data management, analysis, manuscript revision, and redaction. NFT, LEM, and VS contributed to the reviewed draft version of the manuscript and approved the final version.

Corresponding author

Correspondence to Neusa F. Torres.

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Ethics approval and consent to participate

This study was reviewed and approved by the Humanities and Social Sciences Ethical Committee (HSREC) From the University of KwaZulu Natal, Durban, South Africa, and by the National Bioethics Committee for Health (CNBS) form the Ministry of Health, Mozambique. Participants gave written consent to participate and written confirmation that there was an understanding of the objectives of the interview, that the participants themselves were willing and able to participate, and that they could decline to participate further at any time.

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The authors declare no competing interests.

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Torres, N.F., Solomon, V.P. & Middleton, L.E. “Antibiotics heal all diseases”; the factors influencing the pratices of self-medication with antibiotics in Maputo City, Mozambique. J Public Health (Berl.) 31, 73–84 (2023). https://doi.org/10.1007/s10389-020-01416-7

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