Transcript Poster presentation

SELF-MEDICATION WITH ANTIBIOTICS FOR REPRODUCTIVE TRACT
INFECTIONS IN LAO PDR: USE, ATTITUDES AND UNDERSTANDING OF
INFORMATION
Sihavong A, Gneunphonsavath S, Chanthavong K, Visathep A, Choumkhamphanh S,
Xayyavong S, Akkhavong K, Wahlstrom R, Freudenthal S, Stalsby Lundborg C,
Eriksson B, Tomson G
Ministry of Health, Lao PDR; IHCAR, Karolinska Institutet, Sweden
Problem Statement: Self-medication (SM) of antibiotics (AB) for reproductive tract
infections (RTI), including sexually transmitted diseases (STD), was suspected to be high in
Laos, but no studies had been performed. Inappropriate self-medication could contribute to the
continuing increase in antibiotic resistance.
Objectives: To describe AB use as SM for RTI and to explore the perceptions and
understanding of health information, among the adult population in two provinces of Lao PDR
in order to improve drug use and Information, Education and Communication (IEC)
components.
Design: Cross-sectional population based study. Structured interviews (household survey) and
focus group discussions.
Setting and Population: A total of 500 subjects, who had self-medicated for RTI were
recruited from 827 households in the Vientiane Municipality (VTM) and the Champasack
province (CPS), half in urban and half in rural areas.
Intervention: The study was part of an information and education strategy to gain more
knowledge about prevalence and attitudes.
Outcome Measures: Percentage of people using AB as SM for RTI, percentage of advisers for
using AB, percentage of kind of AB used, percentage of sources of information received, and
qualitative aspects on information material (pamphlet).
Results: In total, 16 percent stated use of AB as SM for RTI (28% in women and 2.5% in men)
in both study sites, significantly higher among people in VTM (women 32%, men 3.7%) than
among people in CPS (women 25%, men 1.5%). Drugstores were the first place for seeking
treatment. Advice was reported to be sought from drug sellers or friends or relatives or
following previous treatment. Ampicillin and tetracycline dominated. More than half of the
respondents of both sexes had little knowledge of antibiotics, many using antibiotics with
incorrect duration and dosage. Most people had access to health messages for RTI, largely by
radio and television, but some information was difficult to understand due to some technical
terms or foreign language. Most people understood the messages in the printed pamphlet,
except for some technical terms used, but reported that the photographs were confusing and
needed to be changed.
Conclusions: Great efforts are needed to improve people’s knowledge on rational use of
antibiotics, on prevention and seeking treatment for RTI and STD by improving health
messages including IEC.
Study funded by: Sida and Ministry of Health, Laos
Introduction
• Self-medication with antibiotics: commonly found in
many countries.
• Inappropriate self-medication could contribute to:
- antibiotic resistance
- treatment failure/chronic diseases
- drug side-effects/allergic reaction/toxic poisoning
• Reproductive Tract Infections ( RTI ) including
Sexually Transmitted Diseases ( STD ):
- remain a very common problem worldwide
- impose a burden of morbidity/mortality
- facilitate HIV transmission
=> RTI/STD prevention in combination with appropriate
treatment and health education
=> major public health importance
• No study on self-medication with antibiotics for RTI
performed in Laos
• No evaluation of a pamphlet “STD can be prevented“
published by L-J SHIP (Lao-Japan Sethathirath Hospital
Improvement Project)
=> Highly relevant study to the nation as a response to:
- an awareness of the continuing increase in
antibiotic resistance due to irrational drug use
- the high levels of HIV/STD in countries
neighboring Laos
General objective:
• To describe, in a comprehensive way, the utilization,
knowledge and attitudes on self-medication with antibiotics
for RTI
• To explore the understanding of a pamphlet “STD can be
prevented” among the adult population in two provinces of
Laos
• To provide essential information for future interventions
to improve drug use and IEC components.
Specific objectives:
1. To describe the use of antibiotics as self-medication for
RTI in adults
2. To explore people’s knowledge and attitudes regarding
the use of antibiotics as self-medication for RTI
3. To explore people’s knowledge and attitudes regarding
health information on the use of antibiotics for RTI
4. To explore people’s understanding of the pamphlet “STD
can be prevented” and their views regarding community
intervention for correct treatment and prevention of RTI
Methods (1)
Study design: Cross-sectional population based study
Methods used:
* Structured interviews (household survey): To collect
background information, knowledge and attitudes and health
information
* Focus group discussions: To explore people’s understanding
and views on the pamphlet “STD can be prevented”
Study sites: Vientiane Municipality (VTM) and Champasack
Province (CPS). Half in urban and half in rural areas
Sample size: A total of 500 subjects self-medicated with
antibiotics for RTI recruited from 827 household with
3056 family members.
Inclusion criteria: Women and men aged 18 or more who
had used an antibiotic as self-medication for RTI in the last
one year, and who were willing to participate
Sampling method: Multistage sampling
Data collection: Data collected in March 2002.
Four FGD conducted in the urban areas of VTM and 4 FGD
in the remote areas of CPS. Eight to ten participants in each
FGD.
Data analysis: Data entered by Epi Info (version 6.04) and
analyzed by SPSS (version 10). FGD analyzed by qualitative
method
Methods (2)
Intervention
• IEC activities like radio, television, newspaper or pamphlet
health information
• Pamphlet “STD can be prevented” produced in 2001 by the
cooperation between:
- Sethathirath Hospital
- L-J SHIP
- Health Department of VTM and
- Ministry of Health/European Union/STD Project
• Description of the content and pictures of the pamphlet:
The size of the pamphlet is 30x20 cm, folded into three
sections to make it small enough for people to take with
them. The paper is thick and of good quality.
Photo 1: Close up of the inside of a vagina with an abnormal
vaginal discharge
Photo 2: Close up of a penis with urethral discharge
Photo 3: Close up of a penis with genital ulcer
Photo 4: Close up of scrotum swelling and a doctor’s fingers
with gloves on that are holding it
Picture 5: Close up of a baby with inflammatory eyes and a
doctor’s fingers trying to open it.
Results (1)
Percentage of people using antibiotics as
self-medication for RTI in relation to
all sampled family members and
classified by gender and areas
35%
30%
32%
28%
25%
25%
20%
19%
16%
15%
15%
10%
5%
4%
3%
2%
0%
Both sites
VTM
CPS
Both sexes Women Men
Results (2)
Social-demographic characteristics of people using
antibiotics self-medication for RTI
Mean age of study participants: 34.8 (Std  9.5)
 85% were married
 48% had completed primary school and 42% had
completed secondary school
 78% of female respondents had symptoms of both vaginal
discharge and lower abdominal pain
 85% of male respondents had symptoms of urethral
discharge

Knowledge and attitudes regarding the use of antibiotics
for RTI among people with self-medication
54% of respondents did not understand what an antibiotic
means.
 33% of the antibiotics used were ampicillin
 58 percent were mixed antibiotics, most common
combinations with ampicillin and tetracycline (28%)
 More than 66% of respondents used antibiotics for
inappropriate duration
 Only 9% of them knew the dosage of antibiotics used

Results (3)
Advisers for using antibiotics in both sites
10.80%
30%
Drug seller
Friend/relative
1.60%
57.60%
Following previous treatment
Other advisers
Results (4)
Health seeking
• Of all respondents, 50% replied that they treated themselves
for RTI because of habit, 36% had no time to see physician
• More than 18% followed advice of others or drug
advertisement, either directly (12%) or combined with other
reasons
• Of the 496 respondents who had ever gone to hospital, 59%
replied that the services of medical staff were polite/good,
37% said that they were fair, but 4% said that some medical
staff were impolite/rude/bad
Health information
• 91% of respondents had ever heard any information of RTI
• 10% of them had difficulties of understanding the
information, mostly due to misunderstanding of technical
terms or foreign languages or unclear explanation
• After getting the health information, 39% reported change of
behaviour, but only 17% of all respondents had ever used a
condom
• Respondents in VTM used more condom than those in CPS
(25% VS 9%, p < 0.01)
• Sources of information: - Radio and television 31%
- Drug sellers and friends 18%
Results (5)
Focus group discussions (FGD)
Knowledge and attitudes regarding STD
prevention and seeking treatment:
• Most participants in all FGD had ever heard about STD/AIDS
• Some had very little knowledge about prevention, treatment
and ways of transmission
• Main sources of information regarding STD: drug sellers,
friends, relatives, radio and television
Perception and understanding of the pamphlet
information:
• For most women and men, the pamphlet’s size was good with
useful messages and easy to keep
• Most people understood its messages except for some
technical terms used
• The photographs were confusing and needed to be changed
Perception on the services of medical staff:
• Most FGD participants reported that “ the services of medical
staff are good “
• However, few of them said: “the provision of treatment and
care from some medical staff are not as good as expected”
Conclusion
• More self-medication with antibiotics for RTI among
people in the VTM (women 32%, men 4%) than among
people in CPS (women 25%, men 2%)
• Drugstores: the first place for seeking treatment
• Advice sought from drug sellers or friends or relatives or
following previous treatment
• More than half of respondents of both sexes had little
knowledge of antibiotics, and used them with incorrect
duration and dosage
• The common reasons for self-medication were habit, no
time to see a physician, following advice of others or drug
advertisement
• Most people had access to health messages for RTI,
largely by radio and television
• Some information was difficult to understand due to some
technical terms or foreign language
• Most people understood the messages of the pamphlet,
except for some technical terms used
• The photographs were confusing and needed to be
changed
Implications
• The irrational use of antibiotics for self-treatment of RTI
could have serious adverse effects resulting in antibiotic
resistance, treatment failure, serious complications and
sequelae
• In the short term, there is a need to:
- improve people’s knowledge on rational use of antibiotics,
on prevention and seeking treatment for RTI/STD by
improving health messages including IEC
- train drug sellers to improve their awareness of selling
antibiotics for self-treatment of STD
- improve the pamphlet “STD can be prevented” by
changing the photographs and using less technical terms in
the text
• In the long term, there is a need to:
- consider drug regulation to promote appropriate selling of
antibiotics with or without a prescription
- evaluate other published pamphlets regarding people’s
understanding and views on health information for future
community interventions