Transcript Oral Presentation 1

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, Freudenthal S, Stalsby Lundborg C, Eriksson B,
Wahlstrom R, Tomson G
Ministry of Health, Lao PDR; IHCAR, Karolinska Institutet, Sweden
Background
 Self-medication with antibiotics:
Commonly found in many countries
 Inappropriate self-medication could contribute to
antibiotic resistance/treatment failure/drug side-effects
 Reproductive Tract Infections (RTI) including
Sexually Transmitted Infections (STI):
- remain a very common problem worldwide
- impose a burden of morbidity/mortality
- facilitate HIV transmission
=> RTI/STI prevention with appropriate treatment and
health education: major public health importance
Rationale
 No study on self-medication with antibiotics for RTI
performed in Laos
 No evaluation of a pamphlet “STI can be prevented”
published by L-J SHIP
 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/STI in countries neighboring Laos
(In this study Self-medication with antibiotics is defined as
antibiotic use without prescription by a physician)
General objective
•
To describe, in a comprehensive way, the
utilization, knowledge and attitudes on selfmedication with antibiotics for RTI
•
To explore the understanding of a pamphlet
“STI can be prevented” among the adult population
in two provinces of Laos
•
To provide essential information for future
intervention 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
“STI 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):
collect background information, knowledge and attitudes and health
information
* Focus group discussions:
To explore people’s understanding and views on the pamphlet
“STI can be prevented”
Study sites:
- Vientiane Municipality (VTM)
- 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 households
To
Methods (2)
Inclusion criteria:
- Women and men aged 18 or more
- Using an antibiotic as self-medication for
RTI in the last one year
- Willing to participate
Sampling method: Multistage sampling
Data collection: Data collected in March 2002
4 FGD conducted in the urban areas of VTM and
4 FGD in the remote areas of CPS
8 to 10 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 (3)
Intervention
• IEC activities like radio, television, newspaper or
pamphlet health information
• Pamphlet “STI 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/STI/Project
Description of the content of the pamphlet
Size of pamphlet: 30x20 cm; folded into three sections
Paper is thick and of good quality
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
Both sexes
Women
CPS
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, 32% were housewives

48% had completed only 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
Results (3)
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%)

66% of respondents used antibiotics for 3 to 5 days,
13% for 2 days or less

Only 9% of them knew the dosage of antibiotics used
Results (4)
Advisers for using antibiotics in both sites
10.80%
30%
Drug seller
Friend/relative
1.60%
57.60%
Following previous treatment
Other advisers
Results (5)
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
Health information

91% of respondents had ever heard any information of RTI

10% of them had difficulties of understanding the information

After getting the health information, 39% of them reported change of
behaviour, but only 17% of all respondents had ever used a condom
Sources of information: - radio and television 31%
- drug sellers and friends 18%

Results (6)
Focus group discussions (FGD)
Knowledge and attitudes regarding STI prevention and
seeking treatment:



Most participants in all FGD had ever heard about STI and AIDS
Some had very little knowledge about prevention, treatment and
ways of transmission
Main sources of information regarding STI: 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.
Conclusion


More self-medication with antibiotics for RTI among people in VTM
(women 32%, men 3.7%) than among people in CPS (women 25%,
men 1.5%)
Drugstores: the first place for seeking treatment

Advice sought from drug sellers or friends or relative 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

Most people had access to health messages for RTI, largely by radio
and television, but some information was difficult to understand

Most people understood the messages in the printed pamphlet,
except for some technical terms used

The photographs were confusing and needed to be changed
Implications

Irrational use of antibiotics for self-treatment of RTI could contribute
to the continuing increase in antibiotic resistance/treatment failure

In the short term, there is a need to:
- improve people’s knowledge on rational use of antibiotics for RTI
by improving health messages/IEC
- train drug sellers to improve their awareness of selling antibiotics
for self-treatment of STI
- improve the pamphlet “STI can be prevented” by changing the
photographs and using less technical terms

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
THANK YOU
FOR YOUR ATTENTION