Socio-cultural factors influencing the utilization of first-line Antibiotics in Manyatta 'a' sub-location, Kisumu city, Kenya

Abstract

ABSTRACT The prevalence of self-medication with antibiotics in Kenya in 2009 was 58.2%, in Nyanza 68.5% and Kisumu 64.8%. Although antibiotics resistance is primarily a medical problem, factors influencing its spread are sociocultural, ecological and epidemiological. In Manyatta 'A' sub-location, Kisumu County, little is known about the socio-cultural a factors in the utilization of first-line antibiotics, especially from the perspective of consumers. This study specifically explored knowledge about use of first-line antibiotics among pharmacy clients; analyzed beliefs, perceptions and behavior on antibiotics use and; appraised the methods preferred by pharmacy clients for learning about first-line antibiotics use. The study was guided byKleinman's (1980) explanatory model of health and illness. Study design was descriptive. The study population comprised 28 pharmacies, pharmacy clients, chief pharmacists and pharmacy clerks. Sample size for pharmacies was 8 drawn through Prakash's (1994) 30% threshold. The 8 pharmacies were selected through simple random sampling. Sample size for pharmacy clients was 102 determined through a modified theoretical sampling strategy and justified according to Kathuri and Pals (1993) that a sample of at least 100 is sufficient for a survey. The 102 pharmacy clients, chief pharmacists and pharmacy clerks from the 8 pharmacies were purposively selected. Sample size for household follow-up interview was 31 informants determined according to Prakash 30% rule. The 31 informants were selected through systematic sampling. Quantitative and qualitative data were collected through 102 semi-structured questionnaires. More qualitative anthropological data were collected using 31 unstructured questionnaires, 8 key informant interviews and 3 focus group discussions. Quantitative data were analyzed using descriptive statistics through Excel and results presented in frequency tables. Qualitative data were analyzed thematically and presented throJ'gh verbatim quotes. Results showed that amoxil and septrin were mostly used to treat coughs, diarrhea, and yamo. Yamo is an indigenous disease category referring to a constellation of perceived ailments including boils, rashes, coughs, measles, diarrhea, fever and flu associated with self-medication with antibiotics. Perceived knowledge on indication of the antibiotics was based on socialization and history of previous experience with the drug. Inaccessibility of health services and perceptions of severity or non-severity of illnesses influenced decisions to acquire antibiotics without prescription. The antibiotics regimen was stopped when symptoms disappeared. Preferred. methods of learning about antibiotics use are door-to-door campaign and barazas. The study recommends the need to define more clearly measures of patients' knowledge, evaluation of consumers' perceptions about dosage form preferences, self-medication and non-compliance. Health planners, policy makers and program managers should develop effective interventions on appropriate use of antibiotics that takes into account health beliefs and perceptions of local population.