Resumen
Background: Indiscriminate use of antibacterial is a driver of selection pressure increasing antimicrobial
resistance. This study determined the pattern and predictors of antibacterial use among adults in the rural and urban communities, Oyo State, Nigeria.
Methods: A comparative cross-sectional study was carried out among 999 adults aged > 18 years enrolled at the Local Government Areas randomly selected by multistage sampling. The interviewer-administered semi-structured questionnaire was used to obtain information on respondents’ socio-demographic characteristics, the pattern of antibacterial use, prescribers and sources of drugs acquisition. Analyses were done with SPSS version 22.
Results: A total of 999 adults participated in the study, with mean age of 38±15years. Of the respondents, 501(50.2%) were from rural communities. The respondents’ use of antibacterials was, rural vs urban, lifetime use, 240(47.9%) vs 234(47.0%)[p=0.80], current use, 109(21.8%) vs 108(21.7%) [p=0.80] and past use, 129(25.8%) vs 125(25.1%)[p=0.80]. The commonly used antibacterials were
ampicillin/cloxacillin 94(43.5%) vs 126(53.2%)[p=0.04], amoxicillin 32(14.8%) vs 18(7.6%)[p=0.014],
ampicillin 16(7.4%) vs 40(16.9%)[p=0.002] and trimethoprim/sulfamethoxazole 18(8.3%) vs
13(5.5%)[p=0.23]. Self-prescription is common in both rural and urban communities, 51.3% vs 50.9%
[p=0.85] and the antibacterial were mostly acquired from patent medicine stores, 70.2% vs
60.8%[p=0.032]. Respondents’ residence did not significantly affect antibacterial use [X2=0.02, p=0.5].
The predictors of antibacterial use were low education level [AOR=1.7 (95% CI: 1.3-2.3], age < 65 years
[AOR=1.7 (95% CI: 1.1-2.9], and chronic medical illness [AOR=2.0 (95% CI:1.3-3.0].
Conclusion: Substantial proportion of respondents engaged in indiscriminate antibacterial use. We
suggested effective legislative strategies including the prohibition of sales of antibacterial agents without a prescription and educational interventions aiming at behavioural modification for the public.
Keywords:Antibacterials, Antimicrobial agents, Determinants, Patterns, Self-medication, Surveillance
Résumé
Contexte: L’utilisation indiscriminée d’antibactériens est un facteur de pression de sélection augmentant la résistance aux antimicrobiens. Cette étude a déterminé le schéma et les prédicteurs de l’utilisation des antibactériens chez les adultes dans les communautés rurales et urbaines de l’État d’Oyo, au Nigéria.
Méthodes: Une étude transversale comparative a été menée auprès de 999 adultes âgés de e” 18 ans
inscrits dans les mairies sélectionnées aléatoirement par échantillonnage à plusieurs étapes. Le
questionnaire semi-structuré administré par intervieweur a été utilisé pour obtenir des informations sur les caractéristiques sociodémographiques des répondants, le schéma d’utilisation des antibactériens, les
prescripteurs et les sources d’acquisition des médicaments. Les analyses ont été effectuées avec SPSS
version 22.
Résultats : Un total de 999 adultes a participé à l’étude, avec un âge moyen de 38 ± 15 ans. Parmi les
répondants, 501 (50,2%) provenaient des communautés rurales. L’utilisation d’antibactériens par
les répondants était, rurale vs urbaine, utilisation à vie, 240 (47,9%) vs 234 (47,0%) [p = 0,80], usage
actuel, 109 (21,8%) vs 108 (21,7%) [p = 0,8] et utilisation antérieure, 129 (25,8%) vs 125 (25,1%) [p =
0,80]. Les antibactériens couramment utilisés étaient l’ampicilline / cloxacilline 94 (43,5%) vs 126
(53,2%) [p = 0,04], l’amoxicilline 32 (14,8%) vs 18 (7,6%) [p = 0,014], l’ampicilline 16 (7,4%) vs 40
(16,9%) [p = 0,002] et triméthoprime / sulfaméthoxazole 18 (8,3%) vs 13 (5,5%) [p = 0,23]. L’autoprescription est courante dans les communautés rurales et urbaines, 51,3% contre 50,9% [p = 0,85] et les antibactériens ont été principalement achetés dans les boutiquesde médicaments patent, 70,2% vs 60,8% [p = 0,032]. La résidence des répondants n’a pas affecté significativement l’utilisation des antibactériens [X2 = 0,02, p = 0,5]. Les prédicteurs de l’utilisation des antibactériens étaient un faible niveau d’éducation [AOR = 1,7 (IC à 95%: 1,3-2,3], un âge <65 ans [AOR = 1,7 (IC à 95%: 1,1-2,9]) et une maladie médicale chronique [AOR = 2,0 ( IC à 95%: 1,3-3,0].
Conclusion: Une proportion substantielle de répondants s’est engagée dans l’utilisation antibactérienne indiscriminée. Nous avons proposé des stratégies législatives efficaces, notamment l’interdiction de la vente des agents antibactériens sans ordonnance et des interventions éducatives visant à modifier le comportement du public.
Mots - clés : Antibactériens, agents antimicrobiens, déterminants, modèles, automédication, Surveillance
Correspondence: W.A. Adedeji, Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Nigeria. Email: wad_deji@yahoo.com
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