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dc.contributor.authorKeenan, Katherine
dc.contributor.authorFredricks, Kathryn J.
dc.contributor.authorAl Ahad, Mary Abed
dc.contributor.authorNeema, Stella
dc.contributor.authorMwanga, Joseph R.
dc.contributor.authorBazira, Joel
dc.contributor.authorMike Kesby
dc.contributor.authorHATUA Consortium
dc.date.accessioned2024-03-19T10:07:55Z
dc.date.available2024-03-19T10:07:55Z
dc.date.issued2023
dc.identifier.citationKeenan, K., Fredricks, K. J., Al Ahad, M. A., Neema, S., Mwanga, J. R., Kesby, M., ... & HATUA Consortium Sunday Benjamin Ndaki Pendo Benitez-Paez Fernando Clarkson Madeleine Ke Xuejia Konje Eveline T. (2023). Unravelling patient pathways in the context of antibacterial resistance in East Africa. BMC Infectious Diseases, 23(1), 414.en_US
dc.identifier.urihttp://ir.must.ac.ug/xmlui/handle/123456789/3478
dc.description.abstractBackground: A key factor driving the development and maintenance of antibacterial resistance (ABR) is individuals’ use of antibiotics (ABs) to treat illness. To better understand motivations and context for antibiotic use we use the concept of a patient treatment‑seeking pathway: a treatment journey encompassing where patients go when they are unwell, what motivates their choices, and how they obtain antibiotics. This paper investigates patterns and deter‑ minants of patient treatment‑seeking pathways, and how they intersect with AB use in East Africa, a region where ABR‑attributable deaths are exceptionally high. Methods: The Holistic Approach to Unravelling Antibacterial Resistance (HATUA) Consortium collected quantita‑ tive data from 6,827 adult outpatients presenting with urinary tract infection (UTI) symptoms in Kenya, Tanzania, and Uganda between February 2019‑ September 2020, and conducted qualitative in‑depth patient interviews with a subset (n = 116). We described patterns of treatment‑seeking visually using Sankey plots and explored explanations and motivations using mixed‑methods. Using Bayesian hierarchical regression modelling, we investigated the associa‑ tions between socio‑demographic, economic, healthcare, and attitudinal factors and three factors related to ABR: self‑treatment as a first step, having a multi‑step treatment pathway, and consuming ABs. Results: Although most patients (86%) sought help from medical facilities in the first instance, many (56%) described multi‑step, repetitive treatment‑seeking pathways, which further increased the likelihood of consuming ABs. Higher socio‑economic status patients were more likely to consume ABs and have multi‑step pathways. Reasons for choos‑ ing providers (e.g., cost, location, time) were conditioned by wider structural factors such as hybrid healthcare systems and AB availability. Conclusion: There is likely to be a reinforcing cycle between complex, repetitive treatment pathways, AB consump‑ tion and ABR. A focus on individual antibiotic use as the key intervention point in this cycle ignores the contextual challenges patients face when treatment seeking, which include inadequate access to diagnostics, perceived inef‑ ficient public healthcare and ease of purchasing antibiotics without prescription. Pluralistic healthcare landscapes may promote more complex treatment seeking and therefore inappropriate AB use. We recommend further attention to healthcare system factors, focussing on medical facilities (e.g., accessible diagnostics, patient‑doctor interactions, information flows), and community AB access points (e.g., drug sellers).en_US
dc.description.sponsorshipNational Institute for Health Research, Medical Research Council, and the Department of Health and Social Careen_US
dc.language.isoen_USen_US
dc.publisherBMC Infectious Diseasesen_US
dc.subjectAntibacterial Resistanceen_US
dc.subjectAfricaen_US
dc.subjectAntibioticsen_US
dc.subjectTreatment seekingen_US
dc.subjectHealthcare systemen_US
dc.subjectUrinary tract Infectionen_US
dc.subjectMixed methodsen_US
dc.subjectPatient pathwaysen_US
dc.titleUnravelling patient pathways in the context of antibacterial resistance in East Africaen_US
dc.typeArticleen_US


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