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- Convenors:
-
Justin Dixon
(LSHTM)
Eleanor MacPherson (Malawi-Liverpool-Wellcome Trust)
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- Format:
- Panel
- Sessions:
- Thursday 20 January, -
Time zone: Europe/London
Short Abstract:
In light of concerns around antimicrobial resistance, there is need for anthropological perspectives on how and why antibiotics are used in humans and animals. This panel calls for papers that engage with methodological challenges and innovations for studying antibiotic use in low-resource settings.
Long Abstract:
Anthropologists have long held an interest in pharmaceuticals, exploring diverse themes including their social lives and biographies, the processes and effects of pharmaceuticalisation, and their continuous reconstitution through material semiotic practices. Recently, in response to global concerns around antimicrobial resistance (AMR), particular attention has been drawn to the use of antibiotics, with calls for anthropological research into how these ‘threatened’ commodities are being used around the world in human and animal populations. In responding to these calls, there is a need for anthropologists to produce accounts of local use that speak to ‘global’ categories for antibiotics, including classes like ‘penicillins’, ‘cephalosporins’ and ‘fluroquinolones’, and the WHO’s new stewardship categories of ‘Access’, ‘Watch’ and ‘Reserve’. This is challenging given then that antibiotics and brands are often numerous and variable, and people may not use biomedical terms like ‘antibiotic’. Yet bridging local and global categories is important for making a compelling case, both within and between different settings that, despite appearances of widespread ‘misuse’ and ‘overuse’, these are rooted in persistent inequalities in access to medicines and care as well as enduring colonial legacies.
This panel calls for papers that engage with methodological challenges and innovations for studying antibiotic use in low-resource settings. Themes that papers might address include but are my no means restricted to: the strengths and limitations of ‘traditional’ ethnographic approaches; the role of surveys and novel methodologies in anthropological research; opportunities for and challenges of using quantitative data; and challenges of analysing, interpreting and presenting antibiotic use data.
Accepted papers:
Session 1 Thursday 20 January, 2022, -Yuzana Khine Zaw (London School of Hygiene and Tropical Medicine)
Paper short abstract:
In this paper, I discuss how I adapted the methodological approach described in Whyte et al.’s Social Lives of Medicines, to trace medicines (antibiotics) in Yangon, Myanmar - a context of disorder and decline resulting from decades of authoritarian rule.
Paper long abstract:
Antimicrobial resistance (AMR) has gained much attention, described by some as a global health emergency. At the 2015 World Health Assembly, countries around the world were asked to create national action plans to address AMR, following a blueprint of the World Health Organization’s Global Action Plan (GAP). In this paper, I discuss how I adapted the methodological approach described in Whyte et al.’s Social Lives of Medicines, to trace medicines from households; drug shops; private practices; markets; and pharmaceutical companies in Yangon, Myanmar - a context of disorder and decline. Myanmar, with its authoritarian state and ongoing civil wars, is governed by a fragmentary and volatile rule of law which I have characterised as ‘disorder and decline’. Following this approach, my ethnographic fieldwork illustrates how efforts under the umbrellas of awareness raising and changing behaviours in order to curb antibiotic misuse, can reinforce rather than relieve the conditions that lead to reliance on antibiotics through informal routes. Last, I describe how coping mechanisms have developed in the areas of medicine regulation, prescription, and use as residents adapt to a governance structure characterised by caprice and neglect.
Salome Manyau (Biomedical Research and Training Institute) Justin Dixon (LSHTM) Clare Chandler (London School of Hygiene and Tropical Medicine) Kenny sithole Portia Mareke (Biomedical Research and Training Institute)
Paper short abstract:
Working within the FIEBRE study, a multidisciplinary study exploring febrile illness and antibiotic use in Africa and South-East Asia, l conducted a medicines survey using the drug bag' method to quantitatively and qualitatively study antibiotic use at household level,
Paper long abstract:
Understanding the types of antibiotics used at local level is important for informing stewardship strategies. Current methods used to capture such data relies on verbal elicitations that tend to assume familiarity with medical terminology. This has limitations as the category 'antibiotics' does not translate very well linguistically. More effort is needed to improve accuracy in capturing data on antibiotic use and the 'drug bag' method proved to be a practical, social and fun way of engaging people about antibiotic use at household level.
This paper presents findings and experiences on the use of the 'drug bag' method in 100 households within two high density suburbs of Harare in Zimbabwe. Household members were presented with a 'drug bag' full of antibiotics purchased from their local setting. The 'drug bag' method provided talking points through visualization as participants engaged in 'pile sorting' exercises through which they identified antibiotics they recognized and regularly used. This opened dialogue to discuss their experiences using antibiotics. This method can help improve our understanding of everyday antibiotic use across different settings.
Adélaïde Compaore (Institut de Recherche en Sciences de la SantéClinical Research Unit of Nanoro) Andrea Butcher (University of Helsinki) Koen Peeters (Institute of Tropical Medicine) Salla Sariola (University of Helsinki) Abraham Franssen (Unoversité Saint Louis Bruxelles) Karim Derra (IRSS CRCO Nanoro) Halidou Tinto (IRSS-Clinical Research Unit of Nanoro)
Paper short abstract:
We developed a survey using the Drug Bag Method to generate knowledge on the use of antibiotics, for what purposes they are used, and where they are procured from. In this presentation, We will reflect upon results, the methodological challenges, and ethical questions in the presentation.
Paper long abstract:
In Burkina Faso, little is known about community practices with antibiotics outside healthcare settings. The purpose of our research is therefore to generate knowledge of which antibiotics are commonly used in households, for what purposes, and where they are procured from. Therefore, we developed a survey using the Drug Bag Method, developed by researchers in LSHTM (Dixon et al. 2019), which involves purchasing locally available antibiotics for respondents to identify and classify antibiotics according to availability, local terminologies, and specific uses. In this presentation, we will discuss the collaborative experience and ethical implications for conducting the Drug Bag method in Burkina Faso.
We conducted the study in 2021 with 423 households in the Nanoro health district of Burkina Faso. Designing the survey was a collaborative process between social scientists and researchers from different disciplines at the Clinical Research Unit Nanoro. The aim was to produce a survey whose results would be useful for anthropologists, clinicians, demographers and data scientists. For example, the survey findings will inform the development of in-depth qualitative interviews and observation matrices, whilst some data can be linked to the Nanoro Health and Demographic Surveillance System. However, the exercise did raise some ethical implications. For example, the most commonly recognized antibiotics were purchased from informal sellers, which have arrived in Burkina Faso via illegal smuggling routes. This raised issues of trust, respondent safety, and data sharing. We will reflect upon results, the methodological challenges, and ethical questions in the presentation.