_{Image credit: Patthanan Thavethanutthanawin}

A lack of awareness is often portrayed as a key driver of irrational antibiotic use and the spread of drug resistant superbugs. A new article, led by Warwick University Assistant Professor Marco J Haenssgen, has now revealed how widespread the basic understanding of drug resistance in Southeast Asia is, and that higher levels of awareness are linked to higher antibiotic use in the general population. The researchers call for broader development policy approaches to tackle the superbug crisis.

Published in the medical journal BMJ Open, the research demonstrated that people’s attitudes in rural Thailand and Laos were often consistent with recommendations from the World Health Organization to not buy antibiotics without prescription. However, such attitudes were linked to disproportionately and potentially problematically high rates of prescribed antibiotics from public clinics and hospitals – up to 0.5 additional antibiotic courses per illness on average when controlling for other drivers of antibiotic use. Antibiotics were not universally known in these settings, but people who were aware of antibiotics also used them to a greater extent and were more likely to buy them without a prescription.

The survey further documented that people’s awareness of drug resistance was similar to many industrialised countries. Three in four villagers in Thailand and six in ten in Laos had heard about “drug resistance,” but the term was usually interpreted as a change in the human body rather than as the evolution of bacteria to withstand antibiotic medicine. Thailand and Laos were selected for this study because of their traditionally high rates of antibiotic use and busy international travel patterns, which predispose these countries to the development and spread of drug resistance.

The survey involved 2,141 adults from more than 130 villages, who represent a rural population of 712,000 villagers in Thailand and Laos. Dr Haenssgen argues that the findings have a wider relevance, however. “Ours is not an isolated case. Colleagues in China found for instance that more educated people were more likely to buy non-prescription medicine from unregistered stores, and the behavioural sciences have long established that information alone only accounts for a fraction of healthcare decisions. Public health has to catch up! To tackle the superbug crisis, we need to shift our attention to human decision-making processes and to people’s behavioural responses to local contexts.”

The survey was part of the Antibiotics and Activity Spaces project, a study of antibiotic-related health behaviour in rural Thailand and Lao PDR, funded by the Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with the Department of Health and Department for Environment Food & Rural Affairs (grant ref. ES/P00511X/1, administered by the UK Economic and Social Research Council).