Abstract of Dissertation

Agency : Health Care Providers, Informal Health Care Providers, Antibiotic Prescription

Objective : To understand the treatment choices of informal providers for various diseases treated by them. To describe the antibiotic prescribed in term of frequencies, its groups, and the route of administration. To understand the practice of which antibiotic is more frequent.. To determine whether drugs they use may contribute to antibiotic resistance

Background : Informal health care providers (IHCP) are a large group, not legalized to practice allopathic medicine. The World Health Organization (WHO) recently reemphasized the growing threat of antibiotic resistance, partly due to inappropriate medicine use by the informal health care providers. So, a prospective study to explore prescribing pattern by informal health care providers, in rural Ujjain, India was undertaken during February-April 2014.

Methodology : A Descriptive study was conducted in 12 villages from 3 blocks of Ujjain district (Mahidpur, Ghatiya and Tarana), in Madhya Pradesh state in India, which were selected purposively. Survey was conducted to line list the informal health care providers currently present in the Ujjain district. Data was collected from 18 IHCPs. 2089 prescriptions were studied.

Findings : The common illnesses seen were Cardio respiratory (cough and cold, asthma etc.) which was 33%. Illnesses treated were further classified into the infectious (antibiotic plausible) and non infectious where antibiotic treatment was not mandatory. 66% of them were infectious and 33% illnesses reported were found to be non infectious. Among the illnesses found to be non infectious, 58% were prescribed antibiotics. Among the 2089 prescription studied, 73% received some kind of antibiotic and out of them 26% received more than one antibiotic. 28 types of antibiotics were prescribed by the providers to treat various illnesses. Ciprofloxacin was most frequently prescribed antibiotic (14.4). Oral was the most common route of administration of drug (63%), followed by intra muscular (32%).Doses of the antibiotics prescribed were found to be sub standard (41%).

Recommendations : The antibiotic prescription pattern by the IHCP’s was found to be influenced by their medical qualification and years of work experience. The treatment provided was not according to the clinical guidelines. Multifaceted interventions are needed to reduce unnecessary antibiotic use; peer education and feedback on doctors' use of antibiotics can promote behavior change. Educational interventions for the public should include a public relations campaign with simple messages; clinic based patient education, and community outreach activities.