Submission ID 130623
| Issue/Objective | Antimicrobial stewardship (AMS) efforts in low and middle-income countries (LMICs) largely focus on qualified physicians, despite informal healthcare providers (IPs) delivering a substantial proportion of primary care, particularly for underserved populations. Although these providers frequently dispense antibiotics, their practices remain poorly documented and are not captured in existing surveillance systems. This study aimed to synthesize evidence on antibiotic dispensing practices and their determinants among IPs in LMICs, to inform more inclusive AMS within community-based primary care systems. |
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| Methodology/Approach | Using the Joanna Briggs Institute methodology, this mixed-methods scoping review synthesized evidence on antibiotic dispensing and its determinants among IPs in LMICs. Nine databases were searched, including MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, Web of Science, LILACS, African Journals Online via Africa-Wide Information, and Index Medicus for the South-East Asia Region. A total of 12,095 records were identified, of which 37 studies met the inclusion criteria. |
| Results | Across 31 studies reporting dispensing practices, antibiotic use by IPs varied widely: 18 to 74 percent in studies using standardized methods, 5 to 96 percent in provider-reported studies, and 2 to 86 percent in consumer-reported studies. Eight qualitative studies identified key behavioural and contextual determinants shaping dispensing, including limited knowledge, experience-based learning, patient expectations, peer and pharmaceutical influence, perceived consequences of withholding antibiotics, and economic incentives. |
| Discussion/Conclusion | Antibiotic dispensing by IPs is widespread and represents a substantial, yet largely unmeasured, component of antibiotic use in LMICs. These findings highlight a critical gap in antimicrobial resistance surveillance and underscore the need for stewardship strategies that actively engage IPs within community-based primary care systems. Addressing this gap is essential to advancing global health equity, as excluding this provider group risks overlooking care delivered to underserved populations and limits the effectiveness of system-level AMS efforts. |
| Presenters and Affiliations | Poshan Thapa McGill University Anupama Bhusal Central Department of Public Health, Tribhuvan University Meera Tandan University of Michigan Buna Bhandari Dwyer School of Health Sciences, Indian University South Bend Sumanth Gandra McGill University Diwash Timalsina Swansea University Swostika Thapaliya Central Department of Public Health, Tribhuvan University Shweta Bohora School of Medicine, Faculty of Health, Deakin University Genevieve Gore Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University Charity Oga-Omenka School of Public Health Sciences, Faculty of Health, University of Waterloo Md Asadullah Center for Community Medicine, AIIMS Prachi Shukla World Health Partners Chandrashekhar Joshi World Health Partners Surbhi Sheokand Research Institute of the McGill University Health Centre Mili Dutta World Health Partners Samira Abbasgholizadeh Rahimi Rahimi McGill University Madhukar Pai McGill University Giorgia Sulis School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa |
