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Effects of misuse of antibiotics on Sierra Leonean women

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What are Antibiotics?

Antibiotics are crucial for treating bacterial infections, but their misuse and overuse have become a global health concern. In Sierra Leone, like in many other developing countries, antibiotic abuse is a significant issue that can lead to antibiotic resistance, treatment failure, and adverse health outcomes. Women in Sierra Leone play a vital role in healthcare decision-making for themselves and their families, making them potential key stakeholders in addressing antibiotic misuse. 

Factors Contributing to Antibiotic Misuse among Women 

Lack of Education: The issue of antibiotic misuse among women in Sierra Leone is a pressing public health concern that has gained significant attention in recent years. One of the contributing factors to this problem is women’s lack of education and awareness.  Educating women about proper antibiotic use is crucial.  Lack of understanding about the appropriate use of antibiotics, including dosage regimens, potential side effects, and the importance of completing treatment courses, can result in inappropriate self-medication practices. Various organisations have implemented programmes to increase awareness and improve access to essential medicines in Sierra Leone. Educational campaigns focusing on health promotion are integral to empowering women with accurate information to make informed decisions about their health.

Gender and Authority: At times, gender roles within households can also impact antibiotic use among women. In some communities in Sierra Leone, men often hold the decision-making authority regarding healthcare for the entire family. This can result in women not having the autonomy to seek appropriate medical care or make informed choices about antibiotic usage. Additionally, societal expectations around caregiving responsibilities may place additional pressure on women to prioritise the health of their families over their well-being.

Economic Situation: Economic constraints also play a role in antibiotic misuse among women in Sierra Leone. Poverty limits access to healthcare services and medications, forcing some women to seek cheaper alternatives, such as purchasing antibiotics from street vendors or sharing medications with family members. Financial barriers may prevent women from completing full treatment courses prescribed by healthcare providers, leading to suboptimal outcomes and increased risks of antimicrobial resistance.

Self-Diagnosis and Self-Medication: Antibiotic misuse, particularly self-diagnosis or self-medication, is a significant public health concern in many developing countries, including Sierra Leone. Women may engage in self-diagnosis and self-medication, leading to inappropriate antibiotic use without consulting healthcare professionals. This practice is prevalent due to several factors. Lack of accessible healthcare services is a major contributor to self-diagnosis and self-medication. In rural areas of Sierra Leone, for instance, there is a scarcity of healthcare facilities and qualified medical personnel. Consequently, women often resort to purchasing antibiotics over the counter or from unlicensed vendors when they fall ill.

Cultural beliefs and practices: Traditional healing practices are deeply rooted in Sierra Leonean society, with many believing that certain illnesses can only be treated with specific herbs or medicines. Traditional remedies or folk medicine are preferred or sometimes used alongside modern medicine. This can lead to improper antibiotic use, such as taking antibiotics for viral infections or without proper dosage, influenced by the belief that antibiotics are a panacea for all ailments. Moreover, some women may delay seeking professional medical help due to societal stigma attached to certain diseases or conditions.

Availability and affordability: Antibiotics can easily be accessed in Sierra Leone without prescription and at a relatively low cost. This makes it easy for individuals to stockpile antibiotics for future use by family members and friends.

Low literacy: Furthermore, poor health literacy among the population exacerbates the problem of antibiotic misuse. Many people lack basic knowledge about common illnesses and their appropriate treatments. As a result, they may incorrectly diagnose for themselves or rely on outdated information when deciding to use antibiotics.

Weak regulation: Moreover, weak regulatory frameworks enable the sale and distribution of substandard or counterfeit antibiotics. These products are often cheaper than genuine ones and may contain ineffective or harmful ingredients. 

How healthcare providers contribute  to Antibiotic misuse by Women in Sierra Leone

Antibiotic misuse among women in Sierra Leone is a pressing public health concern that has gained significant attention in recent years. One of the contributing factors to this problem is the behaviour of some healthcare providers who prescribe antibiotics unnecessarily.

Several studies have documented the prevalence of antibiotic misprescription and overuse in Sierra Leone’s healthcare system. For instance, a study published in the Journal of Public Health found that 62% of outpatient prescriptions for acute respiratory tract infections contained antibiotics, even though most infections are viral and do not respond to antibiotics. Another study published in the American Journal of Tropical Medicine and Hygiene reported that 75% of pregnant women received at least one antibiotic prescription during their antenatal care visits, even when they had no signs or symptoms of infection.

Healthcare providers prescribe antibiotics for several reasons. One reason is the lack of diagnostic tools and resources, which makes it difficult for them to accurately diagnose bacterial infections and distinguish them from viral ones. 

The consequences of antibiotic misuse can be serious, particularly in the context of Sierra Leone’s fragile healthcare system. The overuse and misuse of antibiotics can lead to the emergence and spread of antimicrobial resistance, making it more difficult and expensive to treat bacterial infections when they do occur. Furthermore, unnecessary use of antibiotics can expose patients to potential side effects and increase healthcare costs.

Impact of Antibiotic Misuse on Women’s Health

According to a study published by the London School of Hygiene and Tropical Medicine, the first comprehensive analysis of the global impact of Antimicrobial Resistance (AMR), published in The Lancet, estimates that it caused 1.27 million deaths in 2019, and antimicrobial-resistant infections played a role in 4.95 million deaths. Estimates for 204 countries and territories, according to the study, confirm AMR as a global health threat, with the worst impacts in low- and middle-income countries (LMICs). However, higher-income countries also face alarmingly high levels of AMR.

The lack of regulation and oversight in selling and distributing antibiotics in Sierra Leone has led to their widespread availability.

The microbiome disruption in women in Sierra Leone is a significant public health concern due to antibiotic misuse. Microbiome refers to the complex community of microorganisms that inhabit various parts of the human body, including bacteria, viruses, fungi, and other microbes. A healthy microbiome is crucial in maintaining homeostasis and protecting against pathogens. However, the balance of this ecosystem can be disrupted by various factors, including antibiotic use.

Microbiome disruption can have several negative consequences for women’s health. For instance, it can increase the risk of bacterial vaginosis (BV), which is associated with preterm labour and low birth weight.

According to a study,  the prevalence of self-reported antibiotic use among pregnant women in Sierra Leone was 57%. This high antibiotic consumption rate can lead to disrupted microbiomes and contribute to various health issues.

Addressing Antibiotic Misuse among Women

Like in many other countries, Sierra Leone needs targeted education and awareness campaigns to address antibiotic misuse among women.

Sierra Leone faces various challenges related to healthcare, including limited access to quality healthcare services, inadequate infrastructure, and low levels of health literacy. 

Education and awareness campaigns can help improve knowledge about antibiotics, promote proper usage practices, raise awareness about the consequences of antibiotic resistance, and encourage behavioural change towards more responsible antibiotic use.

Women in Sierra Leone should be the primary target audience for education and awareness campaigns. Empowering women with accurate information about antibiotics and their appropriate use will significantly reduce antibiotic misuse, not only among the women themselves but also within their families and communities.

A study conducted in Sierra Leone found that women were more likely than men to purchase antibiotics from informal sources without a prescription.

This behaviour contributes significantly to antibiotic misuse as these sources may provide substandard or counterfeit drugs that are not effective or safe to use.

What do Studies say?

Several studies have documented the prevalence of antibiotic misprescription and overuse in Sierra Leone’s healthcare system. A study published by a health journal, BMC Primary Care, found that 62.42% of outpatient prescriptions for acute respiratory tract infections contained antibiotics, even though most infections are viral and do not respond to antibiotics.

Another study published in the Journal of Pharmaceutical Policy and Practice reported that 65.8% of pregnant women were administered antibiotics at some point during their antenatal care visits, even when they had no signs or symptoms of infection.

Sierra Leone has one of the lowest human development indices (HDI) in the world. According to the United  Development Program (UNDP), Sierra Leone is among the bottom ten countries in the low Human Development Index of 0.458, and ranked 184 out of 193 countries and territories. 

The country’s weak healthcare system further exacerbates this issue. With limited access to quality healthcare services and education, many people resort to self-medication or rely on traditional healers for their health needs.  Women, who make up about 49.9% of Sierra Leone’s population, are disproportionately affected by this problem. They often bear the brunt of caring for their families and communities while also dealing with their health issues. In such circumstances, they may turn to antibiotics without proper medical advice or knowledge of their potential side effects and risks.

What do experts say?

In an interview with DUBAWA, a medical expert and pharmacist Ivan I. T. Jalloh at the Connaught Hospital, the biggest government hospital located in Freetown, explained that the lack of diagnostic tools and resources available to healthcare providers makes it difficult for them to accurately diagnose bacterial infections and distinguish them from viral ones.

“The consequences of antibiotic misuse can be serious, particularly in the context of Sierra Leone’s fragile healthcare system, and also, the overuse and misuse of antibiotics can lead to the emergence and spread of antimicrobial resistance, making it more difficult and expensive to treat bacterial infections when they do occur,” said Pharm. Jalloh.   He added that unnecessary use of antibiotics can expose patients to potential side effects and increase the cost of healthcare.

“Women may be given incorrect dosages or instructions on antibiotics due to a lack of proper consultation with healthcare professionals,” says Dr Moses M’bayo, a medical expert at the Princess Children Maternity Hospital.

“Improper use can result in adverse reactions such as allergic reactions, liver damage, and kidney damage. In extreme cases, it can even lead to death,”  he pointed out.

In an Interview with DUBAWA, Dr Soccoh Kabia, a medical expert at the Choithrams Hospital, stated: “In Sierra Leone, social norms and expectations play a significant role in contributing to antibiotic misuse among women. This issue is multifaceted and influenced by various factors such as cultural beliefs, gender roles, access to healthcare, education levels, and economic status. Understanding the intersection of these elements is crucial in addressing the misuse of antibiotics and promoting proper healthcare practices among women in Sierra Leone.”

Conclusion

Limited access to quality healthcare services is a significant barrier to appropriate antibiotic use in Sierra Leone. Rural areas often lack adequate healthcare facilities, trained medical professionals, and essential medications. Due to the unavailability of formal healthcare services, women living in these underserved regions may resort to self-medication or rely on informal sources for antibiotics. This can lead to incorrect dosage, incomplete treatment courses, and the development of antibiotic resistance.

This report is produced for the DUBAWA 2024 Kwame KarKari Fact-Checking Fellowship in partnership with Epic Radio to facilitate the ethos of truth in journalism and enhance media literacy in Sierra Leone.

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