Pathways of antibiotic use in Bangladesh: Interviews with household members and healthcare providers 2017-2019

The dataset presents transcripts of interviews conducted around antibiotic use in humans and livestock and antimicrobial resistance in Bangladesh. Interviews examined these issues from the perspective of household members and healthcare providers in one urban and one rural site in Bangladesh. A total of 48 household interviews were carried out with the household decision-maker or main care-giver. A total of 46 healthcare provider interviews were carried out with a range of qualified and unqualified providers from human and veterinary medicine. The interviews gathered information on where people sought treatment for illnesses due to infection, what determined their choice of healthcare provider; factors contributing to antibiotic use in humans and animals; knowledge and understanding of antibiotic resistance. Similar questions about antibiotic prescribing and selling practices were asked of healthcare providers.Bangladesh is a low-income country with an estimated 40% of the population living in extreme poverty. Against this background of poverty, Bangladesh is internationally recognised for achieving 'good health at low cost' through community-based interventions to improve the health of the most disadvantaged. However, antibiotic resistant bacteria are known to be present in drinking water, wastewater and in patient samples, and the availability of over-the-counter, inexpensive antibiotics means that there is a high risk of a rapid and uncontrolled spread of antibiotic resistance throughout the population. Studies in Bangladesh suggest that 63% of prescriptions for antibiotics are from practitioners with no qualifications, and antibiotics are prescribed in nearly half (44%) of all consultations in primary health care. Tackling antibiotic resistance is essential for the long term economic development and welfare of the country. In order to slow the spread of antibiotic resistance, there are complexities around balancing the need for access to health for the disadvantaged, at the same time as introducing greater regulation around the prescribing and ready availability of antibiotics. Research is required to better understand the needs of households and individuals for antibiotic treatment for their family and livestock, as well as understanding the prescribing behaviours of qualified and unqualified practitioners. We will study the pathways of antibiotic use 1) from the perspective of lay people who buy or consume antibiotics either for themselves, family members or for livestock and 2) from the perspective of the healthcare practitioners, including qualified and unqualified providers (market sellers, unqualified drug shop owners and untrained 'doctors'). Through in-depth interviews in urban and rural Bangladesh, we will gain a better understanding of behaviours around antibiotic prescribing and consumption as well as establishing whether there is an awareness of antibiotic resistance among healthcare practitioners, or their patients and clients. By interviewing practitioners across the whole range of formal and informal outlets we will assess the potential for practitioners to change prescribing practices or act as agents of change. The findings will provide formative data on which to identify pathways for behaviour change.