Cultural barriers to tackling the superbug crisis

March 9, 2018, University of Oxford
Cultural Barriers in the Superbug Crisis. Credit: Shutterstock

Research led by the University of Oxford has revealed how the complex cultural and social environment in developing countries can complicate the use of new diagnostic technologies to fight the global superbug crisis.

The research, led by Dr. Marco J Haenssgen at the CABDyN Complexity Centre and the Centre for Tropical Medicine and Global Health, involved a new finger-prick blood test (C-reactive protein) to help nurses and doctors decide whether their patients need antibiotic treatment.

The superbug crisis has arisen because microbes are becoming increasingly resistant to antibiotics and other antimicrobials. The severity of the problem has been described in a recent World Bank report entitled 'Drug-Resistant Infections: A Threat to Our Economic Future', which warns that the current trends of antimicrobial use can entail 'a reversal of the public-health gains of the past century, and the economic growth, development, and poverty reduction these gains enabled.'

Among the many contributing factors to drug resistance is the unnecessary use of antibiotics for illnesses that can be cured with other medicines or treatments. New funding is being provided to solve this problem, for examples with the Fleming Fund, the Wellcome Trust, and Nesta's Longitude Prize, providing tens of millions of pounds to identify new to help healthcare staff to end unnecessary antibiotic prescriptions.

Exploring cases in Yangon, Myanmar, and Chiang Rai, Thailand, the studies demonstrated that diagnostic tests for doctors and nurses cannot alone solve the problem of antibiotic over-prescription. The researchers found that healthcare staff generally trusted the new diagnostic technologies and used it to reassure themselves about their treatment decisions. Yet, patients' lifestyles, cultural beliefs around illness and treatment, and the vast diversity of public, private, and unregulated healthcare providers were common barriers to accessing or correctly understanding the test.

Thai research team member Nutcha Charoenboon, said: 'Compared to its neighbours, Thailand is a few steps ahead in reducing antibiotic prescriptions. Healthcare workers (in our case nurses) cannot prescribe antibiotics easily because there is more and more monitoring of prescriptions on the health policy level. The test does help them to come down to the prescription limits. But there are also other factors that direct them away from the test results, for example when patients cannot afford to come back to the health centre for follow-up visits. Nurses would then rather over-prescribe antibiotics and knowingly contribute to the resistance problem than risk their patients' lives. These social realities are what makes it tricky.'

Adding to this point, Yuzana Khine Zaw, a Burmese research team member and lead author of one of the articles, said: 'On the patient side, there are a whole lot of extra complexities, such as cultural ideas of how the body works. If people don't think about illness in terms of bacteria and viruses, then it's quite easy to mis-interpret the purpose of the diagnostic test.

'We saw a lot of patients who believed in it as a comprehensive blood test – not only a test to decide whether they should receive an antibiotic. This could lead to patients thinking they are 'free of all disease' when there is a negative result, although this may not be the case. Furthermore, many patients may not even receive the test due to poverty and time constraints. Rather than going to clinics where the test was offered, patients were more likely to buy the much cheaper assorted yet unlabelled medicine sets from grocery shops and pharmacies (so-called "medicine cocktails") in order to feel better immediately or to avoid taking time off work.'

Lead researcher, Dr. Marco J Haenssgen, said: 'This study actually reflects a lot of social research on new technologies in low- and middle-income countries. We can see how the local context affects the role of diagnostic tests, for instance in light of healthcare staff's phenomenally wide range of tactics when they decide to prescribe or not to prescribe . A new diagnostic test will therefore always interact with existing behaviours and solutions, which can make the test perhaps more, perhaps less effective than planned – depending on the context.'

The research involved interviews and group discussions with 92 nurses, doctors, and fever patients in Chiang Rai and Yangon. The research was part of a larger clinical trial to test the effectiveness of the C-reactive protein test on the primary care level, for which around 2,400 adults and children participated.

Professor Yoel Lubell, leader of the overall clinical trial based at the Mahidol-Oxford Tropical Medicine Research Unit, added: 'A medical intervention such as CRP-testing, while showing promise in the lab or in controlled environments could be used quite differently and have unintended consequences in real life settings. Social research should thus go hand-in-hand with clinical research to ensure that medical interventions introduced into routine care have the desired and intended positive impact.'

Explore further: Who gets unneeded antibiotics most often?

More information: A comparison of patients' local conceptions of illness and medicines in the context of C-reactive protein biomarker testing in Chiang Rai and Yangon. American Journal of Tropical Medicine and Hygiene. … 15-adcc-d8092af70f29

Related Stories

Who gets unneeded antibiotics most often?

February 12, 2018
(HealthDay)—Some patients are more likely than others to get antibiotics they don't need, new research shows.

Antibiotics: On-the-spot tests reduce unnecessary prescriptions

November 5, 2014
Fast, on-the-spot tests for bacterial infections may help to reduce excessive antibiotic use. A systematic review published in The Cochrane Library, found that when doctors tested for the presence of bacterial infections ...

Rapid bacterial infection test reduces antibiotic use

August 2, 2016
Researchers from the Oxford University Clinical Research Unit in Vietnam have shown that using a rapid (5-minute) test can reduce antibiotic misuse for respiratory infections. Cutting the number of unnecessary antibiotic ...

Stopping children getting unnecessary antibiotics for colds and sore throats

October 26, 2017
A collaboration between UK, Canadian and Chinese scientists has helped to reduce the over-prescription of unneeded antibiotics to children in rural China, according to research published today in Lancet Global Health.

It's false to believe that antibiotic resistance is only a problem in hospitals – GP surgeries are seeing it too

April 19, 2017
There are almost weekly alerts of the global threat of antibiotic resistance. They are often abstract and difficult for patients and GPs to relate to. More importantly, they don't help GPs realise the consequences of needlessly ...

Written 'report card' decreases dentists' antibiotic prescriptions

August 30, 2016
Dentists are less likely to prescribe antibiotics after they receive a personalised report detailing their past prescription rates, according to a randomised controlled trial of UK dentists published in PLOS Medicine, by ...

Recommended for you

Drug targets for Ebola, Dengue, and Zika viruses found in lab study

December 13, 2018
No drugs are currently available to treat Ebola, Dengue, or Zika viruses, which infect millions of people every year and result in severe illness, birth defects, and even death. New research from the Gladstone Institutes ...

Faster test for Ebola shows promising results in field trials

December 13, 2018
A team of researchers with members from the U.S., Senegal and Guinea, in cooperation with Becton, Dickinson and Company (BD), has developed a faster test for the Ebola virus than those currently in use. In their paper published ...

Urbanisation and air travel leading to growing risk of pandemic

December 13, 2018
Increased arrivals by air and urbanisation are the two main factors leading to a growing vulnerability to pandemics in our cities, a University of Sydney research team has found.

Researchers discover new interactions between Ebola virus and human proteins

December 13, 2018
Several new connections have been discovered between the proteins of the Ebola virus and human host cells, a finding that provides insight on ways to prevent the deadly Ebola virus from reproducing and could lead to novel ...

Faecal transplants, 'robotic guts' and the fight against deadly gut bugs

December 13, 2018
A simple compound found in our gut could help to stop dangerous bacteria behind severe, and sometimes fatal, hospital infections.

Taking the virus out of a mosquito's bite

December 12, 2018
They approach with the telltale sign—a high-pitched whine. It's a warning that you are a mosquito's next meal. But that mosquito might carry a virus, and now the virus is in you. Now, with the help of state-of-the-art technology, ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.