PhD Study Exposes the Dangers of Self-Medication with Antibiotics

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Dr Neusa Torres-Tovela received a PhD in Public Health for her study on practices of self-medication with antibiotics and non-prescribed antibiotic dispensing in Maputo City, Mozambique.

Supervised by Dr Lyn Middleton and Mr Vernon Solomon, the study aimed to identify, describe and analyse the factors behind self-medication with antibiotics by pharmacy clients and the practices of non-prescribed antibiotic dispensing by pharmacists, given the legal status of antibiotics as prescription-only medicines in Mozambique.

‘In Mozambique, utilisation of antibiotics for self-medication purposes and non-prescribed antibiotic dispensing are common,’ said Torres-Tovela.

‘These prescription-only medicines are being sold, acquired and dispensed without prescriptions at pharmacies and markets. This is concerning in the current post-antibiotic era where we face the global public health problem of antibiotic and antimicrobial resistance. My research was guided by these concerns,’ she added.

‘The study commenced with a systematic scoping review thanks to the expertise of one of the lecturers in the School of Nursing and Public Health, Professor Tivani Mashamba-Thompson who shared knowledge and facilitated hands-on workshops,’ said Torres-Tovela.

Thereafter, she undertook a comprehensive qualitative study in Maputo City. ‘I immersed myself in the world of pharmacy clients who acquired antibiotics without prescriptions and the pharmacists who dispensed these antibiotics. I observed that both phenomena are frequent and that the participants regard them as part of “daily life”.’

The study found that people misused and self-medicated using antibiotics such as Amoxicillin, Cotrimoxazole, Azithromycin, Metronidazole, Amoxicillin with clavulanic acid, Tetracycline, Doxycycline and Erythromycin to treat self-diagnosed respiratory tract infections, a sore throat, fever, cough, vaginal discharge, eye problems, the common flu, urinary infections, wounds, and toothache. Worryingly, these antibiotics were used without physician oversight or for conditions that do not necessarily require antibiotic therapy.

Including the systematic scoping review articles, the research has been published in four international journals, with three more under peer-review.

Torres-Tovela noted that, ‘The research provides the health authorities and entities with considerable evidence-based information to better address the misuse of antibiotics, and to promote improved antibiotic stewardship and conservancy. Such evidence will also be useful for curriculum (re)design for training pharmacists, health professionals and promoters in Mozambique. There is an urgent need to implement health promotion and education programmes that raise awareness of the risks of antibiotic misuse. This will enable individuals and communities to make informed decisions.’

Back in 2013, Torres-Tovela met UKZN’s Professor Sabiha Essack in Mozambique while they were working with the Mozambican team on a global partnership for antimicrobial resistance.

She was part of a meeting where Essack presented a vision of an antimicrobial stewardship and conservancy project funded by Norway.

‘I was inspired and motivated to make use of my background in Social Sciences and Anthropology to develop my research in this field, considering the scarce evidence on antibiotic use and antimicrobial resistance in Mozambique.

‘In 2016, after doing some research on which university I would register at for my PhD studies, I contacted Professor Essack, who remains a real inspiration for me and is very supportive. My decision was also motivated by UKZN’s high ranking among sub-Saharan African universities. Furthermore, Durban is only seven hours driving time from my home in Maputo, which enabled me to drive home to visit my family on long weekends and short holidays. This was the “cherry on the top” that helped me to choose UKZN and I don’t regret it!’ she said. She expressed her thanks to Professors Essack, and Mashamba-Thompson and to her supervisors Dr Middleton and Mr Solomon.

Torres-Tovela is currently disseminating the results of her research to the health authorities and stakeholders in Mozambique. ‘I am preparing presentations and seminars as well as policy briefs that can be used to inform policymakers and health promoters towards the re(design) of health promotion strategies regarding the rational use of antibiotics, supervision and accountability mechanisms.’ She is also involved in research, lecturing and master’s students’ supervision in Mozambique.

Torres-Tovela is married with three children. ‘I regard myself as a simple person and I appreciate being with people with positive thoughts and energy. Physical exercise, especially aerobics and step classes, a good massage, and a little good wine make me feel mentally strong and keep me going,’ she said.

Words: Nombuso Dlamini

Photograph: Supplied