Antibiotic stories: A mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe

Justin Dixon*, Eleanor Elizabeth Macpherson, Susan Nayiga, Salome Manyau, Christine Nabirye, Miriam Kayendeke, Esnart Sanudi, Alex Nkaombe, Portia Mareke, Kenny Sitole, Coll de Lima Hutchison, John Bradley, Shunmay Yeung, Rashida Abbas Ferrand, Sham Lal, Chrissy Roberts, Edward Green, Laurie Denyer Willis, Sarah G. Staedke, Clare I. R. Chandler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.
Design: This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a 'drug bag' survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.
Results: The most self-reported 'frequently used' antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.
Conclusions: Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems -rather than individuals -as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.
Original languageEnglish
Article numbere006920
Pages (from-to)1-15
Number of pages15
JournalBMJ Global Health
Issue number11
Publication statusPublished - 26 Nov 2021


  • public health
  • qualitative study


Dive into the research topics of 'Antibiotic stories: A mixed-methods, multi-country analysis of household antibiotic use in Malawi, Uganda and Zimbabwe'. Together they form a unique fingerprint.

Cite this