Social and psychological determinants of the misuse of antibiotics and tranquilizers in the galician and lebanese populations

Resumo

The misuse of antibiotics and tranquilizers contributes to the development and exacerbation of antibiotic resistance, and dependence and addiction to tranquilizers, two international public health problems with heavy burdens. Antibiotic resistance has long been recognized as a global problem, yet fully validated tools to measure the psychosocial determinants, i.e., Knowledge Attitudes, and Practices of antibiotic misuse are unavailable. Furthermore, no longitudinal epidemiologic studies have been carried out so far. Dependence on tranquilizers is associated with alarming public health indicators, nonetheless related investigation has been limited to sociodemographic and psychiatric determinants. Drugs are deemed misused when taken without medical prescription or with medical advice but without adherence to the treatment regimen in terms of timing, dosage, and duration. The present doctoral project aimed at uncovering the psychosocial and socioeconomic determinants of antibiotic and tranquilizer misuse. The project was carried out in Galicia and Lebanon and involved three stages: 1) Development and validation of questionnaires on Knowledge, Attitudes and Practices (KAP) of antibiotic and tranquilizer misuse in Galician, Arabic and French; 2) Application of the validated questionnaires in Galicia and Lebanon in various epidemiological studies to determine the association of Knowledge and Attitudes with Practices of antibiotic and tranquilizer misuse. This stage also encompassed comparison of findings from cross-sectional and longitudinal approaches related to KAP studies, using data collected from the same individuals, in order to assess and discuss biases associated with each design; and 3) a: Dose-response meta-analyses to summarize inconsistent findings in the literature about the association of income level and education level with antibiotic misuse. b: Meta-analysis on prenatal exposure to macrolide antibiotics as a possible determinant of congenital malformation. For the first time, the present doctoral project provided validated KAP instruments in three languages to be used in studies of antibiotic and tranquilizer misuse. These instruments are the backbone for assessing, designing, and evaluating prevention programs to improve the rational use of these drugs. This doctoral project also uncovered culture-specific misconceptions and Attitudes towards these drugs in two settings, Galicia and Lebanon, with different socioeconomic characteristics and public health systems. Inconsistencies about the association of income and education with antibiotic misuse were also resolved. Understanding the psychosocial and socioeconomic determinants of antibiotic and tranquilizer misuse is crucial to control the progression of antibiotic resistance and tranquilizer dependence.