Background

Community participation is a major component of people-centred health systems, and participatory action research methods have been widely and successfully used to tackle health problems and change behaviours in communities and in hospitals.

The World Health Organisation recommends community mobilisation through participatory group-based learning for the promotion of maternal and newborn health, but this approach has not been used to tackle unnecessary antibiotic use.

Participatory action research can be used to empower communities to generate locally appropriate solutions using a bottom-up approach. Generating local data for what is working or not working provides a powerful feedback loop, engenders a strong sense of ownership, and fosters an appreciation for the importance of evidence to inform decision-making.

The proposed study will evaluate interventions at three levels of the healthcare system: communities, primary healthcare and hospitals. We will evaluate three successively more active approaches to reduce inappropriate antibiotic consumption and prescription in communities and primary healthcare, and we will also test a participatory action research approach for quality improvement in hospitals.

These intervention approaches will seek to increase awareness and understanding of antibiotics, reduce the inappropriate prescribing, dispensing, and use of antibiotics, improve hygiene and sanitation in communities, and ultimately reduce the carriage of drug-resistant, potentially disease-causing bacteria in the population.

Aims

• Community interventions: to evaluate the impact of educational and participatory action research interventions in communities on the proportion of the population reporting antibiotic use in the last month;
• Primary healthcare interventions: to evaluate the impact of antibiotic stewardship training and participatory action research interventions on the proportion of patients with ARI prescribed an antibiotic in routine primary health care;
• Hospital interventions: to evaluate the impact of quality improvement using a participatory action research approach on antibiotic stewardship and antibiotic prescribing;
• Qualitative evaluation: to understand community processes and engagement with behaviour change interventions.