| dc.description.abstract | Self-medication with antimicrobials (SMWA) is a common practice in the world, especially in economically deprived communities with loose regulatory systems. Previous studies in Nyalenda B Ward, found 76.9% of the households perceiving the practice as convenient and appropriate. The SMWA could result into missed diagnosis, misdiagnosis, delay in appropriate treatments and emergence of human pathogens resistance. The Nyalenda informal settlement is not empowered with knowledge of risks of SMWA nor ability to negotiate their inclusion in the health system. The aim of this study was developed in response to unsolved SMWA. The main objective of the study was to determine the effect of community mobilization intervention on SMWA among households in Nyalenda informal settlement. The specific objectives were to establish the reasons for SMWA by households, to evaluate the association of Participatory Learning and Action (PLA) with the different domains of SMWA empowerment (power within, power with and power over) and to determine the effect of empowerment on SMWA. This study was a quasi-experimental trial of a community mobilization intervention that used community empowerment as an intervention strategy, and approached through participatory learning and action (PLA). Based on the sub-divisions in Nyalenda, the intervention took place in Nyalenda B Ward and NyalendaA Ward was used as a control. Baseline and end line survey for the case and the control group used a cluster sampling method with a sample size of 380 households determined by Fisher‟s formula and the study population was all households in Nyalenda A (9,392) and Nyalenda B (10,443). The intervention had two samples, the first was determined arbitrarily and chosen randomly from all the households in Nyalenda B (1501) and the second was determined and chosen purposively from Nyalenda B CHVs (30). Data was collected through structured questionnaires. Chi square analyses were used to establish the socio-demographic characteristics of and reasons for SMWA by Nyalenda informal settlement before and after the intervention. Binary logistic regression analysis evaluated the association of PLA and different domains of empowerment and also determined reasons for SMWA and socio demographics influencing self-medication with antimicrobials among the intervention group. Difference in differences determined the effect of community empowerment on SMWA. Statistical significance was tested at P≤0.05. The intervention and the control group showed similarities in their reasons for SMWA from both their baseline and end line surveys but the intervention group decision to SMWA was informed. The association between PLA domains and all empowerment domains revealed that the odds that each and every PLA domain is associated with every empowerment domain is more than 2 (the range is 2.2-8.6) and at a P<0.0001. Community empowerment on SMWA resulted to an effect size of 52.6% (95% CI=0.469-0.563) and a study on the case community after the intervention revealed that the socio demographics and the reasons for SMWA associated with SMWA were illness or symptoms of illness (OR=1.324, 95% CI=1.129-1.554, P=0.001), age (OR=0.647, 95% CI=0.431-0.973, P=0.037) and information leading to the SMWA (OR=0.732, 95% CI=0.613-0.873, P=0.001). Health insurance schemes [health insurance cover (OR=1.772, 95% CI=0.652-2.887, P=0.133) and Universal Healthcare Services (OR=1.165, 95% CI=0.922-1.472, P=0.201)] had no effect on SMWA. Community mobilization is a successful method for increasing public knowledge and understanding of antimicrobial resistance and appropriate use of antimicrobials, it also reduces SMWA proportion especially when strengthened with structural modification such us improvement of access to antimicrobial prescription among the households in Nyalenda informal settlement in Kisumu County. This intervention should be prolonged to offer sustained change, while the health system should implement policies and laws restricting inappropriate sale of antimicrobials. | en_US |
