Antibiotic Utilization Patterns and perception about antimicrobial resistance among forcibly displaced persons in Uganda, Yemen, and Colombia

Abstract Background Forcibly displaced population are exposed to many socioeconomic determinants, which predispose them to negative health outcomes, like antimicrobial resistant infections (AMR) and inaccessibility to life saving antibiotics. Poor quality antibiotics pose a threat in further driving AMR in these populations. Although there are (inter-)national policies in place to fight AMR there is a gap in recognizing the specific challenges for these people. Our study wanted to investigate the nexus of these global challenges by identifying and analyzing key barriers of access to quality-assured and affordable antimicrobials. Our study sites consisted of three countries that carry a high burden of forced displacement. The study population included South Sudanese refugees in Uganda, internally displaced people (IDPs) in Yemen and Venezuelan migrants in Colombia. Methods Semi-structured questionnaires with single-choice, multiple-choice and open-ended questions were used to capture perceptions of displaced populations about access to and quality of antimicrobials, and their knowledge of AMR. Sample size was 36 refugees in Uganda, 50 IDPs in Yemen and 50 migrants in Colombia. Because of the small study sample size, we conducted mainly univariate analysis. Results The majority of the 136 participants were female and had no health insurance. Obtaining antibiotics/antimicrobials through informal pathways, either without a doctor's prescription or through family and friends, was common across all study sites. Knowledge of AMR was generally low; usage of antibiotics preventatively or inappropriately was practiced especially in Yemen and Uganda. Barriers to access included mainly financial constraints in Colombia and Uganda, prescription requirements in Yemen and Colombia, reachability of healthcare centers in Yemen as well as nonavailability of drugs in Uganda. Conclusion Our multi-centered research identified common barriers to accessing quality antimicrobials among refugees/IDPs/migrants and common use of informal pathways. The results suggest that knowledge gap about AMR may lead to potential misuse of antimicrobials and therefore the rise of AMR within these populations. Possible future interventions designed for similar humanitarian settings should consider these interlinked barriers.