Novel Approach to Collect Ethiopian Voices on Community Antibiotic Use

Our solution will tap into Ethiopia’s community level knowledge, attitude, and practice regarding antibiotics, antibiotic use. Using digital approaches and face-to-face interviews, our solution collects antibiotic use data (humans and animals) and use novel antibiotic photo-identification app to develop interactive and impactful educational radio programs with SMS text message polling.

Dr. Wondwossen Gebreyes, Executive Director of The Ohio State University Global One Health initiative. Dr. Gebreyes is a veterinarian trained in Ethiopia and an expert in antimicrobial resistance.

In Ethiopia, antibiotics are available without prescription and used indiscriminately. While antimicrobial resistance is commonly reported, the scale of community use of antibiotics, including falsified antibiotics, is very limited. The Ethiopian Food and Drug Authority (EFDA) regulates and approves all antibiotics that are manufactured in Ethiopia and imported into the country legally. The illegal antibiotics often lack sufficient effective antibiotic agents and cause more harm to human and animal by delaying improvement and causing potential death.  We do not know the scale illegal antibiotic use for humans or animals. Our solution brings together existing demographic health survey system and implement a novel mobile technology application to collect community level antibiotic use data in humans and food animals. This data will be used to develop an integrated radio programming that addresses key gaps in community knowledge. We emphasize the dangers of falsified antibiotic use in human and veterinary medicine using integrated One Health approach. We will use the data to develop materials that will be instrumental in arming the public with knowledge and awareness. The data will provide regulators and key stakeholders with information that has never been gathered in Ethiopia enabling them to address challenges through various follow-up programs.

The primary target audience we are working to help are the community members. We will be increasing community wide knowledge about the need for antibiotics, antibiotics, antimicrobial resistance, method of antibiotic purchase, and collecting data knowledge, attitude and practice (KAP) including use and mis/use of antibiotics, health seeking behavior, and actual antibiotic consumed. We aim to empower community members with knowledge leading to less wasted money on falsified antimicrobials and in support of their health.

We will also share the key insights from the collected data back to the participants. The app will match the antibiotic photo and inform the consumer if the antibiotic is on the Ethiopian Federal Drug Administration (EFDA) approved list. The app will also provide antibiotic drug information such as side effects, use in pregnancy, etc.

Other target audiences include pharmacists and veterinary medicine dispensers, with focal group SMS chat groups, to gain information on KAP such as antimicrobial prescription practice, antimicrobial stewardship, and antibiotic accessibility. 

The information gathered from the community will also be provided to government ministries such as EFDA and policy makers to inform them the results of KAP, antibiotic use/access and areas of focus for intervention solutions.

Collecting accurate community antibiotic use data from households in Ethiopia is crucial for enhancing public health. By understanding antibiotic usage patterns, we can formulate targeted strategies to combat antibiotic resistance. This data allows us to tailor our radio talk shows with the citizens across many communities, emphasizing responsible antibiotic use and educating communities on the consequences of misuse. Identifying geographic regions with different climates and higher antibiotic consumption allows for focused intervention, ensuring that communities receive appropriate education and resources. This, in turn, promotes the rational and responsible use of antibiotics, reducing the risk of antibiotic-resistant infections. Moreover, such data can guide healthcare providers in implementing evidence-based prescribing practices, contributing to the overall efficacy of antibiotic treatments. Through this proactive approach, Ethiopia can mitigate the emergence of antibiotic resistance, preserving the effectiveness of antibiotics for future generations. Additionally, the collected data enables our team to make adjustments in strategies as needed. Ultimately, gathering antibiotic community data in Ethiopia serves as a vital tool in safeguarding public health and fostering a more sustainable approach to antibiotic usage.

Collecting community antibiotic data in Ethiopia holds the potential to significantly impact vulnerable populations and individuals in remote areas with limited access to doctors. By analyzing the data, we can identify specific health disparities and tailor the radio programs to address the needs of these groups. The community antibiotic data provides an opportunity to understand antibiotic usage patterns acquired at pharmacies without prescriptions versus prescriptions from a doctor in a clinic. Identifying antibiotic usage patterns and documenting antibiotics sold in veterinary drug stores are new data that can inform One Health antibiotic policies. This targeted approach not only improves health outcomes but also minimizes the risk of antibiotic resistance in the population. The insights gained from community antibiotic data can enhance surveillance systems, enabling more rapid responses to emerging resistance threats in vulnerable communities and animals. Ultimately, the collected data becomes a powerful tool to improve the citizen’s knowledge about antibiotics and reduce health disparities in Ethiopia. In summary, the evidence suggests that collecting and analyzing antibiotic data can indeed lead to targeted interventions and improvements in antibiotic use, contributing to the global efforts to combat antimicrobial resistance.

In Year one, antibiotic use data will be collected by trained staff with community participation going door to door engaging with the head of the household and collecting information from primary care provider in specific Dabat-Gondar communities. They will use a tablet, with GPS and elevation capabilities, to record the responses on antibiotic knowledge, attitude and antibiotic usage. This method is currently used in the Dabat-Gondar Demographic Health System sites to record births, deaths, and health outcomes and therefore it can be easily scaled up to include information on antibiotics in additional geographic areas over the three years. Ethiopia has one cellular service provider. The radio antibiotic awareness talk-shows will allow us to extend our geographic reach in year 2 and 3 to additional urban, rural, and pastoral areas. We can use the 10-week pilot radio talk shows to engage and recruit citizens to participate in sharing antibiotic use and knowledge via SMS. The baseline antibiotic data will be used to scale up the number of radio shows in year 2-3. 

We plan to measure and monitor the data collected from in-person knowledge, attitude, and practice (KAP) from the Dabat-Gondar Community in serial intervals. We will first collect baseline (KAP) data, followed by after radio educational messaging. In-person data collection will be more complete and not limited to SMS texting from only those with phones or smart phones who wants to participate. We will be analyzing the data collected from the community households on human and animal antimicrobial consumptions and access.

The antibiotic distributed by Ethiopian FDA to the pharmacies and animal drug stores will be collected and compared to the antibiotic use by the community members for household members and livestock and poultry.

During radio messaging, the number of interactive SMS texts received will be monitored in addition to unique participant information such as age, gender, and total number of text messages received. In addition, qualitative comments and questions will be categorized. The photo app link will be texted to the participants and photos received and compared to EFDA approved legal antibiotic data base will be analyzed.  The number of app use on antibiotic information link for use and side effects will also be monitored.

We do not anticipate any barriers in completing the in-person community survey since the Dabat-Gondar community data collection system is well established. We also do not see any barriers to developing a radio antibiotic awareness program and to broadcast it on the radio. Radio was the primary method used during the COVID-19 pandemic to communicate information and interact with the public in Ethiopia.

Some potential barriers could include the collection of SMS text or photo from participants. We will have a zero-fee texting number for SMS polls but will also provide an incentive to participate and upload their photos. We will provide phone cards for Dabat-Gondar community members to participate in the initial pilot radio program and SMS texting and photo uploads.   Challenges may be encountered when we expand nationally. 

Challenges for the photo-identification app, includes manufacturers brand of imported antibiotics may change over time and the photos would need to be updated to remain useful for the public. 

The Ohio State University Global One Health initiative (GOHi) has been working globally on antimicrobial resistance (AMR) projects for more than 15 years and we believe that creative One Health solutions are needed to address this challenge. The Trinity Challenge provides us with an opportunity to do critical work on AMR that we have not had funding for in the past. The Challenge has allowed us to propose a creative, technologically advanced, community-based solution that fuses the expertise and technology from Ohio State with robust Ethiopian data while amplifying Ethiopian voices to address AMR. Our past projects have worked in human, animal, & environmental health but are funded in silos due sponsor limitations. The Trinity Challenge on AMR provides us with the opportunity to use a true One Health community-based approach, breaking the silos, to improve global health. We have compiled a multi-disciplinary One Health team of experts from the US and Ethiopia to take on the Trinity AMR challenge. We have developed an innovative solution to gather diverse community-citizen data on antibiotic knowledge, use, and access. Our proposal will have major public health impact at the level of the individual, the community, the health system, and the government.

The Ethiopian Ministry of Health, Ethiopian Food and Drug Administration to obtain the legal antibiotics

Ethiotelecom for SMS messaging and photo-uploads

The Ethiopian Medical Association to increase community antibiotic knowledge and use to healthcare providers.

The Ethiopian Veterinary Association need to be engaged to use a One Health Approach for solutions to AMR.

Google-Nonprofit organization within Google for language translation

The World Health Organization to help with Ethiopia Voices training material for the community and to help expand the app to other countries

WhatsApp, Telegram, or other social media companies who are interested in utilizing their platform for community-based input and education.