An intersectional study of poverty, migration, and treatment seeking behaviour on antimicrobial use in a semi-urban area in Tamil Nadu, India

BackgroundUnderstanding antimicrobial use and factors driving it in communities is essential to devise its stewardship and reduce emergence of antimicrobial resistance. ObjectivesTo study the intersectional influence of socioeconomic status, migration and place of treatment on antimicrobial use in a semi urban area in Tamil Nadu, India. MethodsWe conducted a cross-sectional survey among systematically sampled 525 adult men and women from three villages in a semi-urban area in Tiruvallur district. We collected data through structured interviews on incidence of infections in the past 3 months, treatment seeking behaviour, and audited the antimicrobial prescription or empty packs of medicines used. We analyzed the data using R statistical software and performed a multilevel analysis of individual heterogeneity and discriminatory accuracy to study intersectional effects. ResultsWe found that the incidence of infection syndrome was 37% with a majority of them being acute respiratory infections. 143 of them sought treatment, with 40% going to a private general practitioner. People belonging to middle class had a 3.7 times greater odds of going to private sector compared to lower class. Twenty eight (19.6%) of those who sought treatment received an antimicrobial prescription. Sixty percent of them belonged to Access group, 35.7% Watch and 3.6% Restrict group. There was a significant intersectional effect showing middle class- non migrant - private care seekers having 22% probability of antimicrobial use versus lower class - migrant - government care seekers having 16% probability. The variance partition coefficient was 2.6% showing a small by significant portion of the variance contributed by intersectional identities. ConclusionAntimicrobial use in the community is significantly shaped by the intersection of socioeconomic status, migrant status and place of seeking care for the infection. Regulation of private sector prescription patterns and improving access to health care for migrants are key policy interventions.