A comparison of patients’ local conceptions of illness and medicines in the context of C-reactive protein biomarker testing in Chiang Rai and Yangon

Journal article

Antibiotic resistance is not solely a medical but also a social problem, influenced partly by patients’ treatment-seeking behavior and their conceptions of illness and medicines. Situated within the context of a clinical trial of C-reactive protein (CRP) biomarker testing to reduce antibiotic over-prescription at the primary care level, our study explores and compares the narratives of 58 fever patients in Chiang Rai (Thailand) and Yangon (Myanmar). Our objectives are to (1) compare local conceptions of illness and medicines in relation to healthcare seeking and antibiotic demand; and to (2) understand how these conceptions could influence CRP point-of-care testing (POCT) at the primary care level in low- and middle-income country settings. We thereby go beyond the current knowledge about antimicrobial resistance (AMR) and CRP POCT, which consists primarily of clinical research and quantitative data. We find that CRP POCT in Chiang Rai and Yangon interacted with fever patients’ pre-existing conceptions of illness and medicine, their treatment-seeking behavior, and their healthcare experiences, which has led to new interpretations of the test, potentially unforeseen exclusion patterns, implications for patients’ self-assessed illness severity, and an increase in the status of the formal healthcare facilities that provide the test. While we expected that local conceptions of illness diverge from in-built assumptions of clinical interventions, we conclude that this mismatch can undermine the intervention and potentially reproduce problematic equity patterns among CRP POCT users and non-users. As a partial solution, implementers may consider applying the test after clinical examination to validate rather than direct prescription processes.

Authors: Khine Zaw, Y; Charoenboon, N; Haenssgen, M; Lubell, Y

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Society of Tropical Medicine and Hygiene
• Journal: American Journal of Tropical Medicine and Hygiene
• Volume: 98
• Issue: 6
• Pages: 1661 - 1670
• Publication date: 2018-04-09
• Acceptance date: 2018-01-18
• DOI: 10.4269/ajtmh.17-0906
• EISSN: 1476-1645
• ISSN: 0002-9637
• Keywords: local conceptions; antimicrobial resistance; Myanmar; C-reactive protein biomarker; Thailand