Description
Introduction: Antibiotic resistance is a complex global challenge, with significant implications for human health, social well-being, and economic development. International refugee and migrant populations may be particularly vulnerable to the impact of antibiotic resistance, through increased exposure to infections and inequitable access to healthcare services. The objective of this review is to synthesize and map the evidence on access and appropriate use of antibiotics by migrants and refugees, and to identify gaps in knowledge about the barriers migrants and refugees may experience in accessing and using antibiotics. Policy considerations, based on the review, were developed to support equitable access and appropriate use of antibiotics among migrant and refugee populations.
Methodology: We conducted a scoping review to collect evidence on access to and use of antibiotics among migrants and refugees in all WHO regions. Three academic databases (MEDLINE, Scopus, Web of Science) were searched from inception to August 2, 2023 for records published in one of the official UN languages. Access was defined as migrants’ and refugees’ ability to obtain quality-assured antibiotics, including the physical availability and affordability of antibiotics. Appropriate use included patient and prescriber dimensions of appropriate treatment, like guideline concordance, unnecessary prescriptions, self-medication, and non-adherence to treatment regimens. A conceptual framework was used to structure the data extraction and thematic analysis of the barriers to antibiotic use along the access pathway, including approachability, acceptability, availability and accommodation, affordability, and appropriateness as analytical categories.
Results and analysis: The scoping review identified 61 articles that met the inclusion criteria. These were supplemented by 18 systematic reviews identified through snowball searching and 19 grey literature articles. Most of the identified literature on access and appropriate use of antibiotics came from high-income countries and focused on whether access and use for refugees and migrants differed from host populations on three indicators: prescription rates, dispensation or reimbursement rates, and self-reported consumption of prescription antibiotics. Studies on the appropriate use of antibiotics among refugees and migrants suggest inappropriate use of antibiotics by healthcare providers and self-medication are common amongst refugee and migrant populations. In comparison to host populations, refugees and migrants are likely to experience more barriers when accessing health systems, and studies consistently found this can cause them to seek antibiotics through informal networks.
Conclusions: The evidence suggests that refugees’ and migrants’ access to and use of antibiotics and barriers to accessing health services are heterogeneous and influenced by the health systems of the host countries, and other, non-health policies and factors. Based on the findings, policy considerations are given in five areas: global governance, global data collection, overcoming national-level barriers to seeking and utilizing formal care, and receiving adequate and quality care. These policy considerations support the development of resilient health systems to promote health equity among migrants and refugees.
| Contact Geneva Health Forum | I just want to receive information about the GHF 2024 conference / Je souhaite simplement recevoir des informations sur la conférence GHF 2024 |
|---|
