Background
Methods
Study design and setting
Sampling and data collection
Data analysis
Results
Healthcare and antibiotic-seeking behaviour
“When I have a minor headache, sore throat or fever I go to buy medicines from pharmacy.” Family Member # 2-NMCH“When I’m sick such as from headache, tiny ache, I always buy medicines in the village; 1 dose, 2 doses [something] like that.” Family Member # 2-BT
“I usually take one para [paracetamol] and one ampi [ampicillin]. Then I don’t feel any more pain in my stomach.” Family Member #3-NPH“Phsas (healing) in case we have inflammation, intestinal inflammation, gastric inflammation, other wound we can take ampi [ampicillin].” Family Member #4-KCH
“In case of minor sickness, I go to buy medicines but I go to a healthcare centre if it is a severe illness.” Family Member # 2-KRV“I go to hospital when I have a sharp pain in my stomach and/or bowel....like when there is an inside pain, which we cannot know what it is. I cannot go to a pharmacy.” Family Member # 7-BT“We always go to a [private] clinic if we have a severe sickness.” Family Member # 10-MBR
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Interviewer: Did you go to physician H; how many consultations? 5 consultations?
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Participant: We visited physician H 3 times. He gave medicines and my husband got better. After he was better, he relapsed.
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Interviewer: Then you went to another healthcare provider?
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Participant: Yes, after thinking that the hospital was [too] far we went to Pett K.
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Interviewer: How many times did you consult Pett K?
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Participant: Two times. He injected [my husband] and he gave medicines. When we came the third time he told us that he couldn’t treat [him]; couldn’t continue any more. He told us to come to this hospital.
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Interview of Family Member # 001_A_002 KP
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Interviewer: Who is that private Pett? Is he a doctor? Where does he work?
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Participant: I heard that he is a military Pett coming from the camp [Cambodian-Thai camp during civil unrest].
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Interview of Family Member #4-KCH
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Participant: I fetched a Pett to give treatment at my home, the Pett in the village.
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Interviewer: Village Pett … is he a staff from a health centre?
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Participant: He is not a staff in a health centre. He just gives treatment to villagers; but he is not a health centre staff.
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“I generally go to the healthcare centre near my house. I only pay 1000 riels and I’m given medicines for three days.” Family Member # 3-KTL
“I have small grandchildren, their parents go to work. I said to the hospital staff ‘if my husband has typhoid fever please give him IV injections at home’. I don’t want to go to hospital because there’s no one to take care of him in hospital as I’m at home with the grandchildren.” Family Member # 1-KRV
“If I have money I buy medicines, to take two doses. But if I don’t have money I can only buy medicines to take once only.” Family Member # 4-KTL
“It is safer to come to this hospital than to buy medicines outside. We meet the doctor and he advised us to take this or that [medicine] which is effective.” Family Member # 8-MBR
“In real practice as I have experienced the patients just let us inject for one or two days. If they are better, they stop because they don’t have the money [to continue treatment].” Nurse #1-SLL5“For minor cases mostly patients come to buy one or two doses of medicines at the pharmacy because they don’t have much money. They do this because they don’t have money to see a physician.” Pharmacist # 2-SRP
Unrestricted access to antibiotics
“When I have a high temperature or a cold, amox [amoxicillin] and ampi [ampicillin] are given to me mixed together. If I have a runny nose the drug sellers give me ampi, and if this isn’t available it’s replaced with amox.” Family Member #2-NPH“After I realize that cotrim [cotrimoxazole] can cure diarrhoea I always buy it. I buy only one tablet and I crush and grind it with water for my children to drink.” Family Member #1-SRP
“For normal colds without high temperature, patients can take amoxicillin. If they cough or have a high temperature, they take augmentin or cefixime. It depends on the seriousness of the sickness.” Untrained pharmacy attendant #1-PP“It is like what I told you earlier. Antibiotics are mostly used in case of diarrhoea, high temperature, cold and cough.” Untrained pharmacy attendant # 1-NL“Antibiotics should be prescribed for sicknesses such as respiratory inflammation.” Untrained pharmacy attendant #1-KCH“As my routine, I listen to their [patient’s] sickness first. If they have a headache, then I give Alaxan [ibuprofen and paracetamol] or Para [paracetamol]; if they have a cold, I give them Decolgen [anti allergic, decongestant and paracetamol] and vitamin. I can use amox or ampi in the case that they have a sore throat or have a fever for many days ago.” Trained pharmacist #2-SRP
“Yes. It [occurs] in the case [when] we are very busy at home and don’t have enough time to get treatment at [a] clinic, then we can call the nurse to treat us at our house.” Family Member #9-MBR“He (nurse) told me that I had gastric inflammation and then he wrote ceftri [ceftriaxone] injection on a piece of paper. He asked me ‘do you want drugs at the healthcare centre or want me to give the injection at home.’ I thought I wanted him to give the injection [at home] because I don’t have time to go to the healthcare centre to take drugs.” Family Member #6-KCH
“If it’s typhoid fever we prescribe oflocet [fluoroquinolones] for 5 days. If they [patients] don’t recover we prescribe ceftri [cetriaxone].” Nurse #3-NL“If the sickness becomes more severe, we have to use IV injection and ceftri [cetriaxone]. If the sickness is just a simple fever, which is not serious, we continue using oflocet [fluoroquinolone] for 3-5 days.” Nurse #2-NL
“Village Pett are Pett from Pol Pot regime [Khmer Rouge] who have experience (providing health care during that time). They sell medicines and if we need ampi [ampicillin] or amox [amoxicillin], they will sell them to us. They provide injections too.” Family Member #3-BT“It is the same for both treatment at the healthcare centre and treatment from door to door. Some people use Amox as Thnam Psas (antibiotic). Village Petts providing treatment from door to door mostly prescribe Ceftri [ceftriaxone]. They prescribe the high ones. Ceftri is generally used.” Nurse #2-NL
“Yes, there are [unofficial Petts] but far from here in the remote rural area. There are also some Petts who just learn from each other and never went to school. Now we still cannot stop this problem.” Nurse # 1-SLL5
Poor knowledge about antibiotics
“If there is a wound [dambao], mostly people take Thnam Phsas. It can heal both inside and outside of the body.” Family Member #8-MBR“We take ampi [ampicillin] when we have cuts [mout] on arms or legs or when we have a motorbike accident or other small accident. When we take it [ampicillin], it helps to heal the injury [robuos].” Family Member # 2-NMCH“If we have cough and we’re afraid that it will cause throat inflammation we take Thnam Phsas. When I tell drug sellers that I have a cough, cold or sore throat, then they will cocktail it [Thnam Phsas] for me.” Family Member #13-SRP“Based on my understanding, Thnam Phsas [antibiotic] is for throat inflammation.” Family Member #4-NL
“Generally drug cocktail is for common cold, cough or mild sore throat. For common cold and cough I don’t give antibiotic in the cocktail. I only give antibiotics for throat inflammation.” Trained pharmacist #001_A_007 PP“Antibiotics should be prescribed for sicknesses such as respiratory inflammation.” Untrained pharmacy Attendant #3-KCH“For those who have minor sicknesses, sometimes I do not prescribe antibiotics for them, never. Mostly I prescribe them as long as they have throat inflammation. It is like this.” Untrained pharmacy attendant #3-NL“If we see that they have upper breathing inflammation or bronchitis, we prescribe antibiotics for them [patients].” Nurse #5-KRV“We think that the disease could be something related to inflammation, and then we use antibiotics.” Nurse #3-SLL5
“Ampi [ampicillin] and amox [amoxicillin] help us, for example, when I have a stuffy nose, it helps to reduce the clogging and I can breathe more easily, feel better, reduces the temperature and so on.” Family Member #2-NPH“When I have pain, we take it [amoxicillin]. It helps to reduce pain.” Family Member #2-KRV“Yes. Ampi [ampicillin] for less severe disease has less phsas (healing) substance but it has cooling substance inside. For malaria, we can take it [ampicillin] in a mixture as well. For ampi [ampicillin], if there is amox [amoxicillin], we still use ampi [ampicillin] because it has cooling substance. I use [it] like this.” Family Member #4-KCH