Health

Addressing Antimicrobial Resistance (AMR) and Self-medication Practice (SMP) in Developing Countries: A Field Experiment in Bangladesh

Study area

The World Health Organization (WHO) identifies antimicrobial resistance (AMR) as a gradually unfolding pandemic. In third-world countries, insufficient knowledge and awareness about the detrimental health impacts of antibiotics are widespread. Studies have indicated that in Bangladesh, numerous selectively chosen drugs have become ineffective due to antimicrobial resistance. In rural areas, village doctors, or "quacks", who often lack awareness about the harmful effects of antibiotics, are the predominant healthcare providers and a major source of antibiotic prescription. The logistical and financial challenges of accessing government hospitals or registered doctors lead individuals to purchase medicines from local shops without professional advice. Consequently, the routine over-the-counter purchase of commonly prescribed antibiotics persists in an effort to expedite recovery. Overall, addressing the AMR problem is significantly hampered by the general public's knowledge constraints and unawareness about the negative health impacts of antibiotics. This study introduces an innovative information intervention aiming to limit unnecessary antibiotic consumption by influencing the medication behavior of the populace in Bangladesh.

We formed a partnership with a Bangladeshi NGO and initiated a program focused on women's health and nutrition, targeting approximately 820 households across 38 villages in the Dinajpur District of Bangladesh. The program commenced in February 2023. In early October 2023, we conducted a baseline survey on the medication behaviors of the household members. Starting from November, households in the treatment group will receive information and have their transportation costs to local government facilities covered. Concurrently, a subgroup will receive boxes in which to store self-purchased medicines and any medications not prescribed by an MBBS doctor. These boxes serve as a visual reminder that consuming medicines from them may eventually render them ineffective. The setup facilitates our randomized experiment.


Funding Authority: Center for Social and Economic Behavior(C-SEB), University of Cologne.[Partial]

Ethical Approval: Ethics committee of the Faculty of Management, Economics and Social Sciences, University of Cologne.

RCT Registration No: Registered at AEA RCT Registry. RCT ID: AEARCTR-0011418

Local Partner: EHHD Foundation




Climate

Socio-Economic and Behavioral Effects of Improved Urban Drainage in Bangladesh

Photo taken during field visit

We study the effect of improvements in urban drainage infrastructure on climate change resilience with a household survey in Barishal, Bangladesh. Specifically, our project analyzes the socio-economic and behavioral effects of drainage improvements on affected households. Improvements in drainage systems are a key component for flood control and climate change adaptation in many urban settings around the globe. We will use a spatial regression discontinuity design with the distance to the boundaries of the area benefiting from the project as a running variable. We will complement this analysis with a grid-cell level analysis on the likelihood and length of experiencing a flooding event during the rainy season using satellite imagery as an objective measure of risk exposure.


Ethical Approval: Universität Heidelberg

RCT Registration No: Registered at AEA RCT Registry.

RCT ID: AEARCTR-0011481

Tags: Climate change, Improved drainage