A recent study by Sono et al. (2025) titled “Pilot study to evaluate patients’ understanding of key terms and aspects of antimicrobial use in a rural province in South Africa: Findings and Implications” published in Advances in Human Biology reveals widespread self-purchasing of antibiotics in independent pharmacies and significant language barriers affecting patient understanding of antimicrobial resistance.
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Widespread self-purchasing of antibiotics in independent pharmacies and significant language barriers affecting patient understanding of antimicrobial resistance in South Africa.– Sono et al. 2025
Antimicrobial resistance (AMR) is a growing global public health crisis, particularly in low- and middle-income countries like South Africa. Addressing this issue requires an in-depth understanding of patients’ knowledge and concerns about antibiotics and AMR, especially in diverse linguistic communities. This pilot study aims to assess patient comprehension of key terms and concepts related to antimicrobial use through a pre-test of a questionnaire translated into Sepedi, Tshivenda, and Xitsonga.
The study involved translating an existing English-language questionnaire into the three native languages with the assistance of linguistic experts. A total of 30 patients (5 per language for Parts 1 and 2) were interviewed outside 10 pharmacies—both chain and independent—to evaluate their understanding of antibiotics and AMR. The interviews revealed critical language barriers, with terms like ‘antibiotic’ and ‘AMR’ posing comprehension challenges. Additionally, the study highlighted the widespread practice of self-purchasing antibiotics in independent pharmacies, with 8 out of 15 patients receiving antibiotics without a prescription.
How the Study was Conducted
This study was conducted in a rural province of South Africa, where 30 patients were interviewed across 10 community pharmacies, including both chain and independent pharmacies. The primary objective was to assess patients’ understanding of antibiotics and antimicrobial resistance (AMR) using a translated questionnaire in Sepedi, Tshivenda, and Xitsonga.
The English questionnaire was translated by linguistic experts fluent in both the source and target languages. It comprised two parts: Part 1 examined the extent of antibiotic purchases without a prescription and the reasons behind this practice, while Part 2 assessed patients’ knowledge of antibiotics and AMR.
Participants were selected through convenient and purposive sampling, focusing on individuals who spoke one of the three target languages. Patients exiting the pharmacies with medication bags were invited to participate, provided with study details, and asked for written informed consent before the interviewer-administered questionnaire was conducted. Separate patient groups were engaged for Parts 1 and 2 of the questionnaire.
Follow-up interviews were conducted to gather feedback on the questionnaire, with patients sharing their overall impressions and identifying questions that were difficult to understand. Their suggestions were documented to refine the questionnaire for future use.
Collected data were entered into a Microsoft Excel® spreadsheet and analyzed descriptively using frequencies and percentages. Ethical approval was granted by the Sefako Makgatho University Research Ethics Committee, ensuring that all patient responses remained confidential and securely stored.
What the Authors Found
The study revealed a high prevalence of self-purchasing antibiotics, with 11 out of 15 patients in Part 1 receiving antibiotics—8 of whom obtained them without a prescription. Notably, only independent pharmacies engaged in dispensing antibiotics without prescriptions, highlighting a critical area for regulatory intervention.
Patient interviews uncovered significant challenges in understanding key medical terminology, particularly in native languages. Terms such as ‘antibiotic’ and ‘antimicrobial resistance (AMR)’ were often misunderstood, contributing to misconceptions about antibiotic use. One patient, for example, mentioned purchasing antibiotics for the ‘cleansing’ of sexually transmitted infections, underscoring the need for improved health education.
Why is this important?
Antimicrobial Resistance (AMR): AMR is a growing global health threat. It directly contributed to 1.27 million deaths worldwide in 2019 alone. Addressing AMR is critical to preventing it from becoming the next pandemic.
Misuse and Overuse of Antibiotics: The study highlights the prevalent issue of self-purchasing antibiotics without a prescription, especially from independent pharmacies. Misuse and overuse of antibiotics accelerate the development of AMR, making infections harder to treat.
Patient Education and Health Literacy: Understanding patients’ knowledge and misconceptions about antibiotics and AMR is crucial. The study identifies language barriers and knowledge gaps, emphasizing the need for targeted health literacy programs in native languages.
Policy and Regulatory Implications: The findings underscore the need for stricter enforcement of regulations to prevent the dispensing of antibiotics without prescriptions. This can help curb the misuse of antibiotics and reduce AMR.
Cultural and Linguistic Contexts: By translating the questionnaire into native languages, the study acknowledges the diverse linguistic landscape of South Africa. It highlights the importance of culturally and linguistically appropriate communication in healthcare.
Informing Future Studies: The study provides valuable insights that will inform the main study and future research. The revised questionnaires will help better assess patients’ understanding and guide interventions to improve antibiotic use and combat AMR.
Public Health Impact: Ultimately, improving the appropriate use of antibiotics can lead to better health outcomes and reduce the burden of AMR on healthcare systems. Addressing these issues is vital for the well-being of communities in South Africa and beyond.
What the Authors Recommended
- Independent pharmacies were identified as the primary source of antibiotics without prescriptions. The authors recommend stricter enforcement of regulations to curb this practice. Regular monitoring and audits of pharmacies are suggested to ensure compliance with prescription-only antibiotic sales.
- The study emphasizes the need for ongoing health literacy education for both pharmacists and patients, particularly in native languages. This includes explaining key terms like ‘antibiotic’ and ‘antimicrobial resistance (AMR)’ clearly. Implementing campaigns to educate the public on the dangers of misusing antibiotics and the importance of completing prescribed courses.
- The authors recommend revising the questionnaires to include explanations for key terms in both English and the native languages. This helps ensure that patients understand the questions better. Incorporating questions to address common misconceptions, such as whether antibiotics can treat colds and influenza, to improve understanding.
- Ensuring that health communication materials are translated accurately and adapted to the cultural context of the target population. This includes using everyday language to explain medical terms.
- In addition, developing and implementing policies that support the appropriate use of antibiotics and reduce AMR. This includes guidelines for antibiotic prescription and dispensing practices. The government should take a proactive role in promoting antibiotic stewardship and ensuring that regulations are enforced effectively.
The study by Sono et al. (2025) highlights critical gaps in antibiotic regulation, patient education, and language accessibility in South Africa’s rural healthcare landscape. The widespread self-purchasing of antibiotics, particularly from independent pharmacies, underscores the urgent need for stricter enforcement of prescription regulations. Additionally, significant language barriers hinder patient understanding of key medical concepts, exacerbating the risk of antibiotic misuse and antimicrobial resistance (AMR). Addressing these challenges requires a multifaceted approach, including targeted health literacy programs, culturally appropriate communication, and robust policy interventions. By improving patient education and enforcing pharmacy regulations, South Africa can take crucial steps toward mitigating AMR and promoting responsible antibiotic use.
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