# Self-medication and non-adherence to antibiotic prescription and associated factors among Myanmar migrants in Thailand: a cross-sectional study

## TL;DR

Myanmar migrants in Thailand misuse antibiotics at high rates due to factors like lack of healthcare access and education, contributing to antimicrobial resistance.

## Contribution

Identifies specific factors linked to antibiotic misuse among Myanmar migrants in Thailand using a cross-sectional study.

## Key findings

- 28.4% of participants engaged in antibiotic self-medication.
- 67.5% of those prescribed antibiotics did not adhere to the prescription.
- Factors like legal stress and lack of health insurance were strongly associated with non-adherence.

## Abstract

Inappropriate antibiotic use has become a significant driver of the global burden of antimicrobial resistance (AMR). Our study aims to identify the proportion and associated factors of inappropriate antibiotic use, including self-medication of antibiotics, and non-adherence to antibiotic prescriptions among Myanmar migrants in Thailand.

A cross-sectional study was conducted among 348 Myanmar migrants from three Myanmar migrant communities in Samut Sakhon, Thailand. The sample was recruited using convenience sampling, and the survey was conducted using face-to-face interviews. The variables, including predisposing, reinforcing, and enabling factors based on the PRECEDE-PROCEED model, were constructed. Descriptive statistics, Chi-square or Fisher’s Exact tests, and multiple logistic regression were performed to identify associated factors.

The proportion of self-medication among all participants was 28.4% (n = 348), and non-adherence among migrants who took prescribed antibiotics was 67.5% (n = 249). Factors positively associated with antibiotic self-medication are; never visiting a hospital in Thailand (AOR = 3.54, 95% CI = 2.00–6.27), inability to recognize common antibiotic drugs in the photos (AOR = 2.80, 1.56–5.02), and lack of AMR information in the past year (AOR = 1.98, 1.04–3.76). Factors positively associated with non-adherence to antibiotic prescription includes alcohol drinking (AOR = 37.58, 4.55–310.63), moderate to severe legal status-related acculturative stress (AOR = 6.49, 2.10–20.05 for severe stress and AOR = 2.60, 1.20–5.68 for moderate stress), receiving information regarding antibiotic use (AOR = 2.79, 1.40–5.58), working 7 days per week (AOR = 2.36, 1.12–5.01), lack of health insurance (AOR = 2.20, 1.17–4.14) and proximity to a hospital (AOR = 2.22, 1.15–4.28).

High levels of inappropriate antibiotic use among Myanmar migrants highlight the need to integrate migrants into Thailand’s national action plan on AMR. The high prevalence of antibiotic misuse among Myanmar migrants highlights the need to include migrants in Thailand’s national plan to combat antimicrobial resistance. To improve patient understanding and adherence to treatment, healthcare professionals should provide medication guidelines and education on the risks of antimicrobial resistance. Policymakers should focus future policies and interventions on providing interpretation services and establishing institutional mechanisms to ensure migrants’ access to healthcare.