{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T19:19:29Z","timestamp":1778095169384,"version":"3.51.4"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Inappropriate use of antimicrobials is a global public health issue, particularly in developing countries, including Nepal, where over-the-counter sales and self-medication of antimicrobials are common.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>To explore knowledge, perceptions, and practices of antimicrobials and their resistance among medicine dispensers and community members in Nepal.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study was conducted in three rural and five urban municipalities of the Kavrepalanchok district from May 2021 to August 2021. Data were collected using two qualitative approaches: In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). Data were analyzed using thematic analysis that combined deductive and inductive approaches to identify codes under pre-specified themes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 16 In-depth interviews with medicine dispensers and 3 focus group discussions with community members were conducted. Knowledge regarding antimicrobial resistance varied among dispensers. Those with a prior educational background in pharmacy often had good knowledge about the causes and consequences of antimicrobial resistance. Meanwhile, consumers were less aware of antimicrobial resistance. Community members perceived antimicrobials as effective medicines but not long-term solution for treating diseases. They reported that dispensing without a prescription was common and that both consumers and dispensers were responsible for the inappropriate use of antimicrobials. On the contrary, several dispensers said that self-medication was common among the consumers, especially among more educated groups. The medicine dispensers and consumers expressed concerns about the weak enforcement of policies regarding pharmacy drug use and dispensing practices.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Promoting and strengthening the appropriate use of antimicrobials among medicine dispensers and community members is crucial. Bold policies and collective implementation of regulations could help combat antimicrobial resistance.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0297282","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T18:35:35Z","timestamp":1705689335000},"page":"e0297282","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Exploring knowledge, perceptions, and practices of antimicrobials, and their resistance among medicine dispensers and community members in Kavrepalanchok District of Nepal"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7571-9410","authenticated-orcid":true,"given":"Sabina","family":"Marasini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudim","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjali","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1237-2293","authenticated-orcid":true,"given":"Surakshya","family":"Kunwar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roshan Kumar","family":"Mahato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archana","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biraj","family":"Karmacharya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,1,19]]},"reference":[{"key":"pone.0297282.ref001","unstructured":"World Health Organization (WHO). Antimicrobial Resistance: Multi-Country Public Awareness Survey. Geneva: WHO Press [Internet]. 2015. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/194460\/9789241509817_eng.pdf;jsessionid=31B1E8819852FF7F54D1D56BDC87208C?sequence=1"},{"issue":"3","key":"pone.0297282.ref002","article-title":"Tackling drug-resistant infections globally","volume":"7","author":"J O\u2019Neill","year":"2016","journal-title":"Review on Antimicrobial Resistance"},{"issue":"2","key":"pone.0297282.ref003","first-page":"71","article-title":"Ethical use of antimicrobials in the era of multiresistance: a common good for the individual or the society?","volume":"107","author":"D. Mazzon","year":"2016","journal-title":"Recenti Progressi in Medicina"},{"key":"pone.0297282.ref004","unstructured":"World Health Organization (WHO). Fact Sheet Antimicrobial Resistance [Internet]. [cited 2021 Jul 15]. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/antimicrobial-resistance"},{"key":"pone.0297282.ref005","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/1472-6963-14-190","article-title":"Pharmacy practice and injection use in community pharmacies in Pokhara city, Western Nepal","volume":"14","author":"S Gyawali","year":"2014","journal-title":"BMC Health Services Research"},{"issue":"10","key":"pone.0297282.ref006","doi-asserted-by":"crossref","first-page":"760","DOI":"10.2471\/BLT.13.126615","article-title":"Catastrophic household expenditure on health in Nepal: a cross-sectional survey","volume":"92","author":"E Saito","year":"2014","journal-title":"Bulletin of the World Health Organization"},{"key":"pone.0297282.ref007","first-page":"2104","article-title":"Tackling antimicrobial resistance in low-income and middle-income countries","volume":"4","author":"S Pokharel","year":"2019","journal-title":"BMJ Globak Health"},{"key":"pone.0297282.ref008","unstructured":"Karki KB, Aryal KK, Gyawali P, Pandit A, Thapa RK, Maskey J, et al. Quality of drugs and drug use patterns at different level of health care settings in Nepal. Nepal Health Research Council. 2017; http:\/\/nhrc.gov.np\/wp-content\/uploads\/2017\/11\/Final_Drug.pdf"},{"key":"pone.0297282.ref009","unstructured":"Government of Nepal, Ministry of Health. The Drug Act, 2035. Kathmandu, Nepal; 2035."},{"issue":"1","key":"pone.0297282.ref010","first-page":"12","article-title":"History and evolution of pharmaceutical education in Nepal: education versus practice","volume":"28","author":"HP Devkota","year":"2017","journal-title":"Journal of Nepal Pharmaceutical Association"},{"issue":"2","key":"pone.0297282.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3126\/jmcjms.v5i2.19010","article-title":"Brain drain and practice locations of Nepalese medical students","volume":"5","author":"PR Shankar","year":"2018","journal-title":"Janaki Medical College Journal of Medical Science"},{"issue":"9","key":"pone.0297282.ref012","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/S1473-3099(05)70217-6","article-title":"Antimicrobial resistance in developing countries. 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Ansari","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pone.0297282.ref038","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1186\/s12889-017-4910-7","article-title":"Situational analysis of antimicrobial use and resistance in Ghana: policy and regulation","volume":"17","author":"S Kwame Yevutsey","year":"2017","journal-title":"BMC Public Health"},{"issue":"10","key":"pone.0297282.ref039","doi-asserted-by":"crossref","first-page":"240","DOI":"10.18203\/issn.2454-2156.IntJSciRep20184191","article-title":"Study of good pharmacy practice in community pharmacy of three districts of Kathmandu valley, Nepal","volume":"4","author":"R Shrestha","year":"2018","journal-title":"International Journal of Scientific Reports"},{"issue":"2","key":"pone.0297282.ref040","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jadohealth.2014.02.010","article-title":"Self-medication among adolescents aged 18 years: The 1993 Pelotas (Brazil) birth cohort study","volume":"55","author":"AD Bertoldi","year":"2014","journal-title":"Journal of Adolescent Health"},{"issue":"1","key":"pone.0297282.ref041","doi-asserted-by":"crossref","first-page":"68","DOI":"10.3390\/ijerph15010068","article-title":"Self-medication practice and associated factors among residents in Wuhan, China","volume":"15","author":"X Lei","year":"2018","journal-title":"International Journal of Environmental Research and Public Health Public Health"},{"issue":"1","key":"pone.0297282.ref042","first-page":"1","article-title":"Antimicrobial sales in rural and urban pharmacies in northern Vietnam: an observational study","volume":"15","author":"DT Nga","year":"2014","journal-title":"BMC Pharmacology and Toxicology"},{"issue":"5","key":"pone.0297282.ref043","doi-asserted-by":"crossref","first-page":"e001422","DOI":"10.1136\/bmjgh-2019-001422","article-title":"Using rubber stamps and mobile phones to help understand and change antimicrobial prescribing behaviour in private sector primary healthcare clinics in Kenya","volume":"4","author":"B Kleczka","year":"2019","journal-title":"BMJ Global Health"},{"issue":"1","key":"pone.0297282.ref044","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-017-0222-z","article-title":"High burden of antimicrobial resistance among gram negative bacteria causing healthcare associated infections in a critical care unit of Nepal","volume":"6","author":"NP Parajuli","year":"2017","journal-title":"Antimicrobial Resistance & Infection Control"},{"key":"pone.0297282.ref045","unstructured":"Ministry of Health, New ERA, Nepal Health Sector Support Program, ICF. Nepal Health Facility Survey, 2015. Kathmandu, Nepal; 2017."},{"key":"pone.0297282.ref046","unstructured":"Ministry of Health and Population, Government of Nepal. National Antimicrobial Treatment Guidelines [Internet]. 2014. https:\/\/publichealthupdate.com\/national-antimicrobial-treatment-guideline-2014\/"},{"issue":"10","key":"pone.0297282.ref047","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjopen-2019-032422","article-title":"Survey of the pattern of antimicrobial dispensing in private pharmacies in Nepal","volume":"9","author":"A Nepal","year":"2019","journal-title":"BMJ Open"},{"key":"pone.0297282.ref048","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1186\/s12889-016-3428-8","article-title":"Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995\u20132015)","volume":"16","author":"R Ofori-Asenso","year":"2016","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0297282.ref049","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.sapharm.2015.05.008","article-title":"Integration of prescription drug monitoring programs (PDMP) in pharmacy practice: Improving clinical decision-making and supporting a pharmacist\u2019s professional judgment","volume":"12","author":"CW Norwood","year":"2016","journal-title":"Research in Social & Administrative Pharmacy"},{"key":"pone.0297282.ref050","unstructured":"World Health Organization. Medicine in Health Care Delivery, Nepal: Situation Analysis. [Internet]. 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