{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T13:44:51Z","timestamp":1767015891941},"reference-count":60,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,6]]},"abstract":"<jats:p>Antibiotic resistance is not solely a medical but also a social problem, influenced partly by patients\u2019 treatment-seeking behavior and their conceptions of illness and medicines. Situated within the context of a clinical trial of C-reactive protein (CRP) biomarker testing to reduce antibiotic over-prescription at the primary care level, our study explores and compares the narratives of 58 fever patients in Chiang Rai (Thailand) and Yangon (Myanmar). Our objectives are to 1) compare local conceptions of illness and medicines in relation to health-care seeking and antibiotic demand; and to 2) understand how these conceptions could influence CRP point-of-care testing (POCT) at the primary care level in low- and middle-income country settings. We thereby go beyond the current knowledge about antimicrobial resistance and CRP POCT, which consists primarily of clinical research and quantitative data. We find that CRP POCT in Chiang Rai and Yangon interacted with fever patients\u2019 preexisting conceptions of illness and medicines, their treatment-seeking behavior, and their health-care experiences, which has led to new interpretations of the test, potentially unforeseen exclusion patterns, implications for patients\u2019 self-assessed illness severity, and an increase in the status of the formal health-care facilities that provide the test. Although we expected that local conceptions of illness diverge from inbuilt assumptions of clinical interventions, we conclude that this mismatch can undermine the intervention and potentially reproduce problematic equity patterns among CRP POCT users and nonusers. As a partial solution, implementers may consider applying the test after clinical examination to validate rather than direct prescription processes.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0906","type":"journal-article","created":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T07:00:46Z","timestamp":1523343646000},"page":"1661-1670","source":"Crossref","is-referenced-by-count":12,"title":["A Comparison of Patients\u2019 Local Conceptions of Illness and Medicines in the Context of C-Reactive Protein Biomarker Testing in Chiang Rai and Yangon"],"prefix":"10.4269","volume":"98","author":[{"given":"Yuzana","family":"Khine Zaw","sequence":"first","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom;"},{"name":"Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nutcha","family":"Charoenboon","sequence":"additional","affiliation":[{"name":"Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco J.","family":"Haenssgen","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom;"},{"name":"Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"CABDyN Complexity Centre, Sa\u00efd Business School, University of Oxford, Oxford, United Kingdom;"},{"name":"Green Templeton College, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoel","family":"Lubell","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom;"},{"name":"Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"692","article-title":"Non-prescription antimicrobial use worldwide: a systematic review","volume":"11","author":"Morgan","year":"2011"},{"year":"2015","author":"Reardon","key":"b2"},{"key":"b3","series-title":"Health Secur","first-page":"153","article-title":"Antimicrobial resistance is a global health emergency","volume":"13","author":"Toner","year":"2015"},{"key":"b4","series-title":"Lancet Infect Dis","first-page":"481","article-title":"Antimicrobial resistance in developing countries. Part I: recent trends and current status","volume":"5","author":"Okeke","year":"2005"},{"key":"b5","series-title":"Antimicrob Resist Infect Control","first-page":"47","article-title":"The threat of antimicrobial resistance in developing countries: causes and control strategies","volume":"6","author":"Ayukekbong","year":"2017"},{"year":"2016","author":"Chandler","key":"b6"},{"key":"b7","series-title":"BMJ","first-page":"h2682","article-title":"Antimicrobial resistance is a social problem requiring a social solution","volume":"350","author":"Smith","year":"2015"},{"year":"2017","author":"Elsevier","key":"b8"},{"key":"b9","series-title":"Trop Med Int Health","first-page":"286","article-title":"Point\u2010of\u2010care assessment of C\u2010reactive protein and white blood cell count to identify bacterial aetiologies in malaria\u2010negative paediatric fevers in Tanzania","volume":"22","author":"Hildenwall","year":"2017"},{"key":"b10","series-title":"Br J Gen Pract","first-page":"e787","article-title":"Association between point-of-care CRP testing and antibiotic prescribing in respiratory tract infections: a systematic review and meta-analysis of primary care studies","volume":"63","author":"Huang","year":"2013"},{"key":"b11","series-title":"BMC Infect Dis","first-page":"511","article-title":"Performance of C-reactive protein and procalcitonin to distinguish viral from bacterial and malarial causes of fever in southeast Asia","volume":"15","author":"Lubell","year":"2015"},{"key":"b12","series-title":"Trends Microbiol","first-page":"524","article-title":"Tackling antimicrobial resistance at global and local scales","volume":"23","author":"Gelband","year":"2015"},{"key":"b13","series-title":"BMJ","first-page":"j1054","article-title":"Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings","volume":"356","author":"Hopkins","year":"2017"},{"key":"b14","series-title":"Malar J","first-page":"64","article-title":"The complexities of simple technologies: re-imagining the role of rapid diagnostic tests in malaria control efforts","volume":"15","author":"Beisel","year":"2016"},{"key":"b15","series-title":"BMJ Open","first-page":"e012973","article-title":"Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence","volume":"7","author":"Burchett","year":"2017"},{"key":"b16","series-title":"BMJ Glob Health","first-page":"e000067","article-title":"Introducing rapid tests for malaria into the retail sector: what are the unintended consequences?","volume":"2","author":"Hutchinson","year":"2017"},{"key":"b17","series-title":"Soc Sci Med","first-page":"353","article-title":"Therapy as a system-in-action in northeastern Tanzania","volume":"15","author":"Feierman","year":"1981"},{"year":"2002","author":"Whyte","key":"b18"},{"year":"1976","author":"Beals","key":"b19"},{"key":"b20","series-title":"Trop Med Int Health","first-page":"1110","article-title":"Therapeutic itineraries of patients with ulcerated forms of Mycobacterium ulcerans (buruli ulcer) disease in a rural health zone in the Democratic Republic of Congo","volume":"14","author":"Kibadi","year":"2009"},{"key":"b21","series-title":"Soc Sci Med","first-page":"377","article-title":"Health care switching behaviour of malaria patients in a Kenyan rural community","volume":"54","author":"Nyamongo","year":"2002"},{"key":"b22","series-title":"Anthropol Med","first-page":"27","article-title":"Therapeutic itineraries: the medical field in rural Burkina Faso","volume":"11","author":"Samuelsen","year":"2004"},{"key":"b23","series-title":"Br J Gen Pract","first-page":"659","article-title":"C-reactive protein measurement in general practice may lead to lower antibiotic prescribing for sinusitis","volume":"54","author":"Bjerrum","year":"2004"},{"key":"b24","series-title":"BMJ","first-page":"b1374","article-title":"Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial","volume":"338","author":"Cals","year":"2009"},{"key":"b25","series-title":"Scand J Prim Health Care","first-page":"229","article-title":"Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care","volume":"28","author":"Jakobsen","year":"2010"},{"year":"2017","author":"Do","key":"b26"},{"key":"b27","series-title":"J Gen Intern Med","first-page":"408","article-title":"Clinicians\u2019 views and experiences of interventions to enhance the quality of antibiotic prescribing for acute respiratory tract infections","volume":"30","author":"Anthierens","year":"2015"},{"key":"b28","series-title":"Acta Paediatr","first-page":"1192","article-title":"Point\u2010of\u2010care tests for infectious diseases: barriers to implementation across three London teaching hospitals","volume":"106","author":"Bustinduy","year":"2017"},{"key":"b29","series-title":"BMJ Open","first-page":"e012503","article-title":"Qualitative study of primary care clinicians\u2019 views on point-of-care testing for C-reactive protein for acute respiratory tract infections in family medicine","volume":"7","author":"Hardy","year":"2017"},{"key":"b30","series-title":"Arch Dis Child","first-page":"382","article-title":"C-reactive protein point-of-care testing in acutely ill children: a mixed methods study in primary care","volume":"101","author":"Van den Bruel","year":"2016"},{"key":"b31","series-title":"Fam Pract","first-page":"661","article-title":"A multi-country qualitative study of clinicians\u2019 and patients\u2019 views on point of care tests for lower respiratory tract infection","volume":"28","author":"Wood","year":"2011"},{"key":"b32","series-title":"BMJ Open","first-page":"e009959","article-title":"Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption","volume":"6","author":"Huddy","year":"2016"},{"year":"2013","author":"WHO","key":"b33"},{"key":"b34","series-title":"BMJ","first-page":"j3393","article-title":"Risk assessment for antibiotic resistance in south east Asia","volume":"358","author":"Chereau","year":"2017"},{"key":"b35","series-title":"J Antimicrob Chemother","first-page":"694","article-title":"Isoniazid and rifampicin resistance-associated mutations in Mycobacterium tuberculosis isolates from Yangon, Myanmar: implications for rapid molecular testing","volume":"64","author":"Valvatne","year":"2009"},{"key":"b36","series-title":"Lancet","first-page":"86","article-title":"Scrub typhus infections poorly responsive to antibiotics in northern Thailand","volume":"348","author":"Watt","year":"1996"},{"year":"2007","author":"Angrosino","key":"b37"},{"year":"2008","author":"Ayres","key":"b38"},{"year":"2017","author":"QSR International Pty Ltd.","key":"b39"},{"year":"2000","author":"Ministry of Information and Communication Technology","key":"b40"},{"key":"b41","series-title":"Lancet","first-page":"991","article-title":"The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015 Lancet and London International Development Centre commission","volume":"376","author":"Waage","year":"2010"},{"year":"2011","author":"Patcharanarumol","key":"b42"},{"key":"b43","series-title":"BMJ","first-page":"j3415","article-title":"New chapter in tackling antimicrobial resistance in Thailand","volume":"358","author":"Sumpradit","year":"2017"},{"year":"2014","author":"So","key":"b44"},{"year":"2015","author":"Department of Population","key":"b45"},{"year":"2017","author":"World Bank","key":"b46"},{"year":"2017","author":"Ministry of Health and Sports","key":"b47"},{"key":"b48","series-title":"Health Policy","first-page":"17","article-title":"Universal health coverage in Thailand: ideas for reform and policy struggling","volume":"68","author":"Pannarunothai","year":"2004"},{"year":"2008","author":"Skidmore","key":"b49"},{"key":"b50","series-title":"BMJ","first-page":"j2291","article-title":"Antibiotic use in south east Asia and policies to promote appropriate use: reports from country situational analyses","volume":"358","author":"Holloway","year":"2017"},{"key":"b51","series-title":"Annu Rev Psychol","first-page":"477","article-title":"Health psychology: the search for pathways between behavior and health","volume":"59","author":"Leventhal","year":"2008"},{"year":"2010","author":"Staller","key":"b52"},{"year":"2010","author":"Hennink","key":"b53"},{"year":"2005","author":"Mathison","key":"b54"},{"key":"b55","series-title":"Res Social Adm Pharm","first-page":"303","article-title":"Perceptions of drug color among drug sellers and consumers in rural southwestern Nigeria","volume":"3","author":"Brieger","year":"2007"},{"key":"b56","series-title":"Malar J","first-page":"258","article-title":"\u201cEven if the test result is negative, they should be able to tell us what is wrong with us\u201d: a qualitative study of patient expectations of rapid diagnostic tests for malaria","volume":"12","author":"Ansah","year":"2013"},{"key":"b57","series-title":"Malar J","first-page":"23","article-title":"Why do health workers give anti-malarials to patients with negative rapid test results? A qualitative study at rural health facilities in western Uganda","volume":"15","author":"Altaras","year":"2016"},{"key":"b58","series-title":"Crit Public Health","first-page":"48","article-title":"\u2018It puts life in us and we feel big\u2019: shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda","volume":"25","author":"Hutchinson","year":"2015"},{"key":"b59","series-title":"Soc Sci Med","first-page":"2945","article-title":"\u201cI thought it was only ordinary fever!\u201d cultural knowledge and the micropolitics of therapy seeking for childhood febrile illness in Tanzania","volume":"62","author":"Kamat","year":"2006"},{"key":"b60","series-title":"Lancet","first-page":"405","article-title":"The inverse care law","volume":"297","author":"Hart","year":"1971"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/6\/article-p1661.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/6\/article-p1661.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/98\/6\/article-p1661.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T17:23:29Z","timestamp":1722446609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/98\/6\/article-p1661.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,6]]},"references-count":60,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0906","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2018,6,6]]}}}