{
  "abstract": "Introduction Antimicrobial stewardship efforts in low- and middle-income countries (LMICs) largely focus on qualified practitioners, yet informal healthcare providers (IPs) deliver much of the primary care. Although these providers frequently dispense antibiotics, their practices remain poorly documented and are not captured in existing surveillance systems.Methods Using the Joanna Briggs Institute methodology, this scoping review synthesised evidence on antibiotic dispensing and its determinants among IPs in LMICs. Nine databases (MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, Web of Science, LILACS, African Journals Online via Africa-Wide Information and Index Medicus for the South-East Asia Region) were searched, yielding 12 095 records, of which 37 studies met the inclusion criteria.Results Across 31 studies reporting dispensing practices, antibiotic use by IPs varied widely: 18%–74% in studies using standardised methods, 5%–96% in provider-reported studies and 2%–86% in consumer-reported studies. Eight qualitative studies identified key behavioural and contextual determinants shaping dispensing, including limited knowledge, experience-based learning, patient expectations, peer and pharmaceutical influence, perceived consequences of withholding antibiotics and economic incentives.Conclusion Antibiotic dispensing by IPs is widespread and represents a large but unmeasured component of antibiotic use in LMICs. These findings highlight a critical gap in antimicrobial resistance surveillance and highlight the need for stewardship strategies that effectively engage this provider group.",
  "authors": [
    {
      "affiliations": [
        "School of Population and Global Health, McGill University, Montreal, Quebec, Canada",
        "Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada"
      ],
      "name": "Poshan Thapa"
    },
    {
      "affiliations": [
        "University of Michigan, Ann Arbor, Michigan, USA"
      ],
      "name": "Meera Tandan"
    },
    {
      "affiliations": [
        "Dwyer School of Health Sciences, Indiana University South Bend, South Bend, Indiana, USA",
        "Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA"
      ],
      "name": "Buna Bhandari"
    },
    {
      "affiliations": [
        "Washington University School of Medicine, St. Louis, Missouri, USA"
      ],
      "name": "Sumanth Gandra"
    },
    {
      "affiliations": [
        "Swansea University, Swansea, UK"
      ],
      "name": "Diwash Timalsina"
    },
    {
      "affiliations": [
        "Central Department of Public Health, Tribhuvan University, Kathmandu, Nepal"
      ],
      "name": "Swostika Thapaliya"
    },
    {
      "affiliations": [
        "Central Department of Public Health, Tribhuvan University, Kathmandu, Nepal"
      ],
      "name": "Anupama Bhusal"
    },
    {
      "affiliations": [
        "School of Medicine, Deakin University, Burwood, Victoria, Australia"
      ],
      "name": "Shweta Bohora"
    },
    {
      "affiliations": [
        "Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada"
      ],
      "name": "Genevieve Gore"
    },
    {
      "affiliations": [
        "School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada"
      ],
      "name": "Charity Oga-Omenka"
    },
    {
      "affiliations": [
        "Center for Community Medicine, AIIMS, New Delhi, Delhi, India"
      ],
      "name": "Md Asadullah"
    },
    {
      "affiliations": [
        "World Health Partner, Delhi, India"
      ],
      "name": "Prachi Shukla"
    },
    {
      "affiliations": [
        "World Health Partner, Delhi, India"
      ],
      "name": "Chandrashekhar Joshi"
    },
    {
      "affiliations": [
        "Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada"
      ],
      "name": "Surbhi Sheokand"
    },
    {
      "affiliations": [
        "World Health Partner, Delhi, India"
      ],
      "name": "Mili Dutta"
    },
    {
      "affiliations": [
        "Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada",
        "Mila-Quebec AI Institute, Montreal, Quebec, Canada"
      ],
      "name": "Samira Abbasgholizadeh Rahimi"
    },
    {
      "affiliations": [
        "School of Population and Global Health, McGill University, Montreal, Quebec, Canada",
        "Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada"
      ],
      "name": "Madhukar Pai"
    },
    {
      "affiliations": [
        "School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada",
        "Methodological and Implementation Research Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Giorgia Sulis"
    }
  ],
  "title": "Antibiotic dispensing practices and determinants among informal healthcare providers in low- and middle-income countries: a mixed-methods scoping review",
  "uid": "d394155a-e384-5a6c-9ac1-51d2414f038a"
}