Beyond hospital prescription : cultural logics and antibiotics use practices in an urban community in Kisumu, Kenya

Allan, Okeyo (2026) Beyond hospital prescription : cultural logics and antibiotics use practices in an urban community in Kisumu, Kenya. GRADUS, 13 (1). ISSN 2064-8014

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Abstract

This study aimed to investigate the socio-cultural drivers behind the use of first-line antibiotics outside the formal medical system in an informal urban settlement in Kisumu, Kenya. It specifically sought to analyze the cultural logics shaping antibiotic preferences and to document associated self-medication practices. A community-based, cross-sectional mixed-methods study was conducted in an urban community in Kisumu city, Kenya. Data were collected from 102 pharmacy clients, 8 pharmacies, and 31 household informants using semi-structured and unstructured questionnaires, key informant interviews, and focus group discussions. The study revealed a pervasive system of antibiotic use operating "beyond prescription," with 73% of antibiotics acquired without a prescription. Cultural logics significantly shaped practices, including a preference for specific dosage forms culturally coded by age such as syrups for children, capsules for adults. Furthermore, antibiotic courses were frequently self-regulated, with patients discontinuing treatment upon symptomatic relief, a practice they viewed as a logical form of managing their health rather than non-adherence. Key reasons for bypassing formal healthcare included the perception of illness as minor, financial constraints, and dissatisfaction with health institutions. The findings demonstrate that antibiotic use is not merely a matter of biomedical knowledge but is deeply embedded in culturally constructed logics and rational responses to structural constraints. Effective public health interventions to combat antimicrobial resistance must therefore move beyond prescriptive messaging and directly engage with these local understandings and practices.

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