An Integrated Four-Pillar Framework for Addressing Medication Misuse and Antibiotic Resistance in Urban and Rural Afghanistan
Keywords: Afghanistan, Antimicrobial resistance, Irrational medicine use, Mixed-methods, Policy reform
Fayaz Gul Mazloum Yar
Abstract
In Afghanistan, polypharmacy and unsupervised antibiotic use persist despite national guidelines, exacerbating antimicrobial resistance and healthcare inefficiency. We conducted an explanatory sequential mixed-methods study comprising a quantitative prescription audit (n = 400) using WHO core drug-use indicators and patient surveys, followed by semi-structured interviews with 20 key stakeholders and document analysis of regulatory policies. The average number of prescribed medicines was 4.2 ± 1.1 per encounter, with antibiotics prescribed in 68% of encounters and generic prescriptions in only 32% of encounters. Self-medication rates reached 70% in urban areas and 65% in rural areas. Stakeholders identified critical enforcement gaps, limited training to providers, supply-chain failures, and low public awareness as drivers of irrational use of medicine. We propose a four-pillar policy reform framework—strengthened regulation, mandatory continuing medical education, supply-chain resilience measures, and culturally adapted community engagement—that aligns international best practices with Afghanistan’s context. This integrative model offers a scalable roadmap for reducing inappropriate medicine use and combating resistance in conflict-affected settings. Future research should pilot longitudinal evaluations of audit and feedback interventions and mobile pharmacovigilance systems to assess their sustained impact.
