Decreasing Irrational Antimicrobial Use in Bangladesh: A Digital Intervention Program

NCT06313619 | Completed DMC

• 1 other identifier: BSMMU/20236831
• Study Type: interventional
• Target: 27
• Locations: 1 country
• Sites: 1

Brief Summary

We developed 'SmartAMR', a digital pharmacy system featuring real-time records, symptom checks, telemedicine, counselling, and medication reminders. This study aims to assess its feasibility, acceptability, and effectiveness within community pharmacy settings in Bangladesh. A before-after designed pilot quasi experimental study will be conducted in urban areas. Data will be collected in both qualitative and quantitative methods. Multi-cluster sampling method will be used to select study locations. Pharmacists or drug sellers and patients aged more than 18 years and located within selected intervention areas will be our target population. A baseline survey will be conducted among the pharmacy volunteers to evaluate their knowledge, perception, and practice of rational use of anti-microbials prior to any intervention. Additionally, a household survey will be conducted among community members applying systematic random sampling where one adult from every selected household will be approached maintaining gender equality. After collecting the baseline data, intervention will be given to the community people through awareness building campaign and distributing leaflets and posters on rational use of anti-microbials. After three months, a follow-up survey will be conducted with the same questionnaire. For quantitative portion of the study, all the medicine shops in the selected study areas will be included in the study sample. For qualitative part, the sample will be selected purposively until data saturation and a total of 8 experts will be interviewed. Two sets of questionnaires for pharmacy volunteers and the community dwellers will be prepared based on literature review that will include health literacy questions regarding anti-microbial use. The questionnaire for the follow-up data collection will include some additional questions regarding effectiveness, acceptability, adoption, feasibility, and cost of the intervention.

Conditions

Resistance Bacterial; Increased Drug Resistance; Drug Resistance, Microbial

Keywords

Anti-microbial resistance; Digital intervention; Irrational use

Outcome Measures

Primary Outcomes (6)

• Irrational usage of anti-microbials

  Irrational usage of anti-microbials was demonstrated by number and pattern of purchasing of anti-microbials

  12 weeks

• Acceptance rate

  Number of pharmacy agreed and accepted the intervention and install the mobile app.

  12 weeks

• Completion rate

  The number of pharmacy who use the mobile app for the total duration of intervention.

  12 weeks

• AMR Knowledge

  Change in knowledge about antimicrobial resistance among the participants was assessed using a knowledge scale "AMR knowledge scale" that contained 31 questions. The score range will be 0 to 31, with greater score representing better knowledge.

  Before and 12 weeks after the intervention

• AMR attitude

  Participants' attitude towards antimicrobial resistance was evaluated by a three-point Likert-type scale "AMR attitude scale", containing 14 attitude statements. The score range will be 14 to 42, with greater score representing better knowledge.

  Before and 12 weeks after the intervention

• AMR practice

  Participants' practice regarding irrational antimicrobial usage is assessed by a practice scale "AMR practice scale", containing 9 items. Answers to the practice questions are taken on a rating scale (0=never; 1 = rarely; 2 = sometimes; 3 = frequently). Practice score ranges from 0 to 27. Higher score indicates better practice.

  Before and 12 weeks after the intervention

Study Arms (1)

Digital Pharmacy Intervention

EXPERIMENTAL

A total of 39 pharmacy will be included in the intervention. The digital intervention named "SmartAMR" will be introduced among them. The participants will install the mobile app and use it to keep record of the antimicrobial sales in a central database.

Combination Product: SmartAMR

Interventions

SmartAMR COMBINATION_PRODUCT

"SmartAMR" is a digital system including a mobile app that helps keeping record of medicine sales, sending auto-generated messages to the consumers to remind them about medicine taking time and completing doses. It also poses a symptom checker driven by artificial intelligence and a telemedicine service.

Digital Pharmacy Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 18 years and above
• Registered drug seller/pharmacist
• Permanent residents of the study areas
• Willing to participate

You may not qualify if:

• Disoriented or critically ill

Sponsors & Collaborators

• Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh: lead

Study Sites (1)

Bangladesh Medical University

Dhaka, 1000, Bangladesh

Location

Study Officials

• M Atiqul Haque, PhD

  Bangladesh Medical University

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: A single group of pharmacy drug sellers were trained on using a digital pharmacy management system including record keeping, AI symptom checker, telemedicine services, counselling, and SMS reminder for dose completion.

Study Record Dates

• First Submitted: November 25, 2023
• First Posted: March 15, 2024
• Study Start: October 23, 2023
• Primary Completion: April 30, 2024
• Study Completion: October 31, 2024
• Last Updated: September 8, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

BA (1)