A SYSTEMATIC REVIEW OF DETERMINANTS OF SELF-MEDICATION AND ANTIBIOTIC MISUSE IN LOW- AND MIDDLE-INCOME COUNTRIES

Self-medication with antibiotics remains a major public health concern, particularly in low- and middle-income countries (LMICs), where it contributes to inappropriate antibiotic use and the growing burden of antimicrobial resistance. This systematic review examined the prevalence and determinants of antibiotic self-medication in LMICs by synthesising evidence from studies published between 2015 and 2025. The review was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidance. PubMed and Google Scholar were searched using combinations of terms relating to antibiotic self-medication, misuse, determinants, predictors, developing countries and sub-Saharan Africa. Of 50 records identified, 45 remained after duplicate removal, 27 full-text articles were assessed and 20 studies met the eligibility criteria for narrative synthesis. The evidence showed that antibiotic self-medication is common but highly variable across settings, with particularly high estimates reported in several sub-Saharan African populations. The major determinants clustered around behavioural, sociodemographic and health-system factors. Behavioural influences included previous successful antibiotic use, perceiving an illness as minor, confidence in personal knowledge, advice from relatives or peers and the reuse of leftover medicines. Sociodemographic influences included education, income, age, residence and health-insurance status, although their effects were not uniform across settings. Health-system drivers included treatment costs, distance to facilities, long waiting times, poor experiences with health workers, easy access to antibiotics from drug outlets and weak enforcement of prescription regulations. The review concludes that antibiotic self-medication in LMICs is produced by an interaction between individual decision-making and structural barriers to appropriate care. Stronger regulation of antibiotic sales, improved access to affordable and responsive healthcare, community-centred antimicrobial-resistance education and better antibiotic stewardship are required to reduce the practice.