MIRERC092/2025: Exploring Patient-Demand for Anti-Microbials in Pharmacies in Kenya

Abstract

1.0 Executive Summary
Antimicrobial resistance (AMR) is a critical global health threat, with sub-Saharan Africa, including Kenya, bearing the highest mortality burden 1 . While regulatory frameworks exist, over-the-counter provision of antibiotics by pharmacies is common 2 , driven by structural healthcare barriers and patient demand. There remains an ongoing need to develop effective interventions to
tackle the behavioral drivers of AMR. This proposal outlines a project to address this gap by investigating the drivers of patient demand for antibiotics in Kenya in preparation for designing and testing novel, patient-focused interventions.

The current phase is a qualitative exploration. It involves in-depth interviews with pharmacists, adult patients, and parents of child patients in urban and rural Kenyan settings to map the specific decision-making journeys, cognitive heuristics, and contextual drivers of antibiotic-seeking behavior. This stage is designed as a precursor to a future field trial to design and test the most effective interventions in a real-world setting. We envision this work as helping to build our understanding and confidence in the interventions before investing into a full field trial to see if these interventions impact on antibiotic purchasing behavior.

This work will generate novel insights into a critically underexplored facet of the AMR crisis and provide a clear evidence base for developing scalable, impactful interventions in Kenya and other low- and middle-income countries (LMICs). The proposed estimated budget for the qualitative phase of the study is approximately USD 39,267,20 and we propose a series of in-depth qualitative interviews conducted by local research assistants in the interviewee's preferred language. These would be conducted within the network of pharmacies with which the Stanford team has an existing relationship.