3rd Edition of Preventive Medicine World Conference 2027

Abstract

Background: Madhesh Province, in Nepal's Terai lowlands, faces recurrent monsoon flooding, groundwater depletion, and rising heat, conditions increasingly linked to antimicrobial resistance (AMR) through disrupted water access, higher infectious disease burden, and unregulated antibiotic use. Community-level evidence connecting these climate stressors to actual antibiotic-seeking behavior in rural Nepal remains limited. This study examined how residents of Madhesh Province and trainee physicians perceive and describe the links between climate change, healthcare access, and non-prescribed antimicrobial use.

Methods: We conducted six in-depth interviews with a farmer, poultry farmer, pharmacist, health officer, secondary-school student, and job-seeking graduate; one focus group discussion with undergraduate medical students at Janaki Medical College; and a 15-image Photovoice exercise documenting environmental and health conditions across the province. Data were analyzed using thematic framework analysis, combining deductive coding around pre-defined domains (climate exposure, antibiotic behavior, socioeconomic context) with inductive sub-codes drawn directly from participants' own language.

Results: Participants described intensifying heat, erratic rainfall, and groundwater depletion disrupting farming, water access, and daily health, with rising diarrheal, respiratory, and skin illness. Antibiotics were frequently purchased without prescription, courses were stopped early once symptoms eased, and leftover tablets were shared among neighbors; one pharmacist estimated only 30–40% of patients complete a full antibiotic course, while a health officer described declining clinical response to cotrimoxazole and amoxicillin. Photovoice images depicted shared human-animal water sources, unsupervised medicine disposal, and unregulated antibiotic distribution at free health camps, reinforcing narratives of financial strain and eroded trust in rushed clinical encounters as drivers of self-medication.

Conclusion: Community members and medical students in Madhesh Province already experience climate change and antimicrobial resistance as interconnected, everyday realities. Preventive strategies addressing this nexus should combine climate-resilient water infrastructure, stricter enforcement of prescription-only antibiotic dispensing, and sustained community health education, extending stewardship from clinic-based prescribing to household-level prevention.