The Causes Of Non-Adherence To Antibiotic Treatment

Background: Non-adherence to antibiotic treatment is a major public health concern, particularly in low- and middle-income countries where self-medication, financial constraints, and limited therapeutic education are common. Poor adherence contributes to therapeutic failure and accelerates antimicrobial resistance. In the Democratic Republic of Congo (DRC), local data on the determinants of antibiotic non-adherence remain scarce. Objective: To identify socio-economic, educational, behavioral, and healthcare-related factors associated with non-adherence to antibiotic treatment in two urban settings in southern DRC. Methods: A descriptive cross-sectional comparative analytical study was conducted between March and May 2025 in Kolwezi and Lubumbashi. A total of 266 adults who had used at least one antibiotic in the previous six months were interviewed using a structured questionnaire. Nonadherence was defined as failure to comply with at least one element of the prescribed regimen (dose, frequency, or duration). Multivariate logistic regression was performed to identify independent determinants. Results: Overall non-adherence was 46.0% in Kolwezi and 58.6% in Lubumbashi (p = 0.04). The main reported causes were premature discontinuation after symptom improvement (>70%), missed doses, financial constraints, and self-medication. In multivariate analysis, selfmedication (adjusted OR = 2.41; p = 0.001), lack of clear explanations from healthcare personnel (OR = 2.76; p < 0.001), low education level (OR = 1.89; p = 0.017), financial constraints (OR = 1.68; p = 0.046), and residence in Lubumbashi (OR = 1.52; p = 0.042) were independently associated with non-adherence. The model showed good calibration (Hosmer–Lemeshow p = 0.64). Conclusion: Antibiotic non-adherence remains high in southern DRC and is driven by behavioral, educational, and structural factors. Strengthening patient education, improving therapeutic communication, and regulating antibiotic dispensing are critical strategies to enhance adherence and combat antimicrobial resistance. Keywords: Antibiotic adherence; Self-medication; Health literacy; Antimicrobial resistance; Democratic Republic of Congo