Bronwen Holloway defends her PhD work

Due to the rise of antibiotic resistance, it is necessary to prevent overuse and misuse of antibiotics and only need them when necessary. At the same time, antibiotics should be available for those in need, and ensuring access across the world is equally important. Antibiotic consumption rose by 65% globally between 2000 and 2015, mostly driven by increased use in low and middle-income countries. While increased access to antibiotics in developing areas might indicate better care for patients, we must ensure that antibiotic prescribing is only used in the case of bacterial infections and not for other diseases (i.e. viral infections).

(Image removed) Bronwen's defense at the humanities theater in Uppsala, with opponent 
Professor Sabiha Essack joining from South Africa.

Bronwen’s thesis work aimed to understand the causes of acute febrile illness, investigate the current use of antibiotics and diagnostic tools, and evaluate the validity of the C-reactive protein (CRP) test at the RD Gardi Medical College in Ujjain, India. Her thesis mixed qualitative and quantitative research methods, looking at behaviors through a rapid ethnographic study, as well as classifying the causes of febrile illness, antibiotic use, and the performance of the CRP test.

This thesis’ behavioral study highlights the struggles that patients and caregivers go through when the doctors ask for a diagnostic test, with about 50% drop-out through the steps to diagnosis. Organization of the diagnostic services, together with direct and indirect costs, are the main barrier to proper compliance through the diagnostic process. 

Investigating the causes of the febrile illness that patients sought care for, only 24% were categorized as bacterial, with 72% classified as non-bacterial, and 4% as undetermined. Nevertheless, through the course of the acute febrile illness, 41% of patients used antibiotics, mostly from the “Watch” category of the AWaRe classification of antibiotics. The research done to assess the performance of the CRP test showed that this test was too weak to be used as the main indicator of bacterial infection, risking a misdiagnosis if used to drive prescription. 

(Image removed) Now-doctor Holloway celebrating with supervisor Dr. Anna Bergström

We are happy to have been part of this journey to Bronwen's doctoral degree and wish her the best in her next professional steps.

Want to learn more about Bronwen's work? Check out these links:

• ​Dr. Holloway's published PhD thesis: Acute febrile illness, antibiotic use, and the role of diagnostics to target treatment in India.
• Utilisation of diagnostics in India: a rapid ethnographic study exploring context and behaviour. Holloway, B., Mathur, A., Pathak, A. & Bergström, A. 2020. BMJ Open.
• Antibiotic Use before, during, and after Seeking Care for Acute Febrile Illness at a Hospital Outpatient Department: A Cross-Sectional Study from Rural India. Holloway, B., Chandrasekar, H., et.al. 2022. Antibiotics.