Religious Demographics and Unregulated Antibiotic Distribution in Assam: Implications for Antimicrobial Resistance and Public Health Security

Harikumar Pallathadka; Parag Deb Roy

doi:10.55544/jrasb.4.2.12

Authors

Prof. Dr. Harikumar Pallathadka Vice-Chancellor & Professor, Manipur International University, Imphal, Manipur, INDIA. https://orcid.org/0000-0002-0705-9035
Dr. Parag Deb Roy Guwahati, Assam, INDIA.

DOI:

https://doi.org/10.55544/jrasb.4.2.12

Keywords:

antimicrobial resistance, antibiotic stewardship, religious demographics, pharmaceutical regulation, public health security, unregulated drug markets, pharmaceutical governance, community networks, health equity

Abstract

Background in Brief: Antimicrobial resistance (AMR) represents one of the most critical global health security threats of the 21st century, with unregulated antibiotic access significantly contributing to its acceleration. This study investigated the relationship between religious demographic patterns and unauthorized antibiotic distribution in Assam, India, with particular attention to weekly markets (haats) as potential distribution hubs.

Methods in Brief: We conducted a sequential mixed-methods investigation across five districts in Assam with documented religious demographic asymmetry. Data collection included structured market audits (n=67), simulated client visits (n=215), semi-structured interviews with key informants (n=43), geospatial mapping, and quantitative analysis of antibiotic dispensing patterns. The investigation was subsequently expanded to additional districts (n=12) for validation using comparative case analysis. Multi-level regression models were employed to isolate demographic effects while controlling for confounding variables. All procedures received ethical approval, with sensitive data anonymized to protect community identities.

Results in Brief: Unauthorized antibiotic distribution showed significant correlation with religious demographic composition (r=0.78, p<0.001), with structured distribution networks operating predominantly along community lines. Weekly markets demonstrated 3.7-fold higher unregulated antibiotic availability compared to permanent establishments (p<0.001), with distinct seasonal variations corresponding to local disease burden cycles. Analysis of dispensed antibiotics revealed concerning patterns: inadequate treatment duration (78.3%, 95% CI: 72.4-84.2%), incorrect dosage instructions (63.9%, 95% CI: 57.2-70.6%), and absence of contraindication information (90.7%, 95% CI: 86.9-94.5%). Broad-spectrum antibiotics including fluoroquinolones and third-generation cephalosporins comprised 42.3% of unauthorized sales, with significant regional variations corresponding to religious demographic patterns. Laboratory analysis revealed substandard concentration in 37.2% of samples, creating ideal conditions for resistance development.

Conclusion in Brief: Our findings demonstrate systematic circumvention of pharmaceutical regulations with community-specific distribution patterns that raise significant public health security concerns. This study provides the first empirical evidence linking religious demographic compositions to structured antibiotic distribution networks in India. The correlation between religious demographics and unregulated antibiotic distribution underscores the complex sociocultural dimensions of AMR development. Urgent multisectoral interventions are needed, including targeted regulatory enforcement, community-engaged education, enhanced pharmaceutical supply chain integrity, and improved access to legitimate healthcare services. These findings have implications for pharmaceutical governance beyond Assam, particularly in regions with complex religious demographics and limited regulatory capacity.

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