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Hutton G, Chase C, Kennedy-Walker R, Hamilton H. Financial and economic costs of healthcare-associated infections in Africa. J Hosp Infect 2024; 150:1-8. [PMID: 38723903 DOI: 10.1016/j.jhin.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) remain a global health challenge, and have elevated rates in Sub-Saharan Africa. HAIs impact patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and, sometimes, death. The costs of HAIs are increasing due to spreading antimicrobial resistance. A major risk factor for HAIs is lack of water, sanitation and hygiene (WASH); environmental cleaning and healthcare waste management. In Sub-Saharan Africa, these services are lacking in at least 50% of healthcare facilities. AIM To estimate the costs associated with HAIs at national level in 14 countries in Sub-Saharan Africa. METHODS Economic methodologies were employed to estimate the medical costs, productivity losses and value of premature death from HAIs, drawing on national statistics and published studies to populate the economic model. RESULTS In 2022, the number of HAIs was estimated at 4.8 million, resulting in 500,000 deaths. Health-related economic losses amounted to US$13 billion per year, equivalent to 1.14% of combined gross domestic product and US$15.7 per capita. Healthcare costs were US$500 per HAI, and represented 5.6% of total health expenditure. The costs of providing basic WASH were US$0.91 per capita, which, if they reduced HAIs by 50%, would result in benefit-cost ratios of 1.6 (financial healthcare savings alone) and 8.6 (all economic benefits). CONCLUSION HAIs have a major health and economic burden on African societies, and a significant proportion can be prevented. It is critical that health policy makers and practitioners dedicate policy space, resources and training to address HAIs.
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Affiliation(s)
| | - C Chase
- Water Global Practice, World Bank, Washington, DC, USA
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Gnanasekaran S, Jayaraj V, V B Y, Mohanraj PS, Babu C, Rajendran N, Rajendran V. A comprehensive evaluation of water, sanitation and hygiene (WASH) in health facilities: a systematic review and meta-analysis. J Hosp Infect 2024; 151:116-130. [PMID: 39032571 DOI: 10.1016/j.jhin.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/18/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
Despite global recognition, WHO reports reveal significant gaps, with one in four healthcare facilities lacking basic water services, affecting over 1.8 billion people, and 21% lacking sanitation services, impacting 1.5 billion people, especially prevalent in low- and middle-income countries. This study aimed to critically evaluate the current state of water, sanitation and hygiene (WASH) facilities across a diverse range of healthcare settings. This review included various databases such as PubMed, MEDLINE, EMBASE, CINAHL, Scopus and grey literature; eligible studies employing various designs were scrutinized for WASH infrastructure and practices. Methodological quality was rigorously evaluated using the QuADS checklist. Data analysis, performed with R software, involved deriving pooled estimates of WASH intervention effects. Sensitivity analyses were conducted, employing statistical methods such as funnel plots to ensure robustness and mitigate biases. Of the 13,250 articles screened, 18 were included in this review. Meta-analyses revealed significant effect sizes for WASH interventions across domains - water (67.38%), sanitation (53.93%), waste management (40.82%), environment (56.58%), hygiene (66.83%), and management (42.30%). Widespread disparities in WASH persist across healthcare facilities, with rural areas facing notable deficits. Challenges in water quality, sanitation and waste management demand comprehensive, multi-sectoral approaches for improvement.
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Affiliation(s)
- S Gnanasekaran
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - V Jayaraj
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - Yazhini V B
- Department of Otorhinolaryngology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
| | - P S Mohanraj
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - C Babu
- Department of Surgery, Era Lucknow Medical College, Hardoi Road, Sarfarazganj, Lucknow, Uttar Pradesh, India
| | - N Rajendran
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India
| | - V Rajendran
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India.
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Chettry LK, Bohara P, Bohara RC, Rijal R, Khadha S, Subedi H, Giri D, Sharma S, Dhungana U, van der Valen M, Brogan J, Anderson DM. Budgeting and Advocacy to Improve Water, Sanitation, and Hygiene in Health Care Facilities: A Case Study in Nepal. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300491. [PMID: 38936959 PMCID: PMC11216704 DOI: 10.9745/ghsp-d-23-00491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/21/2024] [Indexed: 06/29/2024]
Abstract
Barriers to achieving and sustaining access to water, sanitation, hygiene, cleaning, and waste management (WASH) in health care facilities include a lack of supportive policy environment and adequate funding. While guidelines exist for assessing needs and making initial infrastructure improvements, there is little guidance on how to develop budgets and policies to sustain WASH services. We conducted costing and advocacy activities in Thakurbaba municipality, Nepal, to develop a budget and operations and maintenance policy for WASH in health care facilities in partnership with the municipal government. Our objectives for this study were to (1) describe the process and methods used for costing and advocacy, (2) report the costs to achieve and maintain basic WASH services in the 8 health care facilities of Thakurbaba municipality, and (3) report the outcomes of advocacy activities and policy development. We applied bottom-up costing to enumerate the resources necessary to achieve and maintain basic WASH services and their costs. The annual costs to achieve, operate, and maintain basic access to WASH services ranged from US$4881-US$9695 per facility. Cost findings were used to prepare annual budgets recommended to achieve, operate, and maintain basic services, which were presented to the municipal government and incorporated into an operations and maintenance policy. To date, the municipality has adopted the policy and established a recovery fund of US$3831 for repair and maintenance of infrastructure and an additional US$153 per facility for discretionary WASH spending, which were to be replenished as they were spent. Advocacy at the national level for WASH in health care facilities is currently being championed by the municipality, and findings from this project have informed the development of a nationally costed plan for universal access. This study is intended to provide a roadmap for how cost data can be collected and applied to inform policy.
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Affiliation(s)
| | - Prakash Bohara
- Terre des hommes Foundation, Nepal Country Office, Lalitpur, Nepal
| | | | | | - Sarad Khadha
- Geruwa Rural Awareness Association, Gulariya Municipality, Nepal
| | - Hari Subedi
- Geruwa Rural Awareness Association, Gulariya Municipality, Nepal
| | - Debesh Giri
- Geruwa Rural Awareness Association, Gulariya Municipality, Nepal
| | - Sarbesh Sharma
- Management Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Upendra Dhungana
- Management Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | | | | | - Darcy M Anderson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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4
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Ani LS, Budovich L, Klunko NS, Jumanazarova GU, Nasurova K, Asatullaev K. Reduction of cost and emissions by using recycling and waste management system. BRAZ J BIOL 2024; 83:e279565. [PMID: 38422257 DOI: 10.1590/1519-6984.279565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024] Open
Abstract
In order to evaluate the level of sustainability of an integrated waste management system (IWMS), it is necessary to analyze the impact criteria. Therefore, the purpose of this study is to provide a model for IWMS optimization with the two goals of minimizing the cost and the emission of greenhouse gases of the entire system. Environmental and health problems caused by the lack of proper waste management include the increase in disease, increase in stray animals, pollution of air, water, land, etc. Therefore, it is very important to identify the indicators and improve the efficiency of the waste management system. In the present research, with descriptive-analytical approach, it has been tried to clarify and evaluate the effective indicators in two dimensions of production-segregation and collection-transportation, and find ways to improve the efficiency of the system. In this article, five waste management systems including, incineration, landfill without gas extraction system, plasma incineration, recycling and aerobic decomposition are introduced and their performance in energy production and emission reduction are compared. The results of the evaluation of the basic waste management system (b) show that the amount of pollution is equivalent to 850 kg CO2 per ton of waste. While the amount of emission in the fifth comprehensive management system is reduced to 450 kg CO2 per ton of waste. According to the results obtained in this study, in all the management systems presented, the process of burying waste in sanitary landfills has the greatest effect in increasing pollution. This means that the pollution caused by burying the waste in the sanitary landfill will be reduced with the construction of the gas extraction system and the plasma method and use in electricity production. Despite the increase in initial costs, using the right technology and using the right waste system based on the type of waste and waste recycling has an effect on the efficiency of the system.
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Affiliation(s)
- L S Ani
- Fakultas Kedokteran Universitas Udayana, Departemen Kesehatan Masyarakat dan Kedokteran Pencegahan, Denpasar, Bali, Indonesia
| | - L Budovich
- Russian Technological University - MIREA, Moscow, Russia
| | - N S Klunko
- Russian New University, Department of Philosophy, Moscow, Russia
| | - G U Jumanazarova
- Jizzakh State Pedagogical University, Faculty of Elementary Education, Jizzakh, Uzbeksitan
| | - K Nasurova
- Tashkent Institute of Finance, Department of Scientific Research, Innovation and Training of Scientific and Pedagogical Personnel, Tashkent, Uzbekistan
| | - K Asatullaev
- Tashkent Institute of Finance, Department of Economics, Tashkent, Uzbekistan
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Dorevitch S, Shrestha A. Priority setting for global WASH challenges in the age of wastewater-based epidemiological surveillance. JOURNAL OF WATER AND HEALTH 2024; 22:367-371. [PMID: 38421630 PMCID: wh_2024_298 DOI: 10.2166/wh.2024.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
HIGHLIGHTS
Mortality due to inadequate WASH facilities exceeded that of COVID-19 in the regions of South-East Asia and Africa. The costs and benefits of wastewater-based surveillance are not known; however, the benefits of WASH interventions greatly exceed the costs. The dedication of effort and resources to wastewater-based surveillance and WASH in low- and middle-income countries should reflect disease burdens and cost/benefit assessments.
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Affiliation(s)
- Samuel Dorevitch
- University of Illinois Chicago School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, USA E-mail:
| | - Abhilasha Shrestha
- University of Illinois Chicago School of Public Health, 1603 W. Taylor St., Chicago, IL 60612, USA
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Anderson DM, Mahamane E, Bauza V, Mahamadou KOB, Tantum L, Salzberg A. Effects of environmental conditions on healthcare worker wellbeing and quality of care: A qualitative study in Niger. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002590. [PMID: 38117837 PMCID: PMC10732385 DOI: 10.1371/journal.pgph.0002590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023]
Abstract
Environmental conditions (water, sanitation, hygiene, waste management, cleaning, energy, building design) are important for a safe and functional healthcare environment. Yet their full range of impacts are not well understood. In this study, we assessed the impact of environmental conditions on healthcare workers' wellbeing and quality of care, using qualitative interviews with 81 healthcare workers at 26 small healthcare facilities in rural Niger. We asked participants to report successes and challenges with environmental conditions and their impacts on wellbeing (physical, social, mental, and economic) and quality of care. We found that all environmental conditions contributed to healthcare workers' wellbeing and quality of care. The norm in facilities of our sample was poor environmental conditions, and thus participants primarily reported detrimental effects. We identified previously documented effects on physical health and safety from pathogen exposure, but also several novel effects on healthcare workers' mental and economic wellbeing and on efficiency, timeliness, and patient centeredness of care. Key wellbeing impacts included pathogen exposure for healthcare workers, stress from unsafe and chaotic working environments, staff dissatisfaction and retention challenges, out-of-pocket spending to avoid stockouts, and uncompensated labor. Key quality of care impacts included pathogen exposure for patients, healthcare worker time dedicated to non-medical tasks like water fetching (i.e., reduced efficiency), breakdowns and spoilage of equipment and supplies, and patient satisfaction with cleanliness and privacy. Inefficiency due to time lost and damaged supplies and equipment likely have substantial economic value and warrant greater consideration in research and policy making. Impacts on staff retention and care efficiency also have implications for health systems. We recommend that future research and decision making for policy and practice incorporate more holistic impact measures beyond just healthcare acquired infections and reconsider the substantial contribution that environmental conditions make to the safety of healthcare facilities and strength of health systems.
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Affiliation(s)
- Darcy M. Anderson
- The Water Institute at UNC, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ezechiel Mahamane
- World Vision Niger, Nouveau Marche, Boulevard de la Liberté BP 12713, Niamey, Niger
| | - Valerie Bauza
- The Water Institute at UNC, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | | | - Lucy Tantum
- The Water Institute at UNC, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Aaron Salzberg
- The Water Institute at UNC, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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7
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Prentice-Mott G, Odhiambo A, Conners EE, Mwaki A, Blackstock AJ, Oremo J, Akelo O, Eleveld A, Quick R, Murphy J, Berendes DM. Evaluation of SaTo pans as a new latrine technology in Kisumu County healthcare facilities, Kenya. Trop Med Int Health 2023; 28:881-889. [PMID: 37940633 PMCID: PMC10886420 DOI: 10.1111/tmi.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Innovations to improve public sanitation facilities, especially in healthcare facilities (HCFs) in low-income countries, are limited. SaTo pans represent novel, largely untested, modifications to reduce odour and flies and improve acceptability of HCF sanitation facilities. We conducted a pilot project to evaluate acceptability, cleanliness, flies and odour within latrines in 37 HCFs in Kisumu, Kenya, randomised into intervention (SaTo pan modifications) and control arms by sub-county and HCF level. METHODS At baseline (pre-intervention) and endline (>3 months after completion of SaTo pan installations in latrines in intervention HCFs), we surveyed users, cleaners and in-charges, observed odour and cleanliness, and assessed flies using fly tape. Unadjusted difference-in-difference analysis compared changes from baseline to endline in patient-reported acceptability and observed latrine conditions between intervention and control HCFs. A secondary assessment compared patient-reported acceptability following use of SaTo pan versus non-SaTo pan latrines within intervention HCFs. RESULTS Patient-reported acceptability of latrines was higher following the intervention (baseline: 87%, endline: 96%, p = 0.05). However, patient-reported acceptability was also high in the control arm (79%, 86%, p = 0.34), and the between-arm difference-in-difference was not significant. Enumerator-observed odour declined in intervention latrines (32%-14%) compared with controls (36%-51%, difference-in-difference ratio: 0.32, 95% confidence interval: 0.12-0.84), but changes in flies, puddling of urine and visible faeces did not differ between arms. In the secondary assessment, fewer intervention than control latrines had patient-reported flies (0% vs. 26%) and odour (18% vs. 50%), and reported satisfaction was greater. Most cleaners reported dropholes and floors were easier to clean in intervention versus controls; limited challenges with water for flushing were reported. CONCLUSIONS Our results suggest SaTo pans may be acceptable by cleaners and users and reduce odour in HCF sanitation facilities, though challenges exist and further evaluation with larger sample sizes is needed.
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Affiliation(s)
- Graeme Prentice-Mott
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Erin E Conners
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alex Mwaki
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Anna J Blackstock
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jared Oremo
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Oscar Akelo
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Alie Eleveld
- EIS Service, Safe Water and AIDS Project, Kisumu, Kenya
| | - Robert Quick
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Murphy
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David M Berendes
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Jiang S, Kumah E. Strategizing global health governance: unpacking opportunities and challenges for least developed nations within the WHO pandemic treaty framework. Front Public Health 2023; 11:1321125. [PMID: 38026386 PMCID: PMC10657804 DOI: 10.3389/fpubh.2023.1321125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Exploring the intricacies of the proposed WHO pandemic treaty, this paper underscores its potential benefits and challenges for Least Developed Nations (LDNs) in the global health landscape. While the treaty could elevate LDNs' access to vital resources, fortify health systems, and amplify their voice in global health governance, tangible challenges in safeguarding equitable access, protecting sovereignty, and ensuring compliance are illuminated. Concluding with targeted recommendations, the paper advocates for treaty revisions that assure resource access, safeguard LDNs' autonomy, and foster capacity-building. In essence, the paper emphasizes the imperative of genuinely empowering LDNs, crafting a pandemic treaty that establishes a more equitable, resilient, and inclusive global health future.
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Affiliation(s)
- Shisong Jiang
- School of Law, Chongqing University, Chongqing, China
| | - Emmanuel Kumah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
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Benzian H. SDG 6 - water, sanitation and hygiene are foundational for oral health. Br Dent J 2023; 235:359. [PMID: 37737379 DOI: 10.1038/s41415-023-6337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Habib Benzian
- Deptartment of Epidemiology & Health Promotion, WHO Collaborating Centre Quality Improvement & Evidence-Based Dentistry, New York University, NY, USA; Global Health Research Fellow, Stellenbosch Institute of Advanced Study (STIAS), Stellenbosch, South Africa.
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10
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Mngadi LC, Cuadros DF, Tanser F, Burns JK, Slotow R, Tomita A. Water, sanitation and depression in rural communities: evidence from nationally representative study data in South Africa. PSYCHOL HEALTH MED 2023; 28:2441-2449. [PMID: 36821547 DOI: 10.1080/13548506.2023.2179643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
Clean water and sanitation provisions are essential for good hygiene and health, with rural South Africa facing a simultaneous access crisis of both, the direct health effect of restricted access to both on mental health remaining scarce and largely overlooked. This study investigated the association between access to clean water and sanitation on depression in rural South Africa utilizing the most recent data (year 2017) from the South African National Income Dynamics Study. Our study outcome was depression, based on the 10-item abridged version of the Center for Epidemiologic Studies Depression Scale (data available in SA-NIDS), the main exposures being access to clean water and adequate sanitation facilities (i.e. flushing toilets). Two types of analyses were conducted: first, adjusted logistic regression models were fitted to assess the relationship between lack of access to clean water and adequate sanitation to depression. Second, we conducted mediation analysis to investigate whether access to clean water mediated the relationship between lack of access to toilets and depression. A high proportion of rural participants lacked access to clean water (n = 6,188, 47.6%) and adequate toilets (n = 9,797, 81.6%). The regression analyses indicated that lack of access to both clean water (OR = 1.21, 95% CI: 1.06-1.39) and adequate sanitation (OR = 1.36, 95% CI: 1.10-1.69) were significantly associated with greater odds of depression. The mediation analysis indicated that access to clean water partially mediated the relationship between lack of access to adequate sanitation and depression, the total mediated effect being 18.2% (95% CI: 11.0%-51.0%). Most rural communities in South Africa lack access to basic services that are essential for human dignity and a decent quality of life, leading to opportunities for poor mental health, with its various consequences for socio-economic development and personal wellbeing, including avoidable depression.
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Affiliation(s)
- Lindiwe C Mngadi
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Diego F Cuadros
- Digital Epidemiology Laboratory, Digital Futures, University of Cincinnati, Ohio, USA
| | - Frank Tanser
- Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Centre for Epidemic Response and Innovation (CERI), School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Jonathan K Burns
- Institute of Health Research, University of Exeter, Exeter, UK
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Rob Slotow
- Oppenheimer Fellow in Functional Biodiversity, Centre for Functional Biodiversity, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Department of Genetics, Evolution and Environment, University College, London, UK
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing Platform, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Al Meslamani AZ. Antibiotic resistance in low- and middle-income countries: current practices and its global implications. Expert Rev Anti Infect Ther 2023; 21:1281-1286. [PMID: 37804134 DOI: 10.1080/14787210.2023.2268835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Antibiotic consumption rates are high in both high and low-income countries, but addressing antibiotic practices in low- and middle-income countries (LMICs) is crucial to combatting antibiotic resistance (AR). AREA COVERED This editorial examines the current landscape of antibiotic practices in LMICs, investigate the factors driving such trends including lack of resource equity and shared global responsibility, and explore (AR) global implications, with particular emphasis placed on swift measures to combat its spread. EXPERT OPINION LMICs face three key obstacles that exacerbate AR: inadequate WASH services, climate factors, and misuse of antibiotics. A lack of sanitation and clean water promotes infections, while poor hygiene exacerbates resistant pathogen spread. Global strategies should go beyond simply educating LMICs about antibiotic misuse; they must also understand its repercussions, such as prolonged illnesses and drug-resistant bacteria like MRSA. Addressing this challenge requires multifaceted strategies, including improving WASH services, acknowledging climate impacts, and tightening regulations. Prioritizing WASH requires significant funding, community participation, technology solutions, and partnerships with NGOs. Utilizing social media influencers can boost AR awareness. Antibiotic regulation reforms, manufacturing quality, and seeking antibiotic alternatives are vital. Antimicrobial Stewardship Programs and AI's potential in managing resistant infections are notable.
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Affiliation(s)
- Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
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12
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Lou Z, Huang Y, Li S, Luo Z, Li C, Chu K, Zhang T, Song P, Zhou J. Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study. BMC Public Health 2023; 23:916. [PMID: 37208621 DOI: 10.1186/s12889-023-15765-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Uterine fibroids are the most common benign neoplasm of the uterus and a major source of morbidity for women. We report an overview of trends in uterine fibroids of incidence rate, prevalence rate, years lived with disability (YLDs) rate in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort. METHODS The incident case, incidence rate, age-standardized rate (ASR) for incidence, prevalent case, prevalence rate, ASR for prevalence, number of YLDs, YLD rate, and ASR for YLDs were derived from the Global Burden of Disease 2019 (GBD 2019) study. We utilized an age-period-cohort (APC) model to estimate overall annual percentage changes in the rate of incidence, prevalence, and YLDs (net drifts), annual percentage changes from 10 to 14 years to 65-69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. RESULTS Globally, the incident cases, prevalent cases, and the number of YLDs of uterine fibroids increased from 1990 to 2019 with the growth of 67.07%, 78.82% and 77.34%, respectively. High Socio-demographic Index (SDI) and high-middle SDI quintiles with decreasing trends (net drift < 0.0%), and increasing trends (net drift > 0.0%) were observed in middle SDI, low-middle SDI, and low SDI quintiles in annual percentage change of incidence rate, prevalence rate and YLDs rate over the past 30 years. There were 186 countries and territories that showed an increasing trend in incidence rate, 183 showed an increasing trend in prevalence rate and 174 showed an increasing trend in YLDs rate. Moreover, the effects of age on uterine fibroids increased with age and peaked at 35-44 years and then declined with advancing age. Both the period and cohort effects on uterine fibroids showed increasing trend in middle SDI, low-middle SDI and low SDI quintiles in recent 15 years and birth cohort later than 1965. CONCLUSIONS The global burden of uterine fibroids is becoming more serious in middle SDI, low-middle SDI and low SDI quintiles. Raising awareness of uterine fibroids, increasing medical investment and improving levels of medical care are necessary to reduce future burden.
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Affiliation(s)
- Zheng Lou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yizhou Huang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuting Li
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhou Luo
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunming Li
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ketan Chu
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Zhang
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianhong Zhou
- Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Hannah E, O’Hare B, Lopez M, Hall S. Achieving basic rights in health-care facilities in low-income countries. Lancet Glob Health 2022; 10:e1243. [DOI: 10.1016/s2214-109x(22)00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 10/15/2022]
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