1
|
Bajwa M, Afzal S, Sheikh SA, Saleem Z. Drug Inspector as an antibiotic Steward: challenges and recommendations to implement national action plan of Pakistan on antimicrobial resistance. Expert Rev Anti Infect Ther 2024. [PMID: 38872588 DOI: 10.1080/14787210.2024.2368825] [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: 01/03/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Despite significant measures, low- and middle-income countries (LMICs), including Pakistan, struggle to curtail non-prescription antibiotic sales, enforce regulations, and implement National Action Plan (NAP) against antimicrobial resistance (AMR). NAP Pakistan entails drug inspectors (DIs) to ensure prescription-based sales of antibiotics. This study seeks to understand the perspective of DIs regarding antimicrobial sales without prescription, underlying factors, and policy implementation status. METHODS A qualitative study employing a semi-structured interview guide using in-depth interviews with purposively selected 17 DIs was conducted. Interviews were transcribed verbatim, and data were analyzed following a thematic analysis framework utilizing MAXQDA 2022 software. RESULTS Five main themes emerged after data analysis: (1) drug inspector - the regulator of the antimicrobial armamentarium, (2) the policy context, (3) awareness regarding AMR, (4) barriers to combatting AMR, and (5) the way forward: strategies and recommendations. CONCLUSION A weak regulatory framework, low level of awareness, quackery, vested interests, and socio-economic factors augment inappropriate antibiotic utilization. Opting for better policies and strengthening the DI fraternity as outlined in NAP Pakistan is recommended. Recognizing drug inspectors as effective surveilling units and mobilizing field force against irrational antibiotic utilization is the need of the hour and requires policy reformation.
Collapse
Affiliation(s)
- Mishal Bajwa
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Shairyar Afzal
- Department of Pharmacy Practice, Faculty of Pharmacy, Hamdard University, Pakistan
- Department of Pharmacy, DHQ Hospital Jhelum, Jhelum, Pakistan
| | - Sadaf Areej Sheikh
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Punjab, Pakistan
| | - Zikria Saleem
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| |
Collapse
|
2
|
Ching C, Zaman MH, Wirtz VJ. Evaluation of Surveillance Strategies of Antimicrobial Consumption in Animals. Antibiotics (Basel) 2024; 13:505. [PMID: 38927172 PMCID: PMC11200743 DOI: 10.3390/antibiotics13060505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of this paper is to explore and assess various strategies for monitoring antimicrobial consumption (AMC) in animals, within the context of the One Health approach. Recent studies have shed light on the limited surveillance and data collection for AMC in animals. Using the United States Center for Disease Control and Prevention Policy Analytical Framework, we assess global, national, and farm-level surveillance strategies on public health impact and feasibility using evidence from primary, secondary, and grey literature. From this, we identify key policy mechanisms that support the adoption of surveillance while providing specific recommendations. We find that a global strategy, though valuable for benchmarking and policy guidance, faces participation and data visibility challenges. National-level surveillance offers direct inputs into national action plans but struggles with data uniformity and comparability. Farm-level surveillance, while resource-intensive, provides the most granular data for informing specific interventions. We advocate for a multi-faceted approach to AMC surveillance, emphasizing that legal mandates and financial incentives are crucial for encouraging surveillance participation, along with international cooperation for enhancing participation and data quality. Drawing parallels with public reporting challenges in other sectors can provide valuable lessons on how to address data collection, analysis, and reporting barriers.
Collapse
Affiliation(s)
- Carly Ching
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA;
| | - Muhammad H. Zaman
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA;
- Center on Forced Displacement, Boston University, Boston, MA 02215, USA
| | - Veronika J. Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA;
| |
Collapse
|
3
|
Parajuli A, Mitchell J, King N, Arjyal A, Latham S, King R, Baral S. Drivers of antimicrobial resistance within the communities of Nepal from One Health perspective: a scoping review. Front Public Health 2024; 12:1384779. [PMID: 38706550 PMCID: PMC11066241 DOI: 10.3389/fpubh.2024.1384779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/01/2024] [Indexed: 05/07/2024] Open
Abstract
Background A major driver of antimicrobial resistance (AMR) is the inappropriate use of antimicrobials. At the community level, people are often engaged in behaviors that drive AMR within human, animal, and environmental (One Health) impacts. This scoping review consolidates research to determine (a) the community's knowledge, attitudes, and practices around AMR; (b) existing community-based interventions; and (c) barriers and enablers to addressing AMR in Nepal. Methods This scoping review follows the Joanna Briggs Institute scoping review methodology. Literature indexed in PubMed, Scopus, CINAHL, Global Index Medicus, HINARI-SUMMON, Embase (Ovid), Global Health (Ovid), CAB Abstracts (Ovid), Web of Science, and Google Scholar between January 2000 and January 2023 were reviewed for inclusion. Articles were included in the review if they considered the issues of AMR at the community level in Nepal; this excluded clinical and laboratory-based studies. A total of 47 studies met these criteria, were extracted, and analyzed to consolidate the key themes. Results A total of 31 (66%) articles exclusively included human health; five (11%) concentrated only on animal health; no studies solely focused on environmental aspects of AMR; and the remaining studies jointly presented human, animal, and environmental aspects. Findings revealed inadequate knowledge accompanied by inappropriate practice in both the human and animal health sectors. Four community interventions improved knowledge and practices on the appropriate use of antimicrobials among community people. However, various social and economic factors were found as barriers to the appropriate use of antimicrobials in the community. Conclusion Community engagement and One Health approaches could be key tools to improve awareness of AMR and promote behavioral change related to AM use in communities, as current studies have revealed inadequate knowledge alongside inappropriate practices shared in both human and animal health sectors. Systematic review registration DOI: 10.17605/OSF.IO/FV326.
Collapse
Affiliation(s)
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Natalie King
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
| | | | - Sophia Latham
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | | |
Collapse
|
4
|
Nguyen-Thanh L, Wernli D, Målqvist M, Graells T, Jørgensen PS. Characterising proximal and distal drivers of antimicrobial resistance: An umbrella review. J Glob Antimicrob Resist 2024; 36:50-58. [PMID: 38128730 DOI: 10.1016/j.jgar.2023.12.008] [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: 08/22/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a multifactorial challenge driven by a complex interplay of proximal drivers, such as the overuse and misuse of antimicrobials and the high burden of infectious diseases, and distal factors, encompassing broader societal conditions such as poverty, inadequate sanitation, and healthcare system deficiencies. However, distinguishing between proximal and distal drivers remains a conceptual challenge. OBJECTIVES We conducted an umbrella review, aiming to systematically map current evidence about proximal and distal drivers of AMR and to investigate their relationships. METHODS Forty-seven reviews were analysed, and unique causal links were retained to construct a causality network of AMR. To distinguish between proximal and distal drivers, we calculated a 'driver distalness index (Di)', defined as an average relative position of a driver in its causal pathways to AMR. RESULTS The primary emphasis of the literature remained on proximal drivers, with fragmented existing evidence about distal drivers. The network analysis showed that proximal drivers of AMR are associated with risks of resistance transmission (Di = 0.49, SD = 0.14) and antibiotic use (Di = 0.58, SD = 0.2), which are worsened by intermediate drivers linked with challenges of antibiotic discovery (Di = 0.62, SD = 0.07), infection prevention (Di = 0.67, SD = 0.14) and surveillance (Di = 0.69, SD = 0.16). Distal drivers, such as living conditions, access to sanitation infrastructure, population growth and urbanisation, and gaps in policy implementation were development and governance challenges, acting as deep leverage points in the system in addressing AMR. CONCLUSIONS Comprehensive AMR strategies aiming to address multiple chronic AMR challenges must take advantage of opportunities for upstream interventions that specifically address distal drivers.
Collapse
Affiliation(s)
- Luong Nguyen-Thanh
- SWEDESD - Sustainability Learning and Research Center, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Uppsala Antibiotic Centre (UAC), Uppsala University, Uppsala, Sweden; Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden.
| | - Didier Wernli
- Global Studies Institute and Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Mats Målqvist
- SWEDESD - Sustainability Learning and Research Center, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Tiscar Graells
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Peter Søgaard Jørgensen
- SWEDESD - Sustainability Learning and Research Center, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm, Sweden; Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden.
| |
Collapse
|
5
|
Parajuli A, Garbovan L, Bhattarai B, Arjyal A, Baral S, Cooke P, Latham S, Barrington DJ, Mitchell J, King R. Exploring community insights on antimicrobial resistance in Nepal: a formative qualitative study. BMC Health Serv Res 2024; 24:57. [PMID: 38212733 PMCID: PMC10782613 DOI: 10.1186/s12913-023-10470-2] [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] [Received: 04/24/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is the process by which microbes evolve mechanisms to survive the medicines designed to destroy them i.e. antimicrobials (AMs). Despite being a natural process, AMR is being hastened by the abuse of AMs. In context of Nepal, there is limited information on drivers of AMR and barriers in addressing it from a community perspective. This study explores the local language and terminology used around AMs in the community, commonly used AMs and reasons for their usage, how these AMs are sourced, and the perceived barriers to addressing AMR via One Health approach. METHODS A phenomenological study design was utilized with applied qualitative research theoretically framed as pragmatism. Twelve in-depth interviews and informal discussions with a One Health focus, were purposively conducted with wide range of stakeholders and community resident of Kapilvastu municipality of Nepal during April 2022. The acquired data was analyzed manually via a thematic framework approach. The study obtained ethical approval from ethical review board of Nepal Health Research Council and University of Leeds. RESULTS Nepali and Awadhi languages does not have specific words for AMs or AMR, which is understandable by the community people. Rather, community use full explanatory sentences. People use AMs but have incomplete knowledge about them and they have their own local words for these medicines. The knowledge and usage of AMs across human and animal health is impacted by socio-structural factors, limited Government regulation, inadequate supply of AMs in local government health facilities and the presence of various unregulated health providers that co-exist within the health system. Novel ideas such as the use of visual and smart technology, for instance mobile phones and social media exposure, can enable access to information about AMs and AMR. CONCLUSION This study shows that terminology that is understandable by the community referring to AMs and AMR in Nepali and Awadhi languages does not exist, but full explanatory sentences and colloquial names are used. Despite regular utilisation, communities have incomplete knowledge regarding AMs. Since, knowledge alone cannot improve behaviour, behavioural interventions are required to address AMR via community engagement to co-produce their own solutions. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
| | - Lidis Garbovan
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | | | | | | | - Paul Cooke
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Sophia Latham
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Chester High Road, Neston, Liverpool, CH64 7TE, UK
| | - Dani J Barrington
- School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western, 6009, Australia
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| |
Collapse
|
6
|
Thakral Y, Sahay S, Mukherjee A. Microfoundations of Data-Driven Antimicrobial Stewardship Policy (ASP). Antibiotics (Basel) 2023; 13:24. [PMID: 38247583 PMCID: PMC10812814 DOI: 10.3390/antibiotics13010024] [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: 11/06/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024] Open
Abstract
This paper introduces a comprehensive framework that elucidates the microfoundations of data-driven antimicrobial stewardship programs (ASPs), specifically focusing on resource-constrained settings. Such settings necessitate the utilization of available resources and engagement among multiple stakeholders. The microfoundations are conceptualized as interlinked components: input, process, output, and outcome. Collectively, these components provide a comprehensive framework for understanding the development and implementation of data-driven ASPs in resource-constrained settings. It underscores the importance of considering both the social and material dimensions when evaluating microbiological, clinical, and social impacts. By harmonizing technology, practices, values, and behaviors, this framework offers valuable insights for the development, implementation, and assessment of ASPs tailored to resource-constrained environments.
Collapse
Affiliation(s)
- Yogita Thakral
- Department of Informatics, University of Oslo, 0373 Oslo, Norway;
- HISP India, New Delhi 110025, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, 0373 Oslo, Norway;
- HISP India, New Delhi 110025, India
| | - Arunima Mukherjee
- HISP India, New Delhi 110025, India
- SUSTAINIT—Unit for sustainable health, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| |
Collapse
|
7
|
Al Sattar A, Chisty NN, Irin N, Uddin MH, Hasib FMY, Hoque MA. Knowledge and practice of antimicrobial usage and resistance among poultry farmers: A systematic review, meta-analysis, and meta-regression. Vet Res Commun 2023; 47:1047-1066. [PMID: 36823483 DOI: 10.1007/s11259-023-10082-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
A systematic review was conducted to summarize and synthesize the existing research on poultry farmers' knowledge, practices, and awareness regarding antimicrobial use (AMU) and antimicrobial resistance (AMR). It was undertaken by systematically searching databases, screening and characterizing relevant studies, extracting data, and evaluating the risk of bias. The outcomes were stratified into several subgroups, and pooled prevalence of each subgroup was calculated using a random-effect meta-analysis. Meta-regression was used for selected outcomes to further investigate the potential sources of heterogeneity across studies. Poultry farmers had knowledge and practice gaps on antimicrobial use. While most (65%; 95% CI: 50%-80%) used antimicrobials on poultry for therapeutic purposes, a portion used them to prevent disease (45%; 95% CI: 34%-55%) or boost growth (29%; 95% CI: 13%-46%) and productivity (20%; 95% CI: 6%-34%). 60% (95% CI: 50%-69%) of farmers approached veterinarians for antimicrobial advice, although many consulted drug sellers and fellow farmers. Insufficient antimicrobial residue knowledge (45%; 95% CI: 29%-62%), as well as inadequate awareness and faulty practice on withdrawal periods, were identified. Only 43% (95% CI: 34%-53%) were knowledgeable about AMR. Around half of farmers understood AMR's impacts on poultry, human health, and the environment. Meta-regression demonstrated that the source of heterogeneity for therapeutic antimicrobial use was the type of poultry farmers sampled and their educational qualifications; geographical region was significantly associated with antimicrobial usage based on farmers' experience; and the country's economic state was correlated with farmers' understanding of antimicrobial residue. This study recommends implementing legislation for judicious antimicrobial use, and farmer awareness campaigns to reinforce knowledge about prudent AMU and AMR.
Collapse
Affiliation(s)
- Abdullah Al Sattar
- Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh
| | - Nurun Nahar Chisty
- Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh
| | - Nusrat Irin
- Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh
| | - Md Helal Uddin
- Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh
| | - F M Yasir Hasib
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Md Ahasanul Hoque
- Department of Medicine and Surgery, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Zakir Hossain Road, Khulshi, Chattogram, 4225, Bangladesh.
| |
Collapse
|
8
|
Manji K, Perera S, Hanefeld J, Vearey J, Olivier J, Gilson L, Walls H. An analysis of migration and implications for health in government policy of South Africa. Int J Equity Health 2023; 22:82. [PMID: 37158907 PMCID: PMC10165765 DOI: 10.1186/s12939-023-01862-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/15/2023] [Indexed: 05/10/2023] Open
Abstract
For over a decade, the global health community has advanced policy engagement with migration and health, as reflected in multiple global-led initiatives. These initiatives have called on governments to provide universal health coverage to all people, regardless of their migratory and/or legal status. South Africa is a middle-income country that experiences high levels of cross-border and internal migration, with the right to health enshrined in its Constitution. A National Health Insurance Bill also commits the South African public health system to universal health coverage, including for migrant and mobile groups. We conducted a study of government policy documents (from the health sector and other sectors) that in our view should be relevant to issues of migration and health, at national and subnational levels in South Africa. We did so to explore how migration is framed by key government decision makers, and to understand whether positions present in the documents support a migrant-aware and migrant-inclusive approach, in line with South Africa's policy commitments. This study was conducted between 2019 and 2021, and included analysis of 227 documents, from 2002-2019. Fewer than half the documents identified (101) engaged directly with migration as an issue, indicating a lack of prioritisation in the policy discourse. Across these documents, we found that the language or discourse across government levels and sectors focused mainly on the potential negative aspects of migration, including in policies that explicitly refer to health. The discourse often emphasised the prevalence of cross-border migration and diseases, the relationship between immigration and security risks, and the burden of migration on health systems and other government resources. These positions attribute blame to migrant groups, potentially fuelling nationalist and anti-migrant sentiment and largely obscuring the issue of internal mobility, all of which could also undermine the constructive engagement necessary to support effective responses to migration and health. We provide suggestions on how to advance engagement with issues of migration and health in order for South Africa and countries of a similar context in regard to migration to meet the goal of inclusion and equity for migrant and mobile groups.
Collapse
Grants
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
- Grant number: MR/S013601/1 Health Systems Research Initiative (HSRI) in the UK, a collaboration between the UK MRC, ERSC, DFID, and the Wellcome Trust
Collapse
Affiliation(s)
- Karima Manji
- London School of Hygiene & Tropical Medicine (LSHTM), Faculty of Public Health and Policy, Department of Global Health and Development, London, UK
| | - Shehani Perera
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Johanna Hanefeld
- London School of Hygiene & Tropical Medicine (LSHTM), Faculty of Public Health and Policy, Department of Global Health and Development, London, UK
| | - Jo Vearey
- The African Centre for Migration & Society (ACMS), University of the Witwatersrand, Johannesburg, South Africa
| | - Jill Olivier
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lucy Gilson
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Helen Walls
- London School of Hygiene & Tropical Medicine (LSHTM), Faculty of Public Health and Policy, Department of Global Health and Development, London, UK.
| |
Collapse
|
9
|
Microbial Contamination and Antibiotic Resistance in Marketed Food in Bangladesh: Current Situation and Possible Improvements. Antibiotics (Basel) 2023; 12:antibiotics12030555. [PMID: 36978422 PMCID: PMC10044357 DOI: 10.3390/antibiotics12030555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Antimicrobial resistance (AMR) is a public health problem worldwide. Bangladesh, like its neighboring countries, faces many public health challenges, including access to safe food, inadequate food surveillance, as well as increasing AMR. This study investigated bacterial contamination and the AMR profile of pathogens in marketed food in Bangladesh and explored barriers to reducing AMR in the country. We collected 366 tomatoes, 359 chicken and 249 fish samples from 732 vendors in traditional markets in urban, peri-urban and rural areas in Bangladesh, as well as from 121 modern retails in Dhaka capital to analyse Vibrio cholerae and Escherichia coli in fish, Salmonella in chicken, and Salmonella and E. coli in tomatoes. Antibiotic susceptibility against 11 antibiotics was tested using a disc diffusion test and interpreted by an automated zone inhibition reader. In addition, a qualitative study using key informant interviews was conducted to explore antimicrobial use and AMR reduction potential in Bangladesh. We found E. coli in 14.21% of tomatoes and 26.91% of fish samples, while 7.38% of tomatoes and 17.27% of chicken were positive for Salmonella, and 44.98% of fish were positive for Vibrio cholerae. In total 231/319 (72.4%) of all pathogens isolated were multidrug-resistant (MDR) (resistant to three or more antibiotic groups). Qualitative interviews revealed an inadequate surveillance system for antibiotic use and AMR in Bangladesh, especially in the agriculture sector. To be able to fully understand the human health risks from bacterial hazards in the food and the AMR situation in Bangladesh, a nationwide study with a one health approach should be conducted, within all sectors, including AMR testing as well as assessment of the antimicrobial use and its drivers.
Collapse
|
10
|
Saman A, Chaudhry M, Ijaz M, Shaukat W, Zaheer MU, Mateus A, Rehman A. Assessment of knowledge, perception, practices and drivers of antimicrobial resistance and antimicrobial usage among veterinarians in Pakistan. Prev Vet Med 2023; 212:105836. [PMID: 36634489 DOI: 10.1016/j.prevetmed.2022.105836] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) and irrational antimicrobial usage (AMU) are a global problem, particularly evident in low- and middle-income countries including Pakistan. Our study aimed to assess the knowledge, attitudes and prescribing practices (KAP) of field veterinarians regarding AMR and AMU. METHODS A questionnaire-based online survey was conducted using Google forms to collect data on AMR and AMU from veterinary practitioners in Pakistan between July 25, 2020, and February 2, 2021. The questionnaire was comprised of four sections: 1) Demographic information of the respondents, 2) Knowledge about AMR, and AMU, 3) Antibiotic prescribing behavior, attitudes and influencing drivers and 4) Practices of respondents about AMU and drug disposal. RESULTS A total of 545 participants (Male 84%, Female 16%) completed the survey. The respondents' qualification (P = 0.008), gender (P = 0.007) and type of practitioner (P < 0.001) had a significant association with the mean knowledge score about AMR. Most of the veterinarians had never attended any training, symposium, or awareness session on AMR (63%) and methods to detect antibiotic residues (71%). Participating veterinarians frequently included "critically important antimicrobials" in their treatment regimens. Most veterinarians (60%) prescribed antibiotics for viral diseases. Our study showed that about 44% of veterinarians disposed of expired drugs in the garbage. Antibiotics were prescribed as mass medication and for prophylaxis by 59% and 33% of the veterinarians, respectively, while about 60% of the veterinarians prescribed antibiotics starting with double doses in their treatment regimens. Importantly, only 4% of the veterinarians recognized the concept of One Health. Male veterinarians had higher odds of prescribing mass medication (OR=3.07, P < 0.001) and use of antibiotics for disease prophylaxis (OR=2.31, P = 0.002) than females, whereas improper disposal of expired antimicrobials (OR=2.12, P = 0.003) was more common in female veterinarians. Government veterinarians had 2 (OR=1.95, P = 0.016) and 3 (OR=3.05, P < 0.001) times higher odds to prescribe antibiotics prophylactically and for mass treatments, respectively compared to full-time private veterinarians. CONCLUSION Our study identifies key factors influencing veterinarians' decision about antimicrobial prescription and highlights important shortcomings such as lack of training on rational use of antimicrobials, frequent use of antimicrobials for mass medication and prophylaxis, widespread use of critically important antimicrobials, and improper disposal practices. There is a dire need to improve knowledge of veterinary practitioners regarding AMR and to adopt a One Health approach to rationalize AMU at the national level in line with the regional and international guidelines.
Collapse
Affiliation(s)
- Ayesha Saman
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| | - Mamoona Chaudhry
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| | - Muhammad Ijaz
- Department of Veterinary Medicine, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| | - Waseem Shaukat
- Department of Production Animal Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Muhammad Usman Zaheer
- The Fleming Fund Country Grant Pakistan, Health Security Partners, Washington, DC 20037, USA; Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA.
| | - Ana Mateus
- Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK.
| | - Abdul Rehman
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan.
| |
Collapse
|
11
|
Noor MN, Khan M, Rahman-Shepherd A, Siddiqui AR, Khan SS, Azam I, Shakoor S, Hasan R. Impact of a multifaceted intervention on physicians' knowledge, attitudes and practices in relation to pharmaceutical incentivisation: protocol for a randomised control trial. BMJ Open 2022; 12:e067233. [PMID: 36332959 PMCID: PMC9639112 DOI: 10.1136/bmjopen-2022-067233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands. METHODS AND ANALYSIS This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and will be randomly assigned to intervention and control groups. The intervention group GPs will be exposed to emotive and educational seminars on medical ethics, whereas control group GPs will be given seminars on general medical topics. The primary outcome measure will be GPs' prescribing practices, whereas the secondary outcome measures will be their knowledge and attitudes regarding COI that arises from pharmaceutical incentivisation. In addition to a novel standardised pharmaceutical representatives (SPSR) method, in which field researchers will simulate pharmaceutical marketing with GPs, presurvey and postsurvey, and qualitative interviewing will be performed to collect data on GPs' knowledge, attitudes and practices in relation to COI linked with pharmaceutical incentives. Univariate and multivariate statistical analyses will be performed to measure a change in GPs' knowledge, attitudes and practices, while qualitative analysis will add to our understanding of the quantitative SPSR data. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Pakistan National Bioethics Committee (# 4-87/NBC-582/21/1364), the Aga Khan University (# 2020-4759-1129) and the London School of Hygiene and Tropical Medicine (# 26506). We will release results within 6-9 months of the study's completion. TRIAL REGISTRATION NUMBER ISRCTN12294839.
Collapse
Affiliation(s)
- Muhammad Naveed Noor
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Mishal Khan
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Afifah Rahman-Shepherd
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sabeen Sharif Khan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Iqbal Azam
- Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
- Faculty of Infectious and Tropical Disease, The London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
12
|
Mitchell J, Cooke P, Ahorlu C, Arjyal A, Baral S, Carter L, Dasgupta R, Fieroze F, Fonseca-Braga M, Huque R, Lewycka S, Kalpana P, Saxena D, Tomley F, Tsekleves E, Vu Thi Quynh G, King R. Community engagement: The key to tackling Antimicrobial Resistance (AMR) across a One Health context? Glob Public Health 2022; 17:2647-2664. [PMID: 34882505 DOI: 10.1080/17441692.2021.2003839] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
Antimicrobial resistance (AMR) is a One Health problem underpinned by complex drivers and behaviours. This is particularly so in low - and middle-income countries (LMICs), where social and systemic factors fuel (mis)use and drive AMR. Behavioural change around antimicrobial use could safeguard both existing and future treatments. However, changing behaviour necessitates engaging with people to understand their experiences. This publication describes a knowledge-exchange cluster of six LMIC-based projects who co-designed and answered a series of research questions around the usage of Community Engagement (CE) within AMR. Findings suggest that CE can facilitate AMR behaviour change, specifically in LMICs, because it is a contextualised approach which supports communities to develop locally meaningful solutions. However, current CE interventions focus on human aspects, and demand-side drivers, of AMR. Our cluster suggests that broader attention should be paid to AMR as a One Health issue. The popularity of mixed methods approaches within existing CE for AMR interventions suggests there is interdisciplinary interest in the uptake of CE. Unfortunately, the specificity and context-dependency of CE can make it difficult to evaluate and scale. Nevertheless, we suggest that in synthesising learnings from CE, we can develop a collective understanding of its scope to tackle AMR across contexts. .
Collapse
Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse, UK
| | - Paul Cooke
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse, UK
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Laura Carter
- School of Geography, University of Leeds, Woodhouse, UK
| | - Rajib Dasgupta
- One Health Poultry Hub, UK
- Centre of Social Medicine & Community Health, Jawaharlal Nehru University, New Delhi, India
| | | | | | | | - Sonia Lewycka
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Pachillu Kalpana
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Deepak Saxena
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Fiona Tomley
- One Health Poultry Hub, UK
- Royal Veterinary College, Hatfield, UK
| | | | - Gioa Vu Thi Quynh
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Ha Noi, Vietnam
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse, UK
| |
Collapse
|
13
|
A Formative Assessment of Antibiotic Dispensing/Prescribing Practices and Knowledge and Perceptions of Antimicrobial Resistance (AMR) among Healthcare Workers in Lahore Pakistan. Antibiotics (Basel) 2022; 11:antibiotics11101418. [PMID: 36290076 PMCID: PMC9598410 DOI: 10.3390/antibiotics11101418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Antimicrobial resistance causes significant disease burden in low- and middle-income countries. The objective of this paper is to describe antibiotic dispensing/prescribing practices and underlying factors associated with these practices among community-based healthcare workers. (2) Methods: Cross-sectional survey data were collected from private and public health facilities in 14 union councils, Lahore Pakistan. Respondents included physicians, nurses, lady health workers/volunteers, midwives, pharmacy and medicine shop employees, and medical technicians. Descriptive and bivariate analysis are used to present the data; (3) Results: 177 respondents completed the survey. In terms of weekly dispensing of antibiotics, the most common were Amoxicillin/Augmentin (2.3 [SD 1.5]), Cefixine (2.4 [SD 1.6]), and Azithromycin (2.5 [SD 2.1]). For children, antibiotics were more likely to be prescribed/dispensed for sore throat (54.3%/95) and diarrhea (48.9%/86). For adults, antibiotics were more likely to be prescribed/dispensed for sore throat (67.0%/118), diarrhea (59.7%/105) and burning sensation when urinating (55.7%/176). In total, 55.4% of respondents stated that they have sold partial antibiotic courses to patients/customers. A total of 44.6% of respondents incorrectly answered that antibiotics could be used for viral infections; (4) Conclusions: Data from this study and similar research emphasize the urgent need to implement community-based stewardship programs for all healthcare workers.
Collapse
|
14
|
Mitchell J, O'Neill AJ, King R. Creating a framework to align antimicrobial resistance (AMR) research with the global guidance: a viewpoint. J Antimicrob Chemother 2022; 77:2315-2320. [PMID: 35748621 DOI: 10.1093/jac/dkac205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe here an initial analysis of national and international guidance documents on antimicrobial resistance (AMR) to propose a framework to align AMR research activities with global guidance. The framework provides a summary roadmap for core activities in AMR research and highlights the need for interdisciplinary and One Health collaboration. This analysis also revealed limitations in the current guidance, including a lack of explicit mention of some research activities highly relevant to AMR and a dearth of concrete objectives; consequently, an over-reliance on global guidance could be funnelling research efforts down a generic trajectory without regard to contextual factors. We suggest this framework be used by academics and policymakers to align AMR research and guidance. However, we recommend that deeper exploration be undertaken to fully contextualize the development of meaningful questions based on current knowledge, methodologies and gap analyses.
Collapse
Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, Worsley Building, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.,AMR@Leeds, University of Leeds, Leeds LS2 9JT, UK
| | - Alex J O'Neill
- AMR@Leeds, University of Leeds, Leeds LS2 9JT, UK.,School of Molecular & Cellular Biology, Garstang Building, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, Worsley Building, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.,AMR@Leeds, University of Leeds, Leeds LS2 9JT, UK
| |
Collapse
|
15
|
Sharma G, Mutua F, Deka RP, Shome R, Bandyopadhyay S, Shome BR, Kumar NG, Grace D, Dey TK, Lindahl J. Comparing the Effectiveness of Different Approaches to Raise Awareness About Antimicrobial Resistance in Farmers and Veterinarians of India. Front Public Health 2022; 10:837594. [PMID: 35784225 PMCID: PMC9244170 DOI: 10.3389/fpubh.2022.837594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAntimicrobial resistance (AMR) is a global public health threat. The indiscriminate use of antibiotics in the animal health sector contributes to increasing rates of AMR and studies involving dairy farmers in India have found knowledge levels regarding antibiotics and AMR to be very low. The purpose of this study was to assess different methods to raise awareness and knowledge about AMR and antibiotic use among dairy farmers, paravets (veterinary assistants), and veterinarians.Materials and MethodsThe study was conducted in September-December of 2018 in some parts of Haryana, Assam, Karnataka, and West Bengal. It had two parts: an intervention meeting (September–October 2018) which consisted of focus group discussions (FGD) with farmers, key informant interviews (KII) with veterinary professionals along with distribution of information packages, and then a follow-up survey (November–December 2018). The villages were randomly allocated to either one of the four intervention approaches (1-FGD/KII and information package on AMR; 2-FGD/KI and information on animal health; 3- FGD/KII and information package on animal health plus information on AMR; or 4- only the FGD/KII). A follow-up survey was done to assess the effect of interventions.ResultsIn total, 274 dairy farmers and 51 veterinary professionals (21 veterinarians and 30 paravets) participated in the follow-up survey. Many of the farmers and veterinary professionals who participated in the follow-up survey had been part of the intervention meetings. The average knowledge score of farmers was 7.8. It was found that the knowledge score was higher amongst farmers who had participated in the intervention meetings (p < 0.05), had received intervention approach 2 (p = 0.03) or approach 3 (p = 0.01), and amongst female farmers (p = 0.03) compared to male. The veterinary professionals had good knowledge but lacked interest in training the farmers about antimicrobial resistance.ConclusionOur research demonstrated that a higher percentage of farmers and veterinary professionals who attended the intervention meeting had improved knowledge. Dairy farmers should be regularly educated on antibiotic usage and how to avoid misusing them. Also, veterinary experts should be provided with tools and strategies to educate farmers on the use of antimicrobials.
Collapse
Affiliation(s)
- Garima Sharma
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- *Correspondence: Garima Sharma
| | - Florence Mutua
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
| | - Ram Pratim Deka
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Rajeshwari Shome
- Bacteriology Lab 1, 2, National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | | | - Bibek Ranjan Shome
- Bacteriology Lab 1, 2, National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Naresh Goyal Kumar
- Dairy Microbiology Division, National Dairy Research Institute, Karnal, India
| | - Delia Grace
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Food and Markets Department, Natural Resources Institute, Chatham, United Kingdom
| | - Tushar Kumar Dey
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Bacteriology Lab 1, 2, National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Johanna Lindahl
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| |
Collapse
|
16
|
Setiawan E, Abdul-Aziz MH, Roberts JA, Cotta MO. Hospital-Based Antimicrobial Stewardship Programs Used in Low- and Middle-Income Countries: A Scoping Review. Microb Drug Resist 2022; 28:566-584. [PMID: 35333607 DOI: 10.1089/mdr.2021.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The burden of antimicrobial resistance (AMR) is considerable in many low- and middle-income countries (LMICs), and it is important to describe the antimicrobial stewardship program (ASP) activities found in these countries and report their impact. Importantly, as these programs target prescribing behavior, the factors influencing prescription of antimicrobials must also be taken into account. This scoping review aimed to (1) describe hospital-based ASP activities, (2) report methods used to measure the impact of ASPs, and (3) explore factors influencing antimicrobial prescribing behavior in LMICs. PubMed was searched from database inception until April 2021. Factors influencing antimicrobial prescribing behavior were canvassed using the Capability-Opportunity-Motivation and Behavior framework. Most of ASP studies in LMICs were predominantly conducted in tertiary care and university-based hospitals. Audit of antimicrobial prescriptions with feedback and restrictive-based strategies was the main reported activity. Total antimicrobial consumption was the main method used to measure the impact of ASPs. Positive outcomes were observed for both clinical and microbiological outcomes; however, these were measured from nonrandomized controlled trials. Dominant factors identified through the behavioral framework were a limited awareness of AMR as a local problem, a perception that overprescription of antimicrobials had limited consequences and was mainly driven by a motivation to help improve patient outcomes. In addition, antimicrobial prescribing practices were largely influenced by existing hierarchy among prescribers. Our scoping review suggests that LMICs need to evaluate antimicrobial appropriateness as an added measure to assess impact. Furthermore, improvements in the access of microbiology and diagnostic facilities and ensuring ASP champions are recruited from senior prescribers will positively influence antimicrobial prescribing behavior, helping improve stewardship of antimicrobials in these countries.
Collapse
Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Clinical and Community Pharmacy; and Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, Surabaya, Indonesia
| | - Mohd-Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
17
|
Pahlman K, Fehross A, Fox GJ, Silva DS. Ethical health security in the age of antimicrobial resistance. BMJ Glob Health 2022; 7:e007407. [PMID: 34996766 PMCID: PMC8743836 DOI: 10.1136/bmjgh-2021-007407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Owing to its potential human, social and economic costs, antimicrobial resistance (AMR) is frequently referred to as a threat to health security. Simultaneously, health security and the preservation of antimicrobials are often described as a global public good. However, how the term 'public good' is used in the context of health security, and the values that underpin it, remains ambiguous. Policymaking is never value-free, and a better examination of such values is critical to understanding how issues such as AMR are problematised and how policy decisions are informed. DESIGN We used McDougall's version of critical interpretive synthesis to capture the recurring concepts and arguments within public policy, political science and applied ethics literature on AMR. Articles were analysed by identifying recurring ideas and developing themes across the literature. RESULTS A total of 77 papers were included in our review. In the context of health security and AMR, the concept of 'public good' appears to be used interchangeably with 'common good', reflecting confusion, but sometimes meaningful differences, regarding how antimicrobials, as a good, are conceived. Main approaches to addressing AMR are statism, globalism and regionalism, which appeal to different values in guiding policymakers. Common justificatory values underpinning preservation of antimicrobials as a public good were prevention of harm, solidarity, justice and rights. CONCLUSION The findings suggest that within the literature there is a lack of conceptual clarity as to whether antimicrobials constitute a public good or a common good. Moreover, the way in which antimicrobials are conceived and the approaches through which AMR as a threat to health security is addressed appear to be grounded in values that are often implicit. Being explicit about the values that underpin AMR and health security is not simply an intellectual exercise but has very real policy and programmatic implications.
Collapse
Affiliation(s)
- Kari Pahlman
- Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anson Fehross
- Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Greg J Fox
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Diego S Silva
- Sydney Health Ethics, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
Tompson AC, Manderson L, Chandler CIR. Understanding antibiotic use: practices, structures and networks. JAC Antimicrob Resist 2021; 3:dlab150. [PMID: 34617017 PMCID: PMC8488471 DOI: 10.1093/jacamr/dlab150] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In this article, we consider how social sciences can help us to understand the rising use of antibiotics globally. Drawing on ethnography as a way to research how we are in the world, we explore scholarship that situates antibiotic use in relation to interactions of pathogens, humans, animals and the environment in the context of globalization, changes in agriculture and urbanization. We group this research into three areas: practices, structures and networks. Much of the public health and related social research concerning antimicrobial resistance has focused on antibiotic use as a practice, with research characterizing how antibiotics are used by patients, farmers, fishermen, drug sellers, clinicians and others. Researchers have also positioned antibiotic use as emergent of political-economic structures, shedding light on how working and living conditions, quality of care, hygiene and sanitation foster reliance on antibiotics. A growing body of research sees antibiotics as embedded in networks that, in addition to social and institutional networks, comprise physical, technical and historical connections such as guidelines, supply chains and reporting systems. Taken together, this research emphasizes the multiple ways that antibiotics have become built into daily life. Wider issues, which may be invisible without explication through ethnographic approaches, need to be considered when addressing antibiotic use. Adopting the complementary vantage points of practices, networks and structures can support the diversification of our responses to AMR.
Collapse
Affiliation(s)
- A C Tompson
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK
| | - L Manderson
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown 2193, Johannesburg, South Africa
| | - C I R Chandler
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London WC1H 9SH, UK
| |
Collapse
|
19
|
Haenssgen MJ, Charoenboon N, Thavethanutthanawin P, Wibunjak K. Tales of treatment and new perspectives for global health research on antimicrobial resistance. MEDICAL HUMANITIES 2021; 47:e10. [PMID: 32948667 PMCID: PMC8639946 DOI: 10.1136/medhum-2020-011894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 05/06/2023]
Abstract
Global health champions modernism and biomedical knowledge but tends to neglect knowledge, beliefs and identities of rural communities in low-income and middle-income countries. The topic of antimicrobial resistance represents these common challenges, wherein the growing emphasis on public engagement offers a yet underdeveloped opportunity to generate perspectives and forms of knowledge that are not typically incorporated into research and policy. The medical humanities as an interdisciplinary approach to illness and health behaviour play a central role in cultivating this potential-in particular, through the field's emphasis on phenomenological and intersubjective approaches to knowledge generation and its interest in dialogue between medicine, the humanities and the broader public.We present a case study of public engagement that incorporates three medical humanities methods: participatory co-production, photographic storytelling and dialogue between researchers and the public. Situated in the context of northern Thailand, we explore subcases on co-production workshops with villagers, tales of treatment shared by traditional healers and dialogue surrounding artistic display in an international photo exhibition. Our starting assumption for the case study analysis was that co-produced local inputs can (and should) broaden the understanding of the sociocultural context of antimicrobial resistance.Our case study illustrates the potential of medical humanities methods in public engagement to foreground cultural knowledge, personal experience and 'lay' sensemaking surrounding health systems and healing (including medicine use). Among others, the engagement activities enabled us to formulate and test locally grounded hypotheses, gain new insights into the social configuration of treatment seeking and reflect on the relationship between traditional healing and modern medicine in the context of antimicrobial resistance. We conclude that medical-humanities-informed forms of public engagement should become a standard component of global health research, but they require extensive evaluation to assess benefits and risks comprehensively.
Collapse
Affiliation(s)
- Marco J Haenssgen
- Global Sustainable Development, University of Warwick, Coventry, UK
- Institute of Advanced Study, University of Warwick, Coventry, West Midlands, UK
| | | | | | | |
Collapse
|
20
|
Shakya S, Edwards J, Gupte HA, Shrestha S, Shakya BM, Parajuli K, Kattel HP, Shrestha PS, Ghimire R, Thekkur P. High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal. Public Health Action 2021; 11:24-31. [PMID: 34778012 PMCID: PMC8575380 DOI: 10.5588/pha.21.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
SETTING: Tribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May–October 2019. OBJECTIVE: 1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing. DESIGN: This was a hospital-based, cross-sectional study using routine laboratory records. RESULTS: Among 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ⩾60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ⩾45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ⩾60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR. CONCLUSION: Urine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.
Collapse
Affiliation(s)
- S Shakya
- Central Department of Public Health, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - J Edwards
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - H A Gupte
- Narotam Sekhsaria Foundation, Mumbai, India
| | - S Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu, Nepal
| | - B M Shakya
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - K Parajuli
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - H P Kattel
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - P S Shrestha
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - R Ghimire
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - P Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
| |
Collapse
|
21
|
Broom A, Doron A. Resistant bugs, porous borders and ecologies of care in India. Soc Sci Med 2021; 292:114520. [PMID: 34740470 DOI: 10.1016/j.socscimed.2021.114520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
As social science scholarship has routinely illustrated, professional practice is rarely as contained or coherent as it is often imagined to be. The increasing emphasis on the rise of antimicrobial resistance (AMR) has drawn renewed attention to the interconnectedness of clinic, community, environment and planet, and how proposed 'solutions' to major problems such as AMR require a broad, cross-cutting lens. In this study, set in Hyderabad, India, we draw on a series of interviews with hospital-based clinicians completed during 2019 and early 2020, to unpack the multidimensional, ecological acceleration of AMR and the implications for everyday practice. Their accounts make visible how practice operates in relation to industrial economies, community vulnerabilities, and ecologies. This in turn highlights the problem of epistemic bordering, where 'sites' of AMR are targeted but are prone to leakage and transgressions. We propose an ecological approach to conceptualising antimicrobial practices with implications for AMR interventions being rolled out in the sub-continent and beyond.
Collapse
Affiliation(s)
- Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, New South Wales, Australia.
| | - Assa Doron
- College of Asia & the Pacific, The Australian National University, Australian Capital Territory, Australia.
| |
Collapse
|
22
|
Koduah A, Gyansa-Lutterodt M, Hedidor GK, Sekyi-Brown R, Asiedu-Danso M, Asare BA, Ackon AA, Annan EA. Antimicrobial resistance national level dialogue and action in Ghana: setting and sustaining the agenda and outcomes. ONE HEALTH OUTLOOK 2021; 3:18. [PMID: 34663477 PMCID: PMC8524845 DOI: 10.1186/s42522-021-00051-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) has gained national and international attention. The design and launch of national policy on antimicrobial use and resistance and action plan marked a milestone in Ghana's commitment to control AMR. These strategies are some outcomes of getting and sustaining AMR issues prominence on government's agenda. Understanding the agenda setting processes, policy actors involved and policy change is important as this provides insights on how and why policy actors defined and framed AMR issues to sustain its prominence despite the changing priorities of government agenda. OBJECTIVE To examine the processes of setting and sustaining AMR issues on government agenda, the policy actors involved and resulting outcomes. METHODS A qualitative study was conducted and data collected through interviewing twenty-four respondents and reviewing technical working group meeting reports and health sector documents. Data was analysed drawing on Kingdon's agenda setting framework. RESULT Members of a multisectoral technical working group (AMR platform) formed in 2011 constantly built consensus on AMR problem definition, solutions and actively engaged decision makers to mobilise support and interest. The AMR platform members sustained AMR attention and prominence on government's agenda through the following multisectoral coordination mechanisms: (1) institutionalising AMR platform activities (2) gathering evidence, sharing findings, and supporting research (3) creating awareness and training (4) gaining and maintaining political support. The activities of the AMR platform contributed to three remarkable outcomes and these are (1) maintained network of AMR Champions, (2) design of a national policy on antimicrobial use and resistance in Ghana (1st edition) and national action plan (2017-2021), and (3) Ghana's hosting of the second Global call to action on AMR. CONCLUSION The AMR platform members as influencers concentrated their efforts to move and sustain AMR issues on government agenda. The identified multisectoral coordination mechanisms collectively contributed to agenda setting processes and policy change. The AMR platform engagements are ongoing and it is important the momentum is maintained. As multisectoral coordination and activities are vital especially for AMR 'One Health' approach, we hope this paper presents lessons for better understanding of how and why multisectoral groups influence national level agenda setting processes.
Collapse
Affiliation(s)
- Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy University of Ghana, P. O. Box LG43, Legon, Ghana
| | | | - George Kwesi Hedidor
- World Health Organization Country Office for Ghana, P.O Box MB 142, Accra, Ghana
| | - Reginald Sekyi-Brown
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy University of Ghana, P. O. Box LG43, Legon, Ghana
| | - Michelle Asiedu-Danso
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy University of Ghana, P. O. Box LG43, Legon, Ghana
| | - Brian Adu Asare
- Pharmacy Directorate, Ministry of Health, P. O. Box M44, Accra, Ghana
| | - Angela Ama Ackon
- World Health Organization Country Office for Ghana, P.O Box MB 142, Accra, Ghana
| | - Edith Andrews Annan
- World Health Organization African Region, P.O. Box CY 348, Causeway, Harare, Zimbabwe
| |
Collapse
|
23
|
Durrance-Bagale A, Jung AS, Frumence G, Mboera L, Mshana SE, Sindato C, Clark TG, Matee M, Legido-Quigley H. Framing the Drivers of Antimicrobial Resistance in Tanzania. Antibiotics (Basel) 2021; 10:991. [PMID: 34439041 PMCID: PMC8389026 DOI: 10.3390/antibiotics10080991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
Despite global awareness of the key factors surrounding antimicrobial resistance (AMR), designing and implementing policies to address the critical issues around the drivers of AMR remains complex to put into practice. We identified prevalent narratives and framing used by epistemological communities involved in the response to AMR in Tanzania, interrogated how this framing may inform policymaking, and identified interventions that could be tailored to the groups believed responsible for AMR. We interviewed 114 key informants from three districts and analysed transcripts line by line. Our results suggest that many different groups help drive the spread of AMR in Tanzania and need to be involved in any effective response. Human health is currently perceived as driving the response, while other domains lag behind in their efforts. For AMR programmes to be successful, all sectors need to be involved, including civil society groups, community representatives, and those working in communities (e.g., primary care physicians). However, current plans and programmes largely fail to include these viewpoints. The perceived presence of political will in Tanzania is a significant step towards such a response. Any strategies to tackle AMR need to be tailored to the context-specific realities, taking into account constraints, beliefs, and power dynamics within countries.
Collapse
Affiliation(s)
- Anna Durrance-Bagale
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (A.-S.J.); (T.G.C.); (H.L.-Q.)
| | - Anne-Sophie Jung
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (A.-S.J.); (T.G.C.); (H.L.-Q.)
| | - Gasto Frumence
- Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania; (G.F.); (M.M.)
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 65125, Tanzania; (L.M.); (S.E.M.); (C.S.)
| | - Leonard Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 65125, Tanzania; (L.M.); (S.E.M.); (C.S.)
| | - Stephen E. Mshana
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 65125, Tanzania; (L.M.); (S.E.M.); (C.S.)
- Catholic University of Health and Allied Science, Mwanza 33109, Tanzania
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 65125, Tanzania; (L.M.); (S.E.M.); (C.S.)
- Tabora Research Centre, National Institute for Medical Research, Tabora 45026, Tanzania
| | - Taane G. Clark
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (A.-S.J.); (T.G.C.); (H.L.-Q.)
| | - Mecky Matee
- Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania; (G.F.); (M.M.)
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro 65125, Tanzania; (L.M.); (S.E.M.); (C.S.)
| | - Helena Legido-Quigley
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; (A.-S.J.); (T.G.C.); (H.L.-Q.)
| |
Collapse
|
24
|
Qureshi S, Maria N, Zeeshan M, Irfan S, Qamar FN. Prevalence and risk factors associated with multi-drug resistant organisms (MDRO) carriage among pediatric patients at the time of admission in a tertiary care hospital of a developing country. A cross-sectional study. BMC Infect Dis 2021; 21:547. [PMID: 34107903 PMCID: PMC8191205 DOI: 10.1186/s12879-021-06275-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background The rise of Multidrug-resistant organisms (MDROs) poses a considerable burden on the healthcare systems, particularly in low-middle income countries like Pakistan. There is a scarcity of data on the carriage of MDRO particularly in the pediatrics population therefore, we aimed to determine MDRO carriage in pediatric patients at the time of admission to a tertiary care hospital in Karachi, Pakistan, and to identify the risk factors associated with it. Methods A cross-sectional study conducted at the pediatric department of Aga Khan University Hospital (AKUH) from May to September 2019 on 347 children aged 1–18 years. For identification of MDRO (i.e., Extended Spectrum Beta-Lactamase (ESBL) producers, Carbapenem Resistant Enterobacteriaceae (CRE), Vancomycin Resistant Enterococci (VRE), Methicillin Resistant Staphylococcus aureus (MRSA), Multidrug-resistant (MDR) Acinetobacter species and MDR Pseudomonas aeruginosa), nasal swabs and rectal swabs or stool samples were cultured on specific media within 72 h of hospitalization. Data was collected on a predesigned structured questionnaire on demographics, prior use of antibiotics for > 48 h in the last 6 months, history of vaccination in last 6 months, exposure to health care facility regardless of the time of exposure, ICU stay for > 72 h, and about the prior use of medical devices (urinary catheter, central venous lines etc.) in last 1 year. Statistical analysis was performed by Standard statistical software. Results Out of 347 participants, 237 (68.3%) were found to be MDRO carriers. Forty nine nasal swabs from 346 children (14.2%) showed growth of MRSA. The majority of the stool/rectal swabs (n = 222 of 322; 69%) collected were positive for MDRO. The most isolated species were ESBL Escherichia coli 174/222 (78.3%) followed by ESBL Enterobacter species 37/222 (16.7%) and ESBL Klebsiella pneumoniae 35/222 (15.8%). On univariate analysis, none of the risk factors showed statistically significant association with MDRO carriage. Conclusion Overall, a high prevalence of MDRO carriage was identified among admitted pediatric patients. Implementation of systematic screening may help to identify true burden of MDROs carriage in the health care settings.
Collapse
Affiliation(s)
- Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Noshi Maria
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Zeeshan
- Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Seema Irfan
- Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
| |
Collapse
|
25
|
Cuevas C, Batura N, Wulandari LPL, Khan M, Wiseman V. Improving antibiotic use through behaviour change: a systematic review of interventions evaluated in low- and middle-income countries. Health Policy Plan 2021; 36:594-605. [PMID: 33822953 PMCID: PMC8488384 DOI: 10.1093/heapol/czab021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
Antibiotic resistance (ABR) has been identified as a critical threat to global health at the highest policy fora. A leading cause of ABR is the inappropriate use of antibiotics by both patients and healthcare providers. Although countries around the world have committed to developing and implementing national action plans to tackle ABR, there is a considerable gap in evidence about effective behaviour change interventions addressing inappropriate use of antibiotics in low- and middle-income countries (LMICs), where ABR is growing at an alarming rate. We conducted a systematic review to synthesize evidence about the effectiveness and cost-effectiveness of behaviour change interventions to reduce inappropriate use of antibiotics in LMICs. Three databases were searched using a set of predefined search terms and exclusion criteria. The search identified 43 relevant articles. A narrative synthesis of results was conducted using the Behaviour Change Wheel framework to categorize intervention components. The majority of the reviewed studies were set in lower-middle-income or low-income countries located in Sub-Saharan Africa or East Asia and the Pacific. Twenty-four articles evaluated multi-faceted interventions over a period of 12 months or less. Despite the widespread use of antibiotics in the community, interventions were primarily implemented in public health facilities, targeting health professionals such as doctors, nurses, and other allied medical staff. Although education for providers was the most widely used strategy for influencing antibiotic use, it was shown to be most effective when used in conjunction with training or other enabling and supportive measures to nudge behaviour. Six articles included an evaluation of costs of interventions and found a reduction in costs in inpatient and outpatient settings, and one article found a training and guidelines implementation-based intervention to be highly cost-effective. However, the small number of articles conducting an economic evaluation highlights the need for such analyses to be conducted more frequently to support priority setting in resource-constrained environments.
Collapse
Affiliation(s)
- Carla Cuevas
- Centre for Global Health Economics, Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Neha Batura
- Centre for Global Health Economics, Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth BuildingHigh Street, UNSW Australia. Sydney, New South Wales, 2052, Australia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mishal Khan
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Aga Khan University, National Stadium Road, Karachi, Pakistan
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth BuildingHigh Street, UNSW Australia. Sydney, New South Wales, 2052, Australia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| |
Collapse
|
26
|
Prophylaxis and Treatment against Klebsiella pneumoniae: Current Insights on This Emerging Anti-Microbial Resistant Global Threat. Int J Mol Sci 2021; 22:ijms22084042. [PMID: 33919847 PMCID: PMC8070759 DOI: 10.3390/ijms22084042] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Klebsiella pneumoniae (Kp) is an opportunistic pathogen and the leading cause of healthcare-associated infections, mostly affecting subjects with compromised immune systems or suffering from concurrent bacterial infections. However, the dramatic increase in hypervirulent strains and the emergence of new multidrug-resistant clones resulted in Kp occurrence among previously healthy people and in increased morbidity and mortality, including neonatal sepsis and death across low- and middle-income countries. As a consequence, carbapenem-resistant and extended spectrum β-lactamase-producing Kp have been prioritized as a critical anti-microbial resistance threat by the World Health Organization and this has renewed the interest of the scientific community in developing a vaccine as well as treatments alternative to the now ineffective antibiotics. Capsule polysaccharide is the most important virulence factor of Kp and plays major roles in the pathogenesis but its high variability (more than 100 different types have been reported) makes the identification of a universal treatment or prevention strategy very challenging. However, less variable virulence factors such as the O-Antigen, outer membrane proteins as fimbriae and siderophores might also be key players in the fight against Kp infections. Here, we review elements of the current status of the epidemiology and the molecular pathogenesis of Kp and explore specific bacterial antigens as potential targets for both prophylactic and therapeutic solutions.
Collapse
|
27
|
Micoli F, Bagnoli F, Rappuoli R, Serruto D. The role of vaccines in combatting antimicrobial resistance. Nat Rev Microbiol 2021; 19:287-302. [PMID: 33542518 PMCID: PMC7861009 DOI: 10.1038/s41579-020-00506-3] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 01/29/2023]
Abstract
The use of antibiotics has enabled the successful treatment of bacterial infections, saving the lives and improving the health of many patients worldwide. However, the emergence and spread of antimicrobial resistance (AMR) has been highlighted as a global threat by different health organizations, and pathogens resistant to antimicrobials cause substantial morbidity and death. As resistance to multiple drugs increases, novel and effective therapies as well as prevention strategies are needed. In this Review, we discuss evidence that vaccines can have a major role in fighting AMR. Vaccines are used prophylactically, decreasing the number of infectious disease cases, and thus antibiotic use and the emergence and spread of AMR. We also describe the current state of development of vaccines against resistant bacterial pathogens that cause a substantial disease burden both in high-income countries and in low- and medium-income countries, discuss possible obstacles that hinder progress in vaccine development and speculate on the impact of next-generation vaccines against bacterial infectious diseases on AMR.
Collapse
Affiliation(s)
- Francesca Micoli
- grid.425088.3GSK Vaccines Institute for Global Health, Siena, Italy
| | | | | | | |
Collapse
|
28
|
Gilbert W, Thomas LF, Coyne L, Rushton J. Review: Mitigating the risks posed by intensification in livestock production: the examples of antimicrobial resistance and zoonoses. Animal 2020; 15:100123. [PMID: 33573940 DOI: 10.1016/j.animal.2020.100123] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Major shifts in how animals are bred, raised and slaughtered are involved in the intensification of livestock systems. Globally, these changes have produced major increases in access to protein-rich foods with high levels of micronutrients. Yet the intensification of livestock systems generates numerous externalities including environmental degradation, zoonotic disease transmission and the emergence of antimicrobial resistance (AMR) genes. Where the process of intensification is most advanced, the expertise, institutions and regulations required to manage these externalities have developed over time, often in response to hard lessons, crises and challenges to public health. By exploring the drivers of intensification, the foci of future intensification can be identified. Low- and middle-income (LMICs) countries are likely to experience significant intensification in livestock production in the near future; however, the lessons learned elsewhere are not being transferred rapidly enough to develop risk mitigation capacity in these settings. At present, fragmentary approaches to address these problems present an incomplete picture of livestock populations, antimicrobial use, and disease risks in LMIC settings. A worldwide improvement in evidence-based zoonotic disease and AMR management within intensifying livestock production systems demands better information on the burden of livestock-associated disease, antimicrobial use and resistance and resources allocated to mitigation.
Collapse
Affiliation(s)
- W Gilbert
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - L F Thomas
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK.; International Livestock Research Institute, Nairobi, Kenya
| | - L Coyne
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - J Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK..
| |
Collapse
|
29
|
Dunachie SJ, Day NP, Dolecek C. The challenges of estimating the human global burden of disease of antimicrobial resistant bacteria. Curr Opin Microbiol 2020; 57:95-101. [PMID: 33147565 PMCID: PMC7763986 DOI: 10.1016/j.mib.2020.09.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
Estimating the contribution of antimicrobial resistance (AMR) to global mortality and healthcare costs enables evaluation of interventions, informs policy decisions on resource allocation, and drives research priorities. However assembling the high quality, patient-level data required for global estimates is challenging. Capacity for accurate microbiology culture and antimicrobial susceptibility testing is woefully neglected in low and middle-income countries, and further surveillance and research on community antimicrobial usage, bias in blood culture sampling, and the contribution of co-morbidities such as diabetes is essential. International collaboration between governments, policy makers, academics, microbiologists, front-line clinicians, veterinarians, the food and agriculture industry and the public is critical to understand and tackle AMR.
Collapse
Affiliation(s)
- Susanna J Dunachie
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Nicholas Pj Day
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| |
Collapse
|
30
|
Ogunleye OO, Basu D, Mueller D, Sneddon J, Seaton RA, Yinka-Ogunleye AF, Wamboga J, Miljković N, Mwita JC, Rwegerera GM, Massele A, Patrick O, Niba LL, Nsaikila M, Rashed WM, Hussein MA, Hegazy R, Amu AA, Boahen-Boaten BB, Matsebula Z, Gwebu P, Chirigo B, Mkhabela N, Dlamini T, Sithole S, Malaza S, Dlamini S, Afriyie D, Asare GA, Amponsah SK, Sefah I, Oluka M, Guantai AN, Opanga SA, Sarele TV, Mafisa RK, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Mubita M, Fadare J, Sibomana L, Ramokgopa GM, Whyte C, Maimela T, Hugo J, Meyer JC, Schellack N, Rampamba EM, Visser A, Alfadl A, Malik EM, Malande OO, Kalungia AC, Mwila C, Zaranyika T, Chaibva BV, Olaru ID, Masuka N, Wale J, Hwenda L, Kamoga R, Hill R, Barbui C, Bochenek T, Kurdi A, Campbell S, Martin AP, Phuong TNT, Thanh BN, Godman B. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future. Front Pharmacol 2020; 11:1205. [PMID: 33071775 PMCID: PMC7533592 DOI: 10.3389/fphar.2020.01205] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. OBJECTIVE Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. OUR APPROACH Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. ONGOING ACTIVITIES Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. CONCLUSION There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.
Collapse
Affiliation(s)
- Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Debjani Mueller
- Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | | | - R. Andrew Seaton
- Healthcare Improvement Scotland, Glasgow, United Kingdom
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
- University of Glasgow, Glasgow, United Kingdom
| | | | - Joshua Wamboga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
| | - Nenad Miljković
- Institute of Orthopaedic Surgery “Banjica”, University of Belgrade, Belgrade, Serbia
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, University of Botswana and Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | | | | | - Rehab Hegazy
- Pharmacology Department, Medical Division, National Research Centre, Giza, Egypt
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | | | | | | | | | | | | | | | | | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra, Ghana
| | - George Awuku Asare
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Seth Kwabena Amponsah
- Department of Medical Pharmacology, University of Ghana Medical School, Accra, Ghana
| | - Israel Sefah
- Ghana Health Service, Pharmacy Department, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Hohoe, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N. Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia A. Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Tebello Violet Sarele
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Westville-campus, Durban, South Africa
| | | | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University , Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Laurien Sibomana
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gwendoline Malegwale Ramokgopa
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Carmen Whyte
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Tshegofatso Maimela
- Department of Public Health Medicine, Steve Biko Academic Hospital and the University of Pretoria, Pretoria, South Africa
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
| | - Johannes Hugo
- WHO Collaborating Centre for Social Determinants of Health and Health in all Policies, Pretoria, South Africa
- Department of Family Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Natalie Schellack
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Enos M. Rampamba
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacy, Tshilidzini Hospital, Shayandima, South Africa
| | - Adel Visser
- Eugene Marais Hospital, Pretoria, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Elfatih M. Malik
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
- Community Medicine Council, SMSB, Khartoum, Sudan
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | | | - Chiluba Mwila
- Department of Pharmacy, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Ioana D. Olaru
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nyasha Masuka
- Zimbabwe College of Public Health Physicians, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | | | - Regina Kamoga
- Uganda Alliance of Patients’ Organizations (UAPO), Kampala, Uganda
- Community Health and Information Network (CHAIN), Kampala, Uganda
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, United Kingdom
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tomasz Bochenek
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Antony P. Martin
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- HCD Economics, The Innovation Centre, Daresbury, United Kingdom
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Binh Nguyen Thanh
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| |
Collapse
|
31
|
Rickard J. Bacterial Resistance in Surgical Infections in Low-Resource Settings. Surg Infect (Larchmt) 2020; 21:509-515. [PMID: 32380936 DOI: 10.1089/sur.2020.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is an alarming increase in antimicrobial resistance (AMR) globally, complicating management of surgical infections, especially in low-resource settings. Of particular concern for surgeons are third generation cephalosporin-resistant and carbapenem-resistant Enterobacteriaceae. Methods: The published literature was searched to identify the scope and causative factors of emerging bacterial resistance in low- and middle-income countries (LMICs). Results: Antimicrobial resistance impacts economics, human development, health equity, health security, and food production. Factors that contribute to AMR include use of antibiotic agents in livestock, antibiotic agents in wastewater and sewage, poor sanitation, and overprescribing or unregulated use of antibiotic agents. Because the factors influencing AMR globally are multi-factorial, solutions must be addressed at multiple levels. In LMICs, these can occur through national initiatives, at the facility level, or at the community level with coordination engaging government agencies, the private sector, civil service, and professional groups. Conclusions: There is a growing recognition of the need for national AMR prevention programs. Meanwhile, infection prevention and control programs and antimicrobial stewardship remain cornerstones of management at the facility level.
Collapse
Affiliation(s)
- Jennifer Rickard
- Department of Surgery, University of Minnesota Minneapolis, Minnesota, USA
| |
Collapse
|
32
|
Hayat K, Rosenthal M, Gillani AH, Chang J, Ji W, Yang C, Jiang M, Zhao M, Fang Y. Perspective of Key Healthcare Professionals on Antimicrobial Resistance and Stewardship Programs: A Multicenter Cross-Sectional Study From Pakistan. Front Pharmacol 2020; 10:1520. [PMID: 31998124 PMCID: PMC6967405 DOI: 10.3389/fphar.2019.01520] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Antimicrobial resistance (AMR) is an increasing global threat, and hospital-based antimicrobial stewardship programs (ASPs) are one of the effective approaches to tackle AMR globally. This study was intended to determine the attitude of key healthcare professionals (HCPs), including physicians, nurses, and hospital pharmacists, towards AMR and hospital ASPs. Methods: A cross-sectional study design was used to collect data from HCPs employed in public teaching hospitals of Punjab, Pakistan, from January 2019 to March 2019. A cluster-stratified sampling method was applied. Descriptive statistics, Mann Whitney and Kruskal Wallis tests were used for analysis. Results: A response rate of 81.3% (881/1083) for the surveys was obtained. The majority of the physicians (247/410, 60.2%) perceived AMR to be a serious problem in Pakistani hospitals (p < 0.001). Most of the HCPs considered improving antimicrobial prescribing (580/881, 65.8%; p < 0.001) accompanied by the introduction of prospective audit with feedback (301/881, 75.8%; p < 0.001), formulary restriction (227/881, 57.2%; p = 0.004) and regular educational activities (300/881, 75.6%; p = 0.015) as effective ASP methods to implement hospital ASPs in Pakistan. A significant association was found between median AMR and ASP scores with age, years of experience, and types of HCPs (p < 0.05). Conclusions: The attitude of most of the HCPs was observed to be positive towards hospital-based ASPs regardless of their poor awareness about ASPs. The important strategies, including prospective audit with feedback and regular educational sessions proposed by HCPs, will support the initiation and development of local ASPs for Pakistani hospitals.
Collapse
Affiliation(s)
- Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Mississippi, MS, United States
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| |
Collapse
|
33
|
Chowdhury M, Stewart Williams J, Wertheim H, Khan WA, Matin A, Kinsman J. Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh. Glob Health Action 2019; 12:1824383. [PMID: 33040695 PMCID: PMC7580843 DOI: 10.1080/16549716.2020.1824383] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/11/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The use of large quantities of antimicrobial drugs for human health and agriculture is advancing the predominance of drug resistant pathogens in the environment. Antimicrobial resistance is now a major public health threat posing significant challenges for achieving the Sustainable Development Goals. In Bangladesh, where over one third of the population is below the poverty line, the achievement of safe and effective antibiotic medication use for human health is challenging. OBJECTIVE To explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective. METHODS This qualitative study comprises the second phase of the multi-country ABACUS (Antibiotic Access and Use) project in Matlab, Bangladesh. Information was collected through six focus group discussions and 16 in-depth interviews. Informants were selected from ten villages in four geographic locations using the Health and Demographic Surveillance System database. The Access to Healthcare Framework guided the interpretation and framing of the findings in terms of individuals' abilities to: perceive, seek, reach, pay and engage with healthcare. RESULTS Village pharmacies were the preferred and trusted source of antibiotics for self-treatment. Cultural and religious beliefs informed the use of herbal and other complementary medicines. Advice on antibiotic use was also sourced from trusted friends and family members. Access to government-run facilities required travel on poorly maintained roads. Reports of structural corruption, stock-outs and patient safety risks eroded trust in the public sector. Some expressed a willingness to learn about antibiotic resistance. CONCLUSION Antimicrobial resistance is both a health and development issue. Social and economic contexts shape medicine seeking, use and behaviours. Multi-sectoral action is needed to confront the underlying social, economic, cultural and political drivers that impact on the access and use of antibiotic medicines in Bangladesh.
Collapse
Affiliation(s)
- Moyukh Chowdhury
- Outcomes Research Department, Reveal AB, Stockholm, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Jennifer Stewart Williams
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Heiman Wertheim
- Clinical Research Unit, Oxford University, Hanoi, Vietnam
- Department of Medical Microbiology and Radboud Centre for Infectious Disease, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Enteric and Respiratory Infections Infectious Diseases Division, 68, Shaheed Tajuddin Ahmed Sharani, Dhaka, Bangladesh
| | - Abdul Matin
- International Centre for Diarrhoeal Disease Research, Enteric and Respiratory Infections Infectious Diseases Division, 68, Shaheed Tajuddin Ahmed Sharani, Dhaka, Bangladesh
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
34
|
Mitchell J, Cooke P, Baral S, Bull N, Stones C, Tsekleves E, Verdezoto N, Arjyal A, Giri R, Shrestha A, King R. The values and principles underpinning community engagement approaches to tackling antimicrobial resistance (AMR). Glob Health Action 2019; 12:1837484. [PMID: 33198604 PMCID: PMC7682730 DOI: 10.1080/16549716.2020.1837484] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/13/2020] [Indexed: 11/06/2022] Open
Abstract
This paper presents seven values underpinning the application of Community Engagement (CE) approaches to the One Health challenge of antimicrobial resistance (AMR) developed during an international workshop in June 2019. We define a value as a quality or standard which a CE project is aiming for, whilst a principle is an objective which underpins the value and facilitates its achievement. The values of Clarity, Creativity, (being) Evidence-led, Equity, Interdisciplinarity, Sustainability and Flexibility were identified by a network of 40 researchers and practitioners who utilise CE approaches to tackle complex One Health challenges including, but not limited to, AMR. We present our understanding of these seven values and their underlying principles as a flexible tool designed to support stakeholders within CE for AMR projects. We include practical guidance on working toward each value, plus case studies of the values in action within existing AMR interventions. Finally, we consider the extent to which CE approaches are appropriate to tackle AMR challenges. We reflect on these in relation to the tool, and current literature for both CE and AMR research. Authors and co-producers anticipate this tool being used to scene-set, road map and trouble shoot the development, implementation, and evaluation of CE projects to address AMR and other One Health challenges. However, the tool is not prescriptive but responsive to the context and needs of the community, opening opportunity to build a truly collaborative and community-centred approach to AMR research.
Collapse
Affiliation(s)
- Jessica Mitchell
- Centre for World Cinemas and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Woodhouse, UK
- University of Leeds, Woodhouse, UK
- Nuffield Centre for International Health and Development, Worsley Building University of Leeds, Woodhouse, England
| | - Paul Cooke
- Centre for World Cinemas and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Woodhouse, UK
- University of Leeds, Woodhouse, UK
| | - Sushil Baral
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Naomi Bull
- University of Leeds, Woodhouse, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Stones
- University of Leeds, Woodhouse, UK
- School of Design, University of Leeds, Woodhouse, UK
| | - Emmanuel Tsekleves
- University of Leeds, Woodhouse, UK
- ImaginationLancaster, LICA, Lancaster University, Lancaster, UK
| | - Nervo Verdezoto
- University of Leeds, Woodhouse, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Abriti Arjyal
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Romi Giri
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Ashim Shrestha
- University of Leeds, Woodhouse, UK
- HERD International, Kathmandu, Nepal
| | - Rebecca King
- University of Leeds, Woodhouse, UK
- Nuffield Centre for International Health and Development, Worsley Building University of Leeds, Woodhouse, England
| |
Collapse
|
35
|
Singh SR, Chua AQ, Tan ST, Tam CC, Hsu LY, Legido-Quigley H. Combating Antimicrobial Resistance in Singapore: A Qualitative Study Exploring the Policy Context, Challenges, Facilitators, and Proposed Strategies. Antibiotics (Basel) 2019; 8:E201. [PMID: 31671826 PMCID: PMC6963657 DOI: 10.3390/antibiotics8040201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 10/25/2019] [Accepted: 10/27/2019] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public health threat that warrants urgent attention. However, the multifaceted nature of AMR often complicates the development and implementation of comprehensive policies. In this study, we describe the policy context and explore experts' perspectives on the challenges, facilitators, and strategies for combating AMR in Singapore. We conducted semi-structured interviews with 21 participants. Interviews were transcribed verbatim and were analyzed thematically, adopting an interpretative approach. Participants reported that the Ministry of Health (MOH) has effectively funded AMR control programs and research in all public hospitals. In addition, a preexisting One Health platform, among MOH, Agri-Food & Veterinary Authority (restructured to form the Singapore Food Agency and the Animal & Veterinary Service under NParks in April 2019), National Environment Agency, and Singapore's National Water Agency, was perceived to have facilitated the coordination and formulation of Singapore's AMR strategies. Nonetheless, participants highlighted that the success of AMR strategies is compounded by various challenges such as surveillance in private clinics, resource constraints at community-level health facilities, sub-optimal public awareness, patchy regulation on antimicrobial use in animals, and environmental contamination. This study shows that the process of planning and executing AMR policies is complicated even in a well-resourced country such as Singapore. It has also highlighted the increasing need to address the social, political, cultural, and behavioral aspects influencing AMR. Ultimately, it will be difficult to design policy interventions that cater for the needs of individuals, families, and the community, unless we understand how all these aspects interact and shape the AMR response.
Collapse
Affiliation(s)
- Shweta Rajkumar Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - Alvin Qijia Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
| |
Collapse
|