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Dorta HG, Nandi A. Patterns of antibiotic use for acute respiratory infections in under-three-year-old children in India: A cross-sectional study. J Glob Health 2023; 13:04159. [PMID: 38131631 PMCID: PMC10740384 DOI: 10.7189/jogh.13.04159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Background Despite its mostly viral etiology, antibiotics are frequently used to treat acute respiratory infections (ARIs) in children. India is one of the largest global consumers of antibiotics and has one of the highest rates of resistance to antimicrobial treatments. However, the epidemiology of antibiotic treatment among young children in India is poorly understood. Methods Using nationally representative household survey data from the Indian National Family Health Surveys (NFHS) conducted between 2015 and 2016 and 2019 and 2021, we estimated the prevalence of antibiotic use among 17 472 children under the age of three who reported ARI symptoms within two weeks before their mothers were interviewed. To assess the factors associated with antibiotic use for the treatment of ARI symptoms, we used multivariable logistic regression models that included sociodemographic, child-related, household, and health care related characteristics, with results reported on the prevalence difference (PD) scale. Results We estimated that 18.7% (95% CI = 17.8-19.6) of under-three-year-old (U3) children who exhibited ARI symptoms in the two weeks prior to the survey were given antibiotics as a treatment. The highest prevalence was observed in the southern and northern geographic zones of India. Furthermore, multivariable regression models indicated that children with greater access to health services were more likely to receive antibiotics for ARI treatment, regardless of the type of health care facility (public, private or pharmacy/unregulated). Additionally, the prevalence of antibiotic consumption was higher among children from families with religious affiliations other than Muslim and Hindu backgrounds (i.e. Christian, Sikh, Buddhist/neo-Buddhist, Jain, Jewish, Parsi, no religion and other) (PD = 11.7 (95% CI = 6.3-16.7)) compared to Hindu families and among mothers with a secondary or higher education (PD = 5.8 (95% CI = 1.7-9.9)) compared to mothers lacking formal education. Conclusions Our findings provide an important baseline for monitoring the use of antibiotics for the treatment of acute respiratory infections, and for designing interventions to mitigate potential misuse among young children in India.
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Alajel SM, Alzahrani KO, Almohisen AA, Alrasheed MM, Almomen SM. Antimicrobial Sales Comparison before and after the Implementation of Nationwide Restriction Policy in Saudi Arabia. Antibiotics (Basel) 2023; 13:15. [PMID: 38275325 PMCID: PMC10812388 DOI: 10.3390/antibiotics13010015] [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: 10/05/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/27/2024] Open
Abstract
Antimicrobial dispensing without a prescription has been identified as a significant contributor to the burgeoning crisis of antimicrobial resistance. To combat this, the Saudi Ministry of Health introduced a stringent antimicrobial restriction policy in mid-2018, mandating prescriptions for all antimicrobial drug dispensations at pharmacies. Therefore, this study aimed to assess the immediate impact of this policy on retail antimicrobial sales. To do so, we analyzed annual sales data from 2017 to 2019 sourced from the IQVIA-MIDAS® database, which included a range of antimicrobials, such as antibiotics, antifungals, and other related agents. The analysis revealed a notable reduction in overall antimicrobial sales by 23.2%, decreasing from 818.9 million SAR in 2017 to 648.4 million SAR in 2019. While the Wilcoxon signed-rank test indicated a statistically significant median reduction in total antimicrobial sales post-policy implementation (p = 0.0397), it is important to acknowledge that the long-term effects and adherence to the policy require further investigation. Notably, sales of amoxicillin dropped by 70% in 2019 compared to 2017, contributing largely to the decline. Conversely, a continuous increase in sales of some antimicrobial drugs following the restriction policy was observed, led by amoxicillin/clavulanic acid. Our data support the implementation of antimicrobial restriction measures as an effective means of controlling excessive antimicrobial sales and dispensing without prescriptions.
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Affiliation(s)
- Sulaiman M. Alajel
- Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11561, Saudi Arabia
| | - Khaloud O. Alzahrani
- Molecular Biology Division, Reference Laboratory for Microbiology, Executive Department of Reference Laboratories, Research and Laboratories Sector, Saudi Food and Drug Authority (SFDA), Riyadh 11561, Saudi Arabia;
| | - Amal A. Almohisen
- Statistics Department, King Saud University, Riyadh 11451, Saudi Arabia
| | - Meshael M. Alrasheed
- Drug Safety and Risk Management, Drug Sector, Saudi Food and Drug Authority (SFDA), Riyadh 13513, Saudi Arabia
| | - Salwa M. Almomen
- Research and Studies Department, Research and Laboratory Sector, Saudi Food and Drug Authority (SFDA), Riyadh 13513, Saudi Arabia
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Fazaludeen Koya S, Ganesh S, Selvaraj S, Wirtz VJ, Galea S, Rockers PC. Antibiotic consumption in India: geographical variations and temporal changes between 2011 and 2019. JAC Antimicrob Resist 2022; 4:dlac112. [PMID: 36320447 PMCID: PMC9596537 DOI: 10.1093/jacamr/dlac112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe and compare private sector systemic (J01) antibiotic consumption across Indian states from 2011 to 2019. METHODS We used the nationally representative PharmaTrac dataset to describe the consumption rates in DDD across national, state and state-group [high focus (HF) and non-high focus (nHF)] levels. We used median and IQRs to describe and compare across states and state groups, and relative change and compound annual growth rate (CAGR) to examine temporal changes. RESULTS The annual consumption rate decreased by 3.6% between 2011 and 2019. The share of Access antibiotics decreased (13.1%) and the Access/Watch ratio declined from 0.59 to 0.49. State consumption rates varied widely (HF states reported lower rates) and the inappropriate use increased over the years, especially among HF states. The HF and nHF states showed convergence in the share of the Access and the Access/Watch ratio, while they showed divergence in the use of Discouraged fixed-dose combinations. CONCLUSIONS AND IMPLICATIONS India's private-sector antibiotic consumption rate was lower than global rates. The rates varied across states and appropriateness of use decreased in most states over the years. States with an increase in appropriate use over time could serve as best practice examples. Studies to understand the factors affecting inappropriate use are required alongside improved data systems to monitor the public-sector provision of antibiotics to understand the total consumption.
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Affiliation(s)
| | - Senthil Ganesh
- Public Health Foundation of India, New Delhi, Delhi, India
| | | | | | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
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Mehta A, Brhlikova P, McGettigan P, Pollock AM, Roderick P, Farooqui HH. Systemic antibiotic sales and WHO recommendations, India. Bull World Health Organ 2022; 100:610-619. [PMID: 36188020 PMCID: PMC9511665 DOI: 10.2471/blt.22.287908] [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: 01/19/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To analyse sales of fixed-dose combination and single antibiotics in India in relation to World Health Organization (WHO) recommendations and national regulatory efforts to control antibiotic sales. Methods We extracted data on sales volumes of systemic antibiotics in India from a market research company sales database. We compared the market share of antibiotic sales in 2020 by WHO AWaRe (Access, Watch and Reserve) category and for those under additional national regulatory controls. We also analysed sales of fixed-dose combinations that were: formally approved for marketing or had a no-objection certificate; on the national essential medicines list; and on the WHO list of not-recommended antibiotics. Findings There were 78 single and 112 fixed-dose combination antibiotics marketed in India, accounting for 7.6 and 4.5 billion standard units of total sales, respectively. Access, Watch and Reserve antibiotics comprised 5.8, 5.6 and 0.1 billion standard units of total market sales, respectively. All additionally controlled antibiotics were Watch and Reserve antibiotics (23.6%; 2.9 billion standard units of total sales). Fixed-dose combinations on the WHO not-recommended list were marketed in 229 formulations, with 114 formulations (49.8%) having no record of formal approval or no-objection certificate. While there were no not-recommended fixed-dose combinations on the national list of essential medicines, 13 of the top-20 selling antibiotic fixed-dose combinations were WHO not-recommended. Conclusion The sale of Watch group drugs, and antibiotics banned or not approved, needs active investigation and enforcement in India. The evidence base underpinning formal approvals and no-objection certificates for not-recommended fixed-dose combinations should be audited.
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Affiliation(s)
- Aashna Mehta
- Public Health Foundation of India, Gurugram, India
| | - Petra Brhlikova
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, London, England
| | - Allyson M Pollock
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England
| | - Peter Roderick
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England
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Koya SF, Ganesh S, Selvaraj S, Wirtz VJ, Galea S, Rockers PC. Consumption of systemic antibiotics in India in 2019. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 4:100025. [PMID: 37383993 PMCID: PMC10305917 DOI: 10.1016/j.lansea.2022.100025] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Inappropriate use of antibiotics is a significant driver of antibiotic resistance in India. Largely unrestricted over-the-counter sales of most antibiotics, manufacturing and marketing of many fixed-dose combinations (FDC) and overlap in regulatory powers between national and state-level agencies complicate antibiotics availability, sales, and consumption in the country. METHODS We analyzed cross-sectional data from PharmaTrac, a nationally representative private-sector drug sales dataset gathered from a panel of 9000 stockists across India. We used the AWaRe (Access, Watch, Reserve) classification and the defined daily dose (DDD) metrics to calculate the per capita private-sector consumption of systemic antibiotics across different categories: FDCs vs single formulations; approved vs unapproved; and listed vs not listed in the national list of essential medicines (NLEM). FINDINGS The total DDDs consumed in 2019 was 5071 million (10.4 DDD/1000/day). Watch contributed 54.9% (2783 million) DDDs, while Access contributed 27.0% (1370 million). Formulations listed in the NLEM contributed 49.0% (2486 million DDDs); FDCs contributed 34.0% (1722 million), and unapproved formulations contributed 47.1% (2408 million DDDs). Watch antibiotics constituted 72.7% (1750 million DDDs) of unapproved products and combinations discouraged by the WHO constituted 48.7% (836 million DDDs) of FDCs. INTERPRETATION Although the per-capita private-sector consumption rate of antibiotics in India is relatively low compared to many countries, India consumes a large volume of broad-spectrum antibiotics that should ideally be used sparingly. This, together with significant share of FDCs from formulations outside NLEM and a large volume of antibiotics not approved by the central drug regulators, call for significant policy and regulatory reform. FUNDING Not applicable.
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Affiliation(s)
| | - Senthil Ganesh
- Public Health Foundation of India, New Delhi, Delhi, India
| | | | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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Jeyashree K, Thangaraj J, Rade K, Modi B, Selvaraju S, Velusamy S, Akhil S, Vijayageetha M, Sudha Rani D, Sabarinathan R, Manikandanesan S, Elumalai R, Natarajan M, Joseph B, Mahapatra A, Shamim A, Shah A, Bhardwaj A, Purty A, Vadera B, Sridhar A, Chowdhury A, Shafie A, Choudhury A, Dhrubjyoti D, Solanki H, Sirmanwar K, Khaparde K, Parmar M, Dahiya N, Debdutta P, Ahmed Q, Ramachandran R, Prasad R, Shinde R, Baruah R, Chauhan S, Bharaswadkar S, Achanta S, Sharath BN, Balakrishnan S, Chandra S, Khumukcham S, Mandal S, Chalil S, Shah V, Roddawar V, Rao R, Sachdeva K, Murhekar M. Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015-2020. BMJ Open 2022; 12:e060197. [PMID: 35902192 PMCID: PMC9340578 DOI: 10.1136/bmjopen-2021-060197] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India. DESIGN A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data. SETTING National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status. PARTICIPANTS Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district. OUTCOME MEASURES We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015. RESULTS The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra. CONCLUSION TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.
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Affiliation(s)
| | - Jeromie Thangaraj
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Kiran Rade
- World Health Organization, Country Office for India, New Delhi, India
| | - Bhavesh Modi
- GMERS Medical College & Civil Hospital, Gandhinagar, Gujarat, India
| | - Sriram Selvaraju
- ICMR - National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Sasidharan Akhil
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | | - Bency Joseph
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Almas Shamim
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | - Amar Shah
- USAID India Mission, New Delhi, Delhi, India
| | - Ashok Bhardwaj
- MM Medical College & Hospital, Kumarhatti, Solan, Himachal Pradesh, India
| | - Anil Purty
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Bhavin Vadera
- Wadhwani Institute of Artificial Intelligence, Mumbai, India
| | - Anand Sridhar
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | | | - Asif Shafie
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Avijit Choudhury
- World Health Organization, Country Office for India, New Delhi, India
| | | | | | | | | | - Malik Parmar
- World Health Organization, Country Office for India, New Delhi, India
| | - Nisha Dahiya
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | | | | | - Ranjeet Prasad
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Rohini Shinde
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | | | | | | | | | | | | | | | - Sudarsan Mandal
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | - Vaibhav Shah
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | | | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Kuldeep Sachdeva
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Manoj Murhekar
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Borde K, Medisetty MK, Muppala BS, Reddy AB, Nosina S, Dass MS, Prashanthi A, Billuri P, Mathai D. Impact of an Antimicrobial Stewardship Intervention on Usage of Antibiotics in Coronavirus Disease-2019 at a Tertiary Care Teaching Hospital in India. IJID REGIONS 2022; 3:15-20. [PMID: 35720136 PMCID: PMC8820141 DOI: 10.1016/j.ijregi.2022.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 11/19/2022]
Abstract
High empirical usage of beta-lactams and macrolides seen in COVID 19 patients. Interrupted time series analysis showed significant reduction in antibiotic usage. Stewardship interventions in resource-limited areas can garner positive outcomes.
Background There was evidence that antibiotic usage increased in hospitalized COVID-19 patients during the early days of the pandemic. Objective We assessed the impact of stewardship interventions on antibiotic usage in these patients. Methods We designed a quasi-experimental study using an interrupted time series. Patients were stratified according to the severity category of the illness – mild and moderate-to-severe (O2 saturation ≥94% and <93% respectively). Baseline antibiotic usage data was collected in the pre-intervention phase. Intervention was given in the form of focus group discussion (FGD) and followed up with feedback-audit during the post-intervention phase. Primary outcome was the change in days of therapy (DOT) per 1000 patient-days. Results 361 adult patients were recruited in both phases during July to December, 2020. In the post-intervention phase, DOT per 1000 patient-days reduced from 589 to 523 (P=0.013) and from 843 to 585 (P <0.0001) in mild and moderate-to-severe categories, respectively. De-escalations at 48 hours increased significantly from 21% to 41% (P=0.0079) and from 31% to 62% (P=0.0006), respectively. No difference in mortality was observed. Conclusion We found high usage of empirical antibiotics in adult patients hospitalized with COVID-19. FGD and feedback audits can successfully reduce antibiotic overuse in these patients.
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Affiliation(s)
- Kalyani Borde
- Department of Microbiology, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
| | - Mahender Kumar Medisetty
- Department of General Medicine, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
- Corresponding author: Mahender Kumar Medisetty (Ph No: 9000538043), Address: Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad – 500033.
| | - Baby Shalini Muppala
- Department of General Medicine, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
| | - Aishwarya B Reddy
- Department of General Medicine, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
| | - Sireesha Nosina
- Department of General Medicine, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
| | - Manick S. Dass
- Department of Microbiology, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
| | - A. Prashanthi
- Infection control nurse, Nursing Department, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
| | - Pushpanjali Billuri
- Infection control nurse, Nursing Department, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
| | - Dilip Mathai
- Department of General Medicine, Apollo Institute of Medical Sciences and Research, Apollo Health City Campus, Road No. 92, Film Nagar, Jubilee Hills, Hyderabad, 500033
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Yellappa V, Bindu H, Rao N, Narayanan D. Understanding dynamics of private tuberculosis pharmacy market: a qualitative inquiry from a South Indian district. BMJ Open 2022; 12:e052319. [PMID: 35074813 PMCID: PMC8788189 DOI: 10.1136/bmjopen-2021-052319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In India, retail private pharmacists (RPPs) are often patients' first point of contact for diseases, including tuberculosis (TB). We assessed the factors influencing RPPs' referral of patients with chest symptoms to the National TB Elimination Programme (NTEP) and the way business is carried out with reference to TB drugs. DESIGN We conducted semistructured interviews with a purposive sample of 41 RPPs in a South Indian district between May and October 2013. Data were collected from urban areas (21 RPPs) and rural areas (20 RPPs) employing the principle of data saturation. Data were analysed thematically using NVivo V.9. RESULTS Knowledge and compliance of RPPs regarding TB symptoms and regulatory requirements were found to be poor. The RPPs routinely dispensed medicines over the counter and less than half of the respondents had pharmacy qualifications. None of them had received TB-related training, yet half of them knew about TB symptoms. Practice of self-referrals was common particularly among economically poorer populations who preferred purchasing medicines over the counter based on RPPs' advice. Inability of patients with TB to purchase the full course of TB drugs was conspicuous. Rural RPPs were more likely to refer patients with TB symptoms to the NTEP compared with urban ones who mostly referred such clients to private practitioners (PPs). Reciprocal relationships between the RPPs, PPs, medical representatives and the prevalence of kickbacks influenced RPPs' drug-stocking patterns. PPs wielded power in this nexus, especially in urban areas. CONCLUSION India hopes to end TB by 2025. Our study findings will help the NTEP to design policy and interventions to engage RPPs in public health initiatives by taking cognisance of symbiotic relationships and power differentials that exist between PPs, RPPs and medical representatives. Concurrently, there should be a strong enforcement mechanism for existing regulatory norms regarding over-the-counter sales and record keeping.
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Affiliation(s)
- Vijayashree Yellappa
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
- PPP Division, NITI Aayog, Delhi, Delhi, India
| | - Himabindu Bindu
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Neethi Rao
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
| | - Devadasan Narayanan
- Health Service Delivery, Institute of Public Health Bengaluru, Bangalore, Karnataka, India
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9
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Nair M, Zeegers MP, Varghese GM, Burza S. India's National Action Plan on Antimicrobial Resistance: a critical perspective. J Glob Antimicrob Resist 2021; 27:236-238. [PMID: 34695609 DOI: 10.1016/j.jgar.2021.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022] Open
Abstract
Antimicrobial resistance (AMR) is widely recognised as a global health threat, which is projected to account for more deaths than cancer by 2050. The Government of India has formulated a National Action Plan to tackle AMR (NAP-AMR), largely modelled on the World Health Organization's Global Action Plan on AMR. While the NAP-AMR successfully mirrors the Global Action Plan and lays out ambitious goals, we find that the lack of financial allocation across states, poor enforcement and inadequate multisectoral co-ordination have hampered progress. A broader focus on improving infrastructure for water and sanitation, linking the issue of AMR to existing vertical health programmes for human immunodeficiency virus (HIV) and tuberculosis (TB), prioritising infection prevention and control, strengthening the frontline healthcare workforce in rural and peri-urban settings to reduce reliance on antibiotics, leveraging point-of-care testing and mobile app-based health interventions for diagnosis and surveillance, and adopting a socioecological approach to health and development would help to create an enabling environment for concrete action on AMR in India.
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Affiliation(s)
- M Nair
- Department of Complex Genetics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - M P Zeegers
- Department of Complex Genetics, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - S Burza
- Médecins Sans Frontières, New Delhi, India; London School of Hygiene and Tropical Medicine, London, UK
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