1
|
Ndossi BA, Mjingo EE, Park H, Lee D, Bia MM, Yang H, Seo S, Eom KS. Zoonotic Parasites and Their Association With Human Activities in Northern Tanzania: An Integrated Ecosystem Approach for One Health. J Parasitol Res 2024; 2024:8872837. [PMID: 39071810 PMCID: PMC11281853 DOI: 10.1155/2024/8872837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 05/04/2024] [Accepted: 06/20/2024] [Indexed: 07/30/2024] Open
Abstract
The community's awareness of the prevalence and impact of zoonotic diseases has been significantly underestimated, leading to insufficient implementation of control measures. This study was carried out in Northern Tanzania between 2019 and 2023 to investigate zoonotic parasites and the risks associated with human activities that contribute to zoonotic diseases. Cross-sectional surveys were conducted in 12 villages, including nine in Loliondo Division and three in Babati District. Focus Group Discussions and Key Informant Interviews were conducted to assess the community's knowledge and practices regarding the risks associated with zoonotic diseases in the surveyed areas. A total of 255 samples were collected from various sources, including latrines, households, livestock enclosures, domestic dogs, and chickens. Out of these samples, 152 tested positive for identifiable parasite eggs and oocysts. These parasites included hookworms (21.7%), Trichuris sp. (14.5%), Strongyloides sp. (13.8%), Eimeria sp. (19.7%), Taeniids (5.9%), Hymenolepis sp. (3.3%), Spirometra sp. (2.6%), and Dipylidium sp. (0.7%). Taeniids and Spirometra species were predominantly found in villages near protected areas such as Arash Sokoni, Oloipiri, Sukenya, Wasso, Orkuyiene, Haytemba, and Loliondo. Hookworms were most commonly detected in Arash Sokoni, Loliondo, Isuguro, and Hyatemba, while Strongyloides sp. was prevalent in Wasso, Sukenya, and Olobo villages. The quantitative analysis reveals significant associations between hygiene practices, proximity to livestock enclosures, ecological factors, and human-animal interaction, highlighting their pivotal roles in determining soil-transmitted helminth (STH) prevalence across different villages. This study reveals that there was a generally low level of awareness regarding zoonotic diseases and STHs. The detection of STH samples, combined with the limited understanding of zoonotic diseases, emphasizes the importance of taking proactive measures to reduce transmission risks. Prioritizing education and promoting awareness along with implementing comprehensive strategies are essential steps to effectively tackle the problems linked to STH infections and substantially lessen the public health burden caused by zoonotic diseases.
Collapse
Affiliation(s)
- Barakaeli Abdieli Ndossi
- Tanzania Wildlife Research Institute, P.O. Box 661, Arusha, Tanzania
- Department of ParasitologyParasitology Research Center and International Parasite Resource BankChungbuk National UniversitySchool of Medicine, Cheongju 28644, Republic of Korea
| | | | - Hansol Park
- Department of ParasitologyParasitology Research Center and International Parasite Resource BankChungbuk National UniversitySchool of Medicine, Cheongju 28644, Republic of Korea
| | - Dongmin Lee
- Department of ParasitologyParasitology Research Center and International Parasite Resource BankChungbuk National UniversitySchool of Medicine, Cheongju 28644, Republic of Korea
| | - Mohammed Mebarek Bia
- Department of ParasitologyParasitology Research Center and International Parasite Resource BankChungbuk National UniversitySchool of Medicine, Cheongju 28644, Republic of Korea
| | - Heejae Yang
- Division of Biobanking SolutionsCocoon Inc. 116194-41, Uiryodanji-gil, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sungbo Seo
- Division of Biobanking SolutionsCocoon Inc. 116194-41, Uiryodanji-gil, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Keeseon S. Eom
- Department of ParasitologyParasitology Research Center and International Parasite Resource BankChungbuk National UniversitySchool of Medicine, Cheongju 28644, Republic of Korea
| |
Collapse
|
2
|
Gayawan E, Cameron E, Okitika T, Egbon OA, Gething P. A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria. PLoS One 2024; 19:e0303963. [PMID: 38776302 PMCID: PMC11111079 DOI: 10.1371/journal.pone.0303963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/04/2024] [Indexed: 05/24/2024] Open
Abstract
We assess progress towards improved case management of childhood diarrhea in Nigeria over a period of targeted health systems reform from 2013 to 2018. Individual and community data from three Demographic and Health Survey rounds are leveraged in a geospatial model designed for stratified estimation by venue of treatment seeking and State. Our analysis reveals a highly regionalised health system undergoing rapid change. Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44-0.69; 95% CI] in 2008; 0.70 [0.54-0.83] in 2018) or chemist/pharmacy (0.28 [0.17-0.42] in 2008; 0.48 [0.31-0.64] in 2018). Yet State-level variations in venue attendance and performance by venue have conspired to hold the overall proportion receiving this potentially life-saving therapy (0.45 [0.35-0.55] in 2018) to well-below ideal coverage levels. High performing states that have demonstrated significant improvements include Kano, Jigawa and Borno, while under-performing states that have suffered declines in coverage include Kaduna and Taraba. The use of antibiotics is not recommended for mild cases of childhood diarrhea yet remains concerningly high nationally (0.27 [0.19-0.36] in 2018) with negligible variation between venues. Antibiotic use rates are particularly high in Enugu, Kaduna, Taraba, Kano, Niger and Kebbi, yet welcome reductions were identified in Jigawa, Adamawa and Osun. These results support the conclusions of previous studies and build the strength of evidence that urgent action is needed throughout the multi-tiered health system to improve the quality and equity of care for common childhood illnesses in Nigeria.
Collapse
Affiliation(s)
- Ezra Gayawan
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Ewan Cameron
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Tolu Okitika
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Osafu Augustine Egbon
- Department of Statistics, Federal University of Technology, Akure, Nigeria
- Department of Statistics, Federal University of São Carlos, São Carlos, Brazil
| | - Peter Gething
- Geospatial Health & Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
| |
Collapse
|
3
|
Omar M, Kassem E, Abu-Jabal R, Mwassi B, Cohen D, Muhsen K. Characterization of Antibiotic Treatment among Children Aged 0-59 Months Hospitalized for Acute Bacterial Gastroenteritis in Israel. Antibiotics (Basel) 2024; 13:64. [PMID: 38247623 PMCID: PMC10812600 DOI: 10.3390/antibiotics13010064] [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: 11/28/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We examined the extent and correlates of appropriate antibiotic use among children hospitalized with bacterial acute gastroenteritis (AGE) in Israel, a high-income country setting. METHODS Data were collected from children aged 0-59 months who participated in active hospital-based surveillance of AGE undertaken during 2007-2015. Bacterial AGE was defined as having a positive stool culture for Salmonella, Shigella, Campylobacter, or dysentery. Appropriate antibiotic use was defined as the administration of ciprofloxacin, azithromycin, or third-generation cephalosporins during hospitalization or at discharge. RESULTS Overall, 550 children had bacterial AGE; of those, 369 (67.1% [95% CI 63.1-70.9]) received antibiotics, mostly azithromycin (61.8%) and third-generation cephalosporins (37.9%). Appropriate antibiotic treatment was given to 318/550 (57.8% [95% CI 53.7-61.9]). Children aged 0-11 months vs. 24-49 months were more likely to receive appropriate antibiotic treatment (OR = 1.90 [95% CI 1.09-3.33]). Having dysentery (OR = 5.30 [95% CI 3.35-8.39]), performing blood culture (OR = 1.59 [95% CI 1.02-2.48]), and C-reactive protein (CRP) levels (OR = 1.01 [95% CI 1.01-1.02]) were positively associated with receiving appropriate antibiotic treatment. CONCLUSIONS Most children with bacterial AGE received appropriate antibiotic treatment, which correlated with young age, dysentery, CRP level, and performing blood culture, suggesting more severe illness, thus supporting the clinical decisions of physicians.
Collapse
Affiliation(s)
- Muna Omar
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (M.O.); (R.A.-J.); (D.C.)
| | - Eias Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera 3810101, Israel; (E.K.); (B.M.)
| | - Roula Abu-Jabal
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (M.O.); (R.A.-J.); (D.C.)
| | - Basher Mwassi
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera 3810101, Israel; (E.K.); (B.M.)
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (M.O.); (R.A.-J.); (D.C.)
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel; (M.O.); (R.A.-J.); (D.C.)
| |
Collapse
|
4
|
Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrug-Resistant Sepsis: A Critical Healthcare Challenge. Antibiotics (Basel) 2024; 13:46. [PMID: 38247605 PMCID: PMC10812490 DOI: 10.3390/antibiotics13010046] [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: 12/02/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Sepsis globally accounts for an alarming annual toll of 48.9 million cases, resulting in 11 million deaths, and inflicts an economic burden of approximately USD 38 billion on the United States healthcare system. The rise of multidrug-resistant organisms (MDROs) has elevated the urgency surrounding the management of multidrug-resistant (MDR) sepsis, evolving into a critical global health concern. This review aims to provide a comprehensive overview of the current epidemiology of (MDR) sepsis and its associated healthcare challenges, particularly in critically ill hospitalized patients. Highlighted findings demonstrated the complex nature of (MDR) sepsis pathophysiology and the resulting immune responses, which significantly hinder sepsis treatment. Studies also revealed that aging, antibiotic overuse or abuse, inadequate empiric antibiotic therapy, and underlying comorbidities contribute significantly to recurrent sepsis, thereby leading to septic shock, multi-organ failure, and ultimately immune paralysis, which all contribute to high mortality rates among sepsis patients. Moreover, studies confirmed a correlation between elevated readmission rates and an increased risk of cognitive and organ dysfunction among sepsis patients, amplifying hospital-associated costs. To mitigate the impact of sepsis burden, researchers have directed their efforts towards innovative diagnostic methods like point-of-care testing (POCT) devices for rapid, accurate, and particularly bedside detection of sepsis; however, these methods are currently limited to detecting only a few resistance biomarkers, thus warranting further exploration. Numerous interventions have also been introduced to treat MDR sepsis, including combination therapy with antibiotics from two different classes and precision therapy, which involves personalized treatment strategies tailored to individual needs. Finally, addressing MDR-associated healthcare challenges at regional levels based on local pathogen resistance patterns emerges as a critical strategy for effective sepsis treatment and minimizing adverse effects.
Collapse
Affiliation(s)
- Nishitha R. Kumar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Tejashree A. Balraj
- Department of Microbiology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India;
| | - Swetha N. Kempegowda
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
- Department of Medical Genetics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India
| |
Collapse
|
5
|
Ogunbiyi TS, Fayemi OE, Akanni GB, Ayolabi CI, Hald T. Molecular Characterization of Hetero-Pathogenic and Diarrheagenic Escherichia coli Pathotypes in Diarrheic Children under Five Years and Exposure Environment in Ogun State, South-West Nigeria. Pathogens 2023; 12:1358. [PMID: 38003822 PMCID: PMC10675616 DOI: 10.3390/pathogens12111358] [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: 10/07/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Diarrheagenic Escherichia coli (DEC) is one of the most common etiological agents of moderate-to-severe diarrhea in Low- and Middle-Income Countries (LMICs). Therefore, determining the source(s) of DEC in index cases and exposure environment is important for developing a prevention strategy. The current study aims to investigate the prevalence of DEC among children under 5 years and their exposure environment in Ogun State, Nigeria. METHODS Samples from 228 diarrheic children and their exposure environment were collected and screened for E. coli. Bio-chemically compatible distinct colonies were molecularly characterized using a 7-virulence-gene multiplex PCR with virulence factors (VFs) indicative of four pathotypes of E. coli: enterotoxigenic (ETEC), verotoxigenic (VTEC), enteropathogenic (EPEC), and enteroinvasive (EIEC). Representative pathotypes were subjected to antimicrobial susceptibility and over-expressed efflux pump assays. RESULTS One or more VFs typical of specific pathotypes were detected in 25.9% (59/228) diarrhea cases consisting of ETEC (21.5%) and EPEC (0.4%), while hetero-pathogenic pathotypes were found in 4.0% of cases. Of the food sources, 27.9% (101/362) were positive for DEC, of which ETEC accounted for 21.0%, VTEC 1.9%, EPEC 0.6%, EIEC 0.6%, and hetero-pathogenic pathotypes were 3.9%. Furthermore, ETEC was the only pathotype detected in the wastewater (4/183). Interestingly, the consumption of street-vended foods was the most significant (p = 0.04) risk factor for DEC infection in the study area. A total of 73.3% of selected DEC pathotypes showed resistance to antimicrobials, while 27.5% demonstrated over-expression of efflux pump activity. CONCLUSION The high prevalence of ETEC across all sources and the occurrence of hetero-pathogenic DEC in diarrheic children and food sources emphasizes the importance of establishing a better strategy for the control and prevention of diarrhea among children in low- and medium-income households.
Collapse
Affiliation(s)
- Tosin Segun Ogunbiyi
- Department of Biological Sciences, Mountain Top University, Ibafo, 110106 Ogun State, Nigeria; (G.B.A.); (C.I.A.)
| | - Olanrewaju Emmanuel Fayemi
- Department of Biological Sciences, Mountain Top University, Ibafo, 110106 Ogun State, Nigeria; (G.B.A.); (C.I.A.)
| | - Gabriel Bidemi Akanni
- Department of Biological Sciences, Mountain Top University, Ibafo, 110106 Ogun State, Nigeria; (G.B.A.); (C.I.A.)
| | - Christianah Idowu Ayolabi
- Department of Biological Sciences, Mountain Top University, Ibafo, 110106 Ogun State, Nigeria; (G.B.A.); (C.I.A.)
- Department of Microbiology, University of Lagos, Akoka, 101017 Lagos State, Nigeria
| | - Tine Hald
- National Food Institute, Technical University of Denmark, 2800 Kongens Lyngby, Denmark;
| |
Collapse
|
6
|
Paulsamy P, Venkatesan K, Hamoud Alshahrani S, Hamed Mohamed Ali M, Prabahar K, Prabhu Veeramani V, Khalil Elfaki N, Elsayed Ahmed R, Ahmed Elsayes H, Hussein Ahmed Abdalla Y, Babiker Osmsn Mohammed O, Ahmed Qureshi A, Alqahtani F, Shaik Alavudeen S. Parental health-seeking behavior on self-medication, antibiotic use, and antimicrobial resistance in children. Saudi Pharm J 2023; 31:101712. [PMID: 37601142 PMCID: PMC10432793 DOI: 10.1016/j.jsps.2023.101712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/22/2023] [Indexed: 08/22/2023] Open
Abstract
Aim and Objectives The study sought to identify parental trends in children's self-medication, health-seeking behavior, knowledge of self-medication, antibiotic use, and antimicrobial resistance in Asir, Saudi Arabia. Methods A web-based cross-sectional study was carried out by a survey questionnaire. Snow Ball sampling technique was used to select the Eight hundred and sixteen parents with children in the Asir region by WhatsApp and email, and 650 participants who met the inclusion criteria consented to participate in the study. Results There were 1809 episodes of childhood illnesses reported during the study period. The mean scores are on knowledge at 8.11 ± 2.43, favorable attitude at 17.60 ± 1.17, and practice was 7.72 ± 1.72, and a significant correlation was found between knowledge, attitude, and practice (KAP) at p = 0.01. Out of 624, the majority of parents showed strong knowledge and proficiency in antibiotics. However, the attitude scores of over 50% towards the usage of antibiotics were subpar. Around 54% of parents were self-medicating their children and 43% were unaware that skipping doses contributes to anti-microbial resistance (AMR). The facilitators for self-medication were male gender (aOR: 2.13; 95% CI: 1.26-3.98, p < 0.05), having more children (aOR: 2.78; 95% CI: 1.27-4.12 p < 0.01), professional qualification (aOR:3.07; 95% CI 1.57- 4.68; p < 0.01), residing in urban area (aOR: 3.17; 95% CI: 2.13-5.61, p < 0.05), working in health care (aOR: 5.99; 95% CI: 1.78-18.2, p < 0.01) and high income (aOR: 3.57; 95% CI: 2.08-6.34, p < 0.05). Conclusions The findings indicated that the majority of parents had unfavorable views and improper practices of antibiotic usage. Strategic education programs to the targeted population, especially to the parents about side effects of antibiotics, dangerous consequences of self-medication, and crucial AMR concerns must be addressed immediately.
Collapse
Affiliation(s)
- Premalatha Paulsamy
- College of Nursing, Mahala Branch for Girls, King Khalid University, Asir, Saudi Arabia
| | - Krishnaraju Venkatesan
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Asir, Saudi Arabia
| | | | - Maha Hamed Mohamed Ali
- Faculty of Medical and Applied Science, Public Health Department, King Khalid University, Asir, Saudi Arabia
| | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
- Department of Pharmacy Practice, Faculty of Pharmacy, Dr. M.G.R. Educational and Research Institute, Velappanchavadi, Chennai, Tamil Nadu, India
| | - Vinoth Prabhu Veeramani
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Rasha Elsayed Ahmed
- Medical-Surgical Nursing, College of Nursing, Tanta University, Egypt
- College of Nursing, Mahala Branch for Girls King Khalid University, Asir, Saudi Arabia
| | - Hala Ahmed Elsayes
- Psychiatric and Mental Health Nursing, Faculty of Nursing, Tanta University, Egypt
- Psychiatric and Mental Health Nursing, Faculty of Nursing, King Abdul Aziz University, Saudi Arabia
| | | | | | - Absar Ahmed Qureshi
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Asir Province, Saudi Arabia
| | - Friyal Alqahtani
- Department of Community Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | |
Collapse
|
7
|
Asmaa Y, Kakalia S, Irtza M, Malik R, Jamshaid M, Farrukh H. Antibiotic Use for Febrile Children in a Tertiary Care Hospital's Outpatient Department: A Cross-Sectional Study. Cureus 2023; 15:e40356. [PMID: 37456455 PMCID: PMC10339664 DOI: 10.7759/cureus.40356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Background Irrational prescription of antibiotics is contributing to the antimicrobial resistance crisis in low and middle-income countries. Antibiotic stewardship programs need to be implemented to rationalize the use of antibiotics, but data on antibiotic prescriptions in pediatric outpatient departments is minimal. This study aimed to determine the frequency of antibiotic prescriptions in febrile children attending the Paediatric Outpatient Department (OPD) at Combined Military Hospital, Lahore, and observe the factors affecting the decision to prescribe antibiotics. Methodology A cross-sectional, descriptive study with non-probability sampling in the Department of Paediatrics at the Combined Military Hospital (CMH), Lahore, was conducted over two years. The confidence limit was 95%, and the anticipated population proportion was 32%. The primary outcome was the proportion of children aged two months to 10 years presenting to the OPD with fever who received antibiotics. Further analysis included the effect of patient-level risk factors on antibiotic prescription, especially in children with respiratory tract infections (RTIs). Results Of the 225 children analyzed, 137 (61%) received antibiotics. Of these antibiotic prescriptions, 123 (90%) were second-line antibiotics. Older age (odds ratio (OR) = 2.3, 1.18-4.46), high fever (OR = 2.48, 1.37-4.5), presenting in autumn and winter seasons (OR = 2.85, 1.53-5.3), ill appearance (OR = 2.71, 1.12-6.55), tachycardia (OR = 4.28, 1.22-15.01), and tachypnea (OR = 4.01, 1.14-14.12) were associated with increased likelihood of antibiotic prescription. Antibiotic prescriptions in children with RTIs were associated with lower RTI (OR = 12.96, 3.49-48.08), probable bacterial infection (OR = 12.37, 4.77-30.05), tachycardia (OR = 10.88, 1.28-92.24), tachypnea (OR = 14.73, 3.14-68.99), and increased work of breathing (OR = 7.8, 2.05-29.56). Conclusions The evidence of the widespread inappropriate use of antibiotics in OPDs, particularly for upper RTIs, highlights the need for an antibiotic stewardship program. Antibiotic overprescription promotes antibiotic resistance, prolonging illness and increasing healthcare costs.
Collapse
Affiliation(s)
- Yumna Asmaa
- Department of Paediatrics, Combined Military Hospital Lahore, Lahore, PAK
| | - Spenta Kakalia
- Department of Paediatrics, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Muhammad Irtza
- Medical School, Services Institute of Medical Sciences, Lahore, Lahore, PAK
| | - Rahat Malik
- Department of Paediatrics, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Muqaddas Jamshaid
- Department of Paediatrics, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Huma Farrukh
- Department of Paediatrics, MedEast Hospital, Lahore, PAK
| |
Collapse
|
8
|
Umeokonkwo CD, Onah CK, Adeke AS, Igwe-Okomiso DO, Umeokonkwo AA, Madubueze UC, Dauda SO, Okeke KC, Versporten A, Oduyebo OO, Goossens H, Agu AP. Antimicrobial use among paediatric inpatients in a Nigerian tertiary hospital: A three-year point prevalence survey. J Infect Prev 2023; 24:71-76. [PMID: 36815059 PMCID: PMC9940237 DOI: 10.1177/17571774231152719] [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: 09/03/2021] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Aim Antimicrobials are among the most widely prescribed therapeutic agents among paediatric population. Irrational use of these agents increases the risk of antimicrobial resistance. We described the prevalence and pattern of antimicrobial use among paediatric inpatients from 2017 to 2019. Subject and Method The study was a repeated point prevalence survey over a 3-year period using the global point prevalence standardized tools among all paediatric inpatients. The prevalence of antimicrobial use, the prescription indicators and patterns of antimicrobial use were estimated. Result Among 191 paediatric inpatients assessed, the 3-year period prevalence antimicrobial use was 85.9% (164/191) with prevalence of 80.6% in 2017, 94.6% in 2018, and 83.6% in 2019. Antimicrobial agents used ranged from one agent (20.1%) to five different agents (5.5%). Parenteral route (66.6%) was the preferred route of administration. The reason for the use of antimicrobial agents (92.6%) and the stop/review date (99.5%) were mostly well documented. Only 4.5% of the antimicrobial use were targeted. There were no antimicrobial guidelines or policy guiding the use of antimicrobial agents, except the national guideline on the treatment of malaria and tuberculosis. Ceftriaxone, a third generation cephalosporin was the most commonly used agent across the period under review. Community-acquired infection was the commonest indication for antimicrobial use. Conclusion Our findings of high antimicrobial prevalence has raised the attention for the need to develop hospital-based antimicrobial guideline and antimicrobial stewardship program to protect the vulnerable children, their contacts and the environment from the impact of antimicrobial resistance.
Collapse
Affiliation(s)
- Chukwuma D Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Cosmas K Onah
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Azuka S Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Dorothy O Igwe-Okomiso
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Adanna A Umeokonkwo
- Department of Paediatric, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ugochukwu C Madubueze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Saheed O Dauda
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Kingsley C Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Oyinlola O Oduyebo
- Department of Microbiology, Lagos University Teaching Hospital, Surulere, Nigeria
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Adaoha P Agu
- Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria
| |
Collapse
|
9
|
Albarqouni L, Palagama S, Chai J, Sivananthajothy P, Pathirana T, Bakhit M, Arab-Zozani M, Ranakusuma R, Cardona M, Scott A, Clark J, Smith CF, Effa E, Ochodo E, Moynihan R. Overuse of medications in low- and middle-income countries: a scoping review. Bull World Health Organ 2023; 101:36-61D. [PMID: 36593777 PMCID: PMC9795388 DOI: 10.2471/blt.22.288293] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/04/2023] Open
Abstract
Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries - with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications.
Collapse
Affiliation(s)
- Loai Albarqouni
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Sujeewa Palagama
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Julia Chai
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Thanya Pathirana
- School of Medicine and Dentistry, Griffith University, Sunshine Coast, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Respati Ranakusuma
- Clinical Epidemiology and Evidence-Based Medicine Unit, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Anna Scott
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | | | - Emmanuel Effa
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, Robina, QLD, 4229, Australia
| | | |
Collapse
|
10
|
Sánchez X, Calderón N, Solis O, Jimbo-Sotomayor R. Antibiotic Prescription Patterns in Children Under 5 Years of Age With Acute Diarrhea in Quito-Ecuador. J Prim Care Community Health 2023; 14:21501319231196110. [PMID: 37646173 PMCID: PMC10467298 DOI: 10.1177/21501319231196110] [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: 06/08/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Diarrheal disease remains a significant cause of child mortality, particularly in regions with limited access to healthcare and sanitation. Inappropriate practices, including unjustified medication prescriptions, pose challenges in the management of acute diarrhea (AD), especially in low- and middle-income countries. OBJECTIVE This study analyzed antibiotic prescription patterns and assessed compliance with Integrated Management of Childhood Illness (IMCI) guidelines in children under 5 with AD in the Ministry of Public Health (MOPH) Ambulatory Care Centers of Quito city, Ecuador. METHODS A cross-sectional design was used, collecting electronic health records (EHR) of patients diagnosed with AD from 21 health facilities in District 17D03. A probabilistic and stratified sampling approach was applied. Patient characteristics, prescriber characteristics, treatments, and compliance of IMCI guideline recommendations were evaluated. A stepwise logistic regression analysis examined the association between antibiotic prescription and patient and physician characteristics. RESULTS A total of 359 children under 5 years of age were included, with 58.77% being girls. 85.24% of the cases of AD were attributed to gastroenteritis and colitis of infectious and unspecified origin. Amebiasis and other protozoal intestinal diseases accounted for 13.37% and 1.11% of the cases, respectively. The completion rates of recording various IMCI parameters varied; parameters such as duration of diarrhea, presence of blood in stool, and evidence of sunken eyes had high completion rates (100%, 100%, and 87.47%, respectively), while parameters like state of consciousness, presence of thirst, and type of diarrhea had low completion rates (0.28%, 0.28%, and 0.84%, respectively). None of the cases had all parameters fully recorded. Antimicrobials were prescribed in 38.72% of the cases. Children aged 3 to 5 years had higher odds of receiving antimicrobial prescription for AD (aOR: 4.42, 95% CI 2.13-9.18, P < .0001) compared to those under 1 year, after adjusting for the number of loose stools per day, gender, and age of the health professional. CONCLUSION Variations in IMCI guideline compliance were observed, with no cases fully adhering to the guidelines. Antimicrobial prescription rates were notably high, especially among older children. Further research and specialized interventions are necessary to gain comprehensive insight into the factors underlying non-compliance with the IMCI guidelines.
Collapse
Affiliation(s)
- Xavier Sánchez
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
- Community and Primary Care Research Group - Ecuador (CPCRG-E), Quito, Ecuador
| | - Nathali Calderón
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Olga Solis
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Ruth Jimbo-Sotomayor
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
- Community and Primary Care Research Group - Ecuador (CPCRG-E), Quito, Ecuador
| |
Collapse
|
11
|
Sánchez X, Leal G, Padilla A, Jimbo R. Medical cost of acute diarrhea in children in ambulatory care. PLoS One 2022; 17:e0279239. [PMID: 36525458 PMCID: PMC9757569 DOI: 10.1371/journal.pone.0279239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to estimate the direct medical cost per episode and the annual cost for acute diarrhea (AD) in children under five years of age in Ambulatory Care Centers of the Ministry of Public Health (MOPH) of Ecuador. METHODS A cost of illness study with a provider perspective was carried out through a micro-costing of health resources and valuated in international dollars. Medical consultations and laboratory tests were valued using the tariff framework of services for the National Health System and for the prescribed medications, a reported cost registry of pharmacy purchases made in the year of study was used. RESULTS A total of 332 electronic health records of children under five years of age were included in the analysis. Laboratory tests were performed on 37.95% (126/332), medications were prescribed to 93.67% (311/332) of the children, and antimicrobials were prescribed to 37.35% (124/332) of the children, representing an antibiotic prescription rate of 26.51% (88/332) and an antiparasitic prescription rate of 10.84% (36/332). The mean cost of the MOPH per child per episode of AD was US$45.24 (2019 dollars) (95% CI:43.71 to 46.76). CONCLUSION The total estimated cost of AD in children under five years of age for the MOPH in 2019 was about US$6,645,167.88 million (2019 dollars) (95% CI: 6,420,430.77 to 6,868,436.12). A high proportion of the direct medical cost of AD in children under five years of age in outpatient settings is due to unnecessary laboratory tests.
Collapse
Affiliation(s)
- Xavier Sánchez
- Centro de Investigación en Salud para América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Gerardine Leal
- Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Angel Padilla
- Postgrado de Medicina Familiar y Comunitaria, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
| | - Ruth Jimbo
- Centro de Investigación en Salud para América Latina (CISeAL), Facultad de Medicina, Pontificia Universidad Católica del Ecuador (PUCE), Quito, Ecuador
- * E-mail:
| |
Collapse
|
12
|
Almalag HM, Al-Yamani MJ, Alsalloum HF. An Exploration of the Public’s Attitude toward Antibiotic Use and Prescription in Light of the Recent Ministry of Health Regulations: A Cross-Sectional Study in the Kingdom of Saudi Arabia. Healthcare (Basel) 2022; 10:healthcare10081520. [PMID: 36011176 PMCID: PMC9408441 DOI: 10.3390/healthcare10081520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Restricting antibiotic (AB) use with prescriptions and ensuring proper knowledge and attitudes toward AB use is important to reduce antibiotic resistance (ABR). To prevent resistanse problem, several countries have applied prescribing restrictions. Thus, the aim of this work was to re-evaluate the public knowledge and attitudes related to AB use in light of the recent Ministry of Health (MOH) restrictions on AB prescriptions. Methods: A cross-sectional, population-based survey was distributed through various social media platforms. The survey was distributed via email and personal social media. Data were collected and analyzed using appropriate statistical tests. Result: A total of 1333 participants completed the survey. Most participants were female (i.e., 70%), aged 18–24 years old (i.e., 40%), and were aware of the AB restrictions implemented by the MOH. In addition, 77% of participants were aware of the MOH Emergency Call Center (i.e., the 937 Service), but most did not know that it could be used to obtain an AB prescription. Conclusion: Although the knowledge and attitude of the general Saudi population appear better than before, it remains clear that some elements of the population’s knowledge, attitude, and practice need to be strengthened. This could be achieved by utilizing effective channels such as the MOH 937 Service and increased advertising.
Collapse
Affiliation(s)
- Haya M. Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Correspondence: ; Tel.: +966-118-057-859
| | | | - Haya F. Alsalloum
- Clinical Pharmacy Unit, Pharmacy Services Department, King Khalid University Hospital, King Saud University Medical City, Riyadh 11461, Saudi Arabia
- University Oncology Center, King Saud University Medical City, Pharmaceutical Services, King Saud University Medical City, Riyadh 11461, Saudi Arabia
| |
Collapse
|
13
|
Jabak SJ, Kawam L, El Mokahal A, Sharara AI. Management of acute diarrhea in the emergency department of a tertiary care university medical center. J Int Med Res 2022; 50:3000605221115385. [PMID: 35942579 PMCID: PMC9373141 DOI: 10.1177/03000605221115385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To examine the management of acute diarrhea in the emergency department (ED)
of a large university medical center. Methods Retrospective cross-sectional study over a 10-month period of adult patients
(age ≥18 years) presenting to the ED with acute diarrhea. Results Data for 780 patients were reviewed; 101 met the exclusion criteria. Of the
679 patients with acute community-acquired diarrhea, 582 (85.7%) were
discharged home and constituted the study cohort of mostly healthy adults
(mean age: 32.5 ± 14.5 years). The rate of antibiotic prescription at
discharge was 26%. Inappropriate use of antibiotics occurred in 28% of the
patients. The presence of fever (odds ratio (OR) = 3.52), leukocytosis
(OR = 1.72), and older age (OR = 1.16) were predictors of antibiotic
prescription. Patients with dehydration, comorbidities, or bloody diarrhea
were more likely to receive antibiotics. Microbiological studies and
cross-sectional imaging were ordered in 12.4% and 11.7% of the patients,
respectively, but provided very low yield (<10% for both) resulting in
significantly higher visit charges. Inappropriately prescribed antibiotics
at discharge resulted in higher charges in the ED compared with no
antibiotic prescription. Conclusion Acute diarrhea management in our ED is suboptimal and does not adhere to
practice guidelines, resulting in unnecessary antibiotic prescriptions,
investigations, and cost.
Collapse
Affiliation(s)
| | | | | | - Ala I Sharara
- Ala I. Sharara, Professor of Medicine,
Division of Gastroenterology, American University of Beirut Medical Center, Riad
El-Solh, Beirut 1107 2020, Lebanon.
| |
Collapse
|
14
|
Hays JP, Ruiz-Alvarez MJ, Roson-Calero N, Amin R, Murugaiyan J, van Dongen MBM. Perspectives on the Ethics of Antibiotic Overuse and on the Implementation of (New) Antibiotics. Infect Dis Ther 2022; 11:1315-1326. [PMID: 35608734 PMCID: PMC9127288 DOI: 10.1007/s40121-022-00656-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
The continuing rise in global antimicrobial resistance is seen by many governments and international organizations as a major threat to worldwide health. This means that many publications have already described the problems concerning the overuse of currently available antibiotics and potential solutions to this crisis, including the development of new alternatives to antibiotics. However, in this manuscript, the authors approach the subject of increasing global antimicrobial resistance from two perspectives not normally covered by previous publications, namely the ethical use of antibiotics and potential issues relating to the implementation of new antibiotics.
Collapse
Affiliation(s)
- John P Hays
- Department of Medical Microbiology & Infectious Diseases, Erasmus University Medical Centre (Erasmus MC), Rotterdam, the Netherlands.
| | - Maria Jose Ruiz-Alvarez
- Research Coordination and Support Service (CORI), National Institute of Health (ISS) Viale Regina-Elena, 299, Rome, Italy
| | | | - Rohul Amin
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | | |
Collapse
|
15
|
Mwanga-Amumpaire J, Ndeezi G, Källander K, Obua C, Migisha R, Nkeramahame J, Stålsby Lundborg C, Kalyango JN, Alfvén T. Capacity to provide care for common childhood infections at low-level private health facilities in Western, Uganda. PLoS One 2021; 16:e0257851. [PMID: 34669729 PMCID: PMC8528317 DOI: 10.1371/journal.pone.0257851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. METHODS We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. RESULTS Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. CONCLUSION Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.
Collapse
Affiliation(s)
- Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, Mbarara, Uganda
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Karin Källander
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Programme Division, Health Section, UNICEF, New York, New York, United States of America
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Richard Migisha
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juvenal Nkeramahame
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Joan Nakayaga Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pharmacy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tobias Alfvén
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Afroze F, Faruk MT, Kamal M, Kabir F, Sarmin M, Chakraborty M, Hossain MR, Shikha SS, Chowdhury VP, Islam MZ, Ahmed T, Chisti MJ. The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh. Antibiotics (Basel) 2021; 10:antibiotics10101255. [PMID: 34680835 PMCID: PMC8532929 DOI: 10.3390/antibiotics10101255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Antibiotic exposure in the pediatric intensive care unit (PICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine the utility of simple bedside screening tools and predicting factors to avoid antibiotic overuse in the ICU among children with diarrhea and critical illness. METHODS We conducted a retrospective, single-center, case-control study that included children aged 2-59 months who were admitted to PICU with diarrhea and critical illness between 2017 and 2020. RESULTS We compared young children who did not receive antibiotics (cases, n = 164) during ICU stay to those treated with antibiotics (controls, n = 346). For predicting the 'no antibiotic approach', the sensitivity of a negative quick Sequential Organ Failure Assessment (qSOFA) was similar to quick Pediatric Logistic Organ Dysfunction-2 (qPELOD-2) and higher than Systemic Inflammatory Response Syndrome (SIRS). A negative qSOFA or qPELOD-2 score calculated during PICU admission is superior to SIRS to avoid antibiotic overuse in under-five children. The logistic regression analysis revealed that cases were more often older and independently associated with hypernatremia. Cases less often had severe underweight, altered mentation, age-specific fast breathing, lower chest wall in-drawing, adventitious sound on lung auscultation, abdominal distension, developmental delay, hyponatremia, hypocalcemia, and microscopic evidence of invasive diarrhea (for all, p < 0.05). CONCLUSION Antibiotic overuse could be evaded in PICU using simple bedside screening tools and clinical characteristics, particularly in poor resource settings among children with diarrhea.
Collapse
Affiliation(s)
- Farzana Afroze
- Correspondence: (F.A.); (M.J.C.); Tel.: +880-(0)2-2222-77001-10 (ext. 2187) (F.A.); +880-(0)2-2222-77001-10 (ext. 2334) (M.J.C.)
| | | | | | | | | | | | | | | | | | | | | | - Mohammod Jobayer Chisti
- Correspondence: (F.A.); (M.J.C.); Tel.: +880-(0)2-2222-77001-10 (ext. 2187) (F.A.); +880-(0)2-2222-77001-10 (ext. 2334) (M.J.C.)
| |
Collapse
|
17
|
Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157742. [PMID: 34360041 PMCID: PMC8345429 DOI: 10.3390/ijerph18157742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
In Uganda, >50% of sick children receive treatment from primary level-private health facilities (HF). We assessed the appropriateness of care for common infections in under-five-year-old children and explored perspectives of healthcare workers (HCW) and policymakers on the quality of healthcare at low-level private health facilities (LLPHF) in western Uganda. This was a mixed-methods parallel convergent study. Employing multistage consecutive sampling, we selected 110 HF and observed HCW conduct 777 consultations of children with pneumonia, malaria, diarrhea or neonatal infections. We purposively selected 30 HCW and 8 policymakers for in-depth interviews. Care was considered appropriate if assessment, diagnosis, and treatment were correct. We used univariable and multivariable logistic regression analyses for quantitative data and deductive thematic analysis for qualitative data. The proportion of appropriate care was 11% for pneumonia, 14% for malaria, 8% for diarrhea, and 0% for neonatal infections. Children with danger signs were more likely to receive appropriate care. Children with diarrhea or ability to feed orally were likely to receive inappropriate care. Qualitative data confirmed care given as often inappropriate, due to failure to follow guidelines. Overall, sick children with common infections were inappropriately managed at LLPHF. Technical support and provision of clinical guidelines should be increased to LLPHF.
Collapse
|
18
|
Lanyero H, Ocan M, Obua C, Stålsby Lundborg C, Nanzigu S, Katureebe A, N Kalyango J, Eriksen J. Antibiotic use among children under five years with diarrhea in rural communities of Gulu, northern Uganda: a cross-sectional study. BMC Public Health 2021; 21:1254. [PMID: 34187421 PMCID: PMC8244156 DOI: 10.1186/s12889-021-11254-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Diarrhea is the second leading cause of mortality in children under 5 years of age globally, and the risk of death increases with practices such as restriction of fluid intake and inappropriate use of antibiotics. We determined the prevalence of antibiotic use in managing diarrhea in children under 5 years of age in rural communities of Gulu district, northern Uganda. Method A cross-sectional study among children under 5 years with diarrhea, from households selected using multi-stage sampling. A researcher administered questionnaire was used to obtain data from caregivers of these children. Results Of the 856 children recruited, 318 (37.1%, 318/856) had experienced diarrhea, where 263 (82.7%, 263/318) had diarrhea with acute respiratory infections (ARIs), and 55 (17.3%, 55/318) had diarrhea without ARIs. The majority (89.6%, 285/318) of the children had non-bloody diarrhea. A high proportion (82.8%) of the children with non-bloody diarrhea also had ARIs. Bloody diarrhea was reported for 33 (10.4%) children including those with ARIs, and only 6 of these (18.2%) children had bloody diarrhea without ARIs. Of the 318 children with diarrhea, over half (52%, CI: 46–57) were administered antibiotics. Of the 55 children who had diarrhea without ARIs, over a third (38%, CI: 26–51) were administered antibiotics. Similarly, of the 263 children with diarrhea and ARIs, 54% (CI: 48–60) were treated with antibiotics. The determinants of antibiotic use included; children living in peri-urban settings (AOR: 3.41, CI: 1.65–7.08, P = 0.001), getting treatment from health facility (AOR: 1.76, CI: 1.06–2.93, P = 0.029), and having diarrhea with ARIs (AOR: 3.09, CI: 1.49–6.42, P = 0.003). Conclusion Antibiotic use is common among children under 5 years with diarrhea in rural communities of northern Uganda.
Collapse
Affiliation(s)
- Hindum Lanyero
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden
| | - Sarah Nanzigu
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Joan N Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda.,Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.,Department of infectious diseases, South General Hospital, 118 83, Stockholm, Sweden
| |
Collapse
|
19
|
Hu YJ, Zhou X, Wang S, Willcox M, Garner C, Brown D, Becque T, Stuart B, Han Z, Chang Q, Moore M, Little P. Diarrhoea Management using Over-the-counter Nutraceuticals in Daily practice (DIAMOND): a feasibility RCT on alternative therapy to reduce antibiotic use. Pilot Feasibility Stud 2021; 7:126. [PMID: 34130752 PMCID: PMC8204461 DOI: 10.1186/s40814-021-00850-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although rarely indicated, antibiotics are commonly used for acute diarrhoea in China. We conducted a randomised, double blind exploratory clinical trial of loperamide, berberine and turmeric for treatment of acute diarrhoea. METHODS Adults with acute uncomplicated diarrhoea aged 18 to 70 were randomised to 4 groups: (A) loperamide; (B) loperamide and berberine; (C) loperamide and turmeric; (D) loperamide, berberine and turmeric. All participants were given rescue ciprofloxacin for use after 48 h if symptoms worsened or were unimproved. Primary endpoints were feasibility and ciprofloxacin use during the 2-week follow-up period. Semi-structured interviews were conducted following recruitment and were analysed thematically. Recruiting doctors, delivery pharmacists and research assistants were blinded to treatment allocation. RESULTS Only 21.5% (278/1295) of patients screened were deemed eligible, and 49% (136/278) of these consented and were entered into the final analysis. Most participants had mild symptoms, because most patients with moderate or severe symptoms wanted to be given antibiotics. Follow-up was good (94% at 2 weeks). Only three participants used rescue antibiotics compared to 67% of acute diarrhoea patients in the hospital during the recruitment period. The median symptom duration was 14 h in group B (interquartile range (IQR) 10-22), 16 h in group D (IQR 10-22), 18 h in group A (IQR 10-33) and 20 h in group C (IQR 16-54). Re-consultation rates were low. There were no serious treatment-related adverse events. Most interviewed participants said that although they had believed antibiotics to be effective for diarrhoea, they were surprised by their quick recovery without antibiotics in this trial. CONCLUSION Although recruitment was challenging because of widespread expectations for antibiotics, patients with mild diarrhoea accepted trying an alternative. The three nutraceuticals therapy require further evaluation in a fully powered, randomised controlled trial among a broader sample. TRIAL REGISTRATION ChiCTR-IPR-17014107.
Collapse
Affiliation(s)
- Yanhong Jessika Hu
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia. .,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
| | - Xudong Zhou
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Zhejiang, 310058, Hangzhou, China
| | - Shanjuan Wang
- Affiliated Hospital of Jiading District Centre, Shanghai Institute of Health Science, No. 1 Chengbei Rd, Jiading Qu, Shanghai Shi, 201800, China
| | - Merlin Willcox
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, United Kingdom
| | - Colin Garner
- Antibiotic Research UK, Genesis 5, York Science Park, Heslington, York, YO10 5DQ, United Kingdom
| | - David Brown
- Alchemy Biomedical Consulting, St Johns Innovation Centre, Cowley Road, Cambridge, CB4 0WS, United Kingdom
| | - Taeko Becque
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, United Kingdom
| | - Beth Stuart
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, United Kingdom
| | - Zongru Han
- Affiliated Hospital of Jiading District Centre, Shanghai Institute of Health Science, No. 1 Chengbei Rd, Jiading Qu, Shanghai Shi, 201800, China
| | - Qin Chang
- Affiliated Hospital of Jiading District Centre, Shanghai Institute of Health Science, No. 1 Chengbei Rd, Jiading Qu, Shanghai Shi, 201800, China
| | - Michael Moore
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, United Kingdom
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, United Kingdom
| |
Collapse
|
20
|
Sultana R, Luby SP, Gurley ES, Rimi NA, Swarna ST, Khan JAM, Nahar N, Ghosh PK, Howlader SR, Kabir H, Khan S, Jensen PKM. Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study. PLoS Negl Trop Dis 2021; 15:e0009439. [PMID: 34115764 PMCID: PMC8221788 DOI: 10.1371/journal.pntd.0009439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/23/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods. The illness cost borne by households, known as out-of-pocket expenditure was 74% of the total health expenditure in Bangladesh in 2017. Most of the studies in Bangladesh that estimated the cost of diarrheal illness collected data from hospital patients and mostly targeted under-five children. Information on economic burden of diarrhea borne by households of low-income urban communities who commonly had ≤ 2 US$ dollar income per capita per day still remained unknown. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 2015 to July 2016 to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 (2,147 BDT) and non-severe diarrhea was US$ 6.36 (499 BDT). A single diarrheal episode substantially affects financial capability of the low-income urban community: a severe episode can cost 4.35 days (17%) and a non-severe episode can cost 1 day (4%) of income of a households. Preventing diarrhea preserves health and supports financial livelihoods.
Collapse
Affiliation(s)
- Rebeca Sultana
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
- icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Stephen P. Luby
- Stanford University, Stanford, California, United States of America
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Nazmun Nahar
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
21
|
Prah I, Ayibieke A, Mahazu S, Sassa CT, Hayashi T, Yamaoka S, Suzuki T, Iwanaga S, Ablordey A, Saito R. Emergence of oxacillinase-181 carbapenemase-producing diarrheagenic Escherichia coli in Ghana. Emerg Microbes Infect 2021; 10:865-873. [PMID: 33879019 PMCID: PMC8110189 DOI: 10.1080/22221751.2021.1920342] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The emergence and spread of carbapenemase-producing bacteria are serious threats to public health. We characterized two OXA-181-producing Escherichia coli isolates from pediatric patients with diarrhea from Ghana. blaOXA-181 was localized on the self-conjugative IncX3-containing plasmid in the E. coli ST410 isolate, belonging to an emerging lineage, and an IncFIC(FII)-containing plasmid in E. coli ST940. The blaOXA-181-qnrS1 region was found on the IS26 composite transposon, which contained a 366-bp deletion in the region encoding the Rep A protein for the IncX3-containing plasmid. The IncFIC(FII) plasmid was novel and integrated with an approximately 39-kb IncX1 plasmid through conjugal transfer. Both plasmids clustered close to plasmids from Switzerland. To the best of our knowledge, this is the first report describing the presence of an IncX3 plasmid containing blaOXA-181 in strains closely related to the B4/H24RxC clade in Africa, suggesting its emergence and the need to strengthen antimicrobial resistance surveillance.
Collapse
Affiliation(s)
- Isaac Prah
- Department of Molecular Microbiology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Molecular Virology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Alafate Ayibieke
- Department of Molecular Microbiology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Samiratu Mahazu
- Department of Molecular Microbiology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.,Department of Environmental Parasitology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Chihiro Tani Sassa
- Department of Clinical Laboratory, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
| | - Takaya Hayashi
- Department of Molecular Virology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shoji Yamaoka
- Department of Molecular Virology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Toshihiko Suzuki
- Department of Bacterial Pathogenesis, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shiroh Iwanaga
- Department of Environmental Parasitology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Anthony Ablordey
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ryoichi Saito
- Department of Molecular Microbiology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| |
Collapse
|
22
|
Physician Perception and Diagnosis of Intestinal Parasitic Infections among Patients with Gastrointestinal Symptoms in Ghana. J Parasitol Res 2021; 2021:6695313. [PMID: 34007480 PMCID: PMC8102122 DOI: 10.1155/2021/6695313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022] Open
Abstract
This study evaluated physicians' perception and diagnosis of intestinal parasitic infections (IPI) in patients with gastrointestinal (GI) symptoms. This cross-sectional survey used a Google form questionnaire distributed online. Demographic and clinical practice information was solicited, including if “IPI was considered as a diagnosis in the last patient seen,” “if stool investigation was requested among the last patients seen,” and physicians' perception of the burden of IPI in the country. Using Pearson chi-square and multivariate logistic regression analysis, we tested the significance of the associations of the job cadre of the physicians and their perception of the IPI burden with consideration of IPI as a diagnosis in the last patient seen, request for stool investigation in the last patient seen, and overall frequency of the request for stool investigation. Ultimately, 184 physicians responded. The majority agreed to “often seeing patients with GI symptoms” (156, 84.7%), “not considering IPI among the last patient seen” (106, 57.6%), and “not requesting stool investigation among the last patient seen with symptoms” (136, 73.9%). House officers (81, 44.2%) constituted the highest proportion of physicians who considered IPI as a diagnosis among the last patient seen (39, 48.1%, p = 0.05). Most physicians (138, 75%) considered IPI as a burden in Ghana. They constituted significant proportions of the physicians who considered IPI as a diagnosis among their last patients seen (65, 83.3%, p = 0.02) and were twice more likely to consider IPI as a diagnosis among the last patients seen than their colleagues who did not consider IPI as a burden in Ghana (AOR 2.26, p = 0.04). The consideration of IPI as a diagnosis among patients with GI symptoms and request for stool investigations was low among physicians in this study. Further engagements with physicians in Ghana are needed to help improve their diagnosis of IPI in patients with GI symptoms.
Collapse
|
23
|
David EE, Igwenyi IO, Iroha IR, David CN, Mbah PC, Okpala OF, Ukeh NU, Ogbaji O, Ugwurauma CE, Chukwuma GC. Trends in Empirical Treatment of Hospitalized Children with Acute Gastroenteritis in Nigeria. RECENT ADVANCES IN ANTI-INFECTIVE DRUG DISCOVERY 2021; 16:237-244. [PMID: 34719369 DOI: 10.2174/2772434416666211022155438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/30/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Acute gastroenteritis is a common infectious disease with a high rate of morbidity and mortality in children below five years of age. Appropriate empirical treatment is therefore vital for reducing the incidence of the disease. OBJECTIVE This study aimed at determining the trends in the empirical treatment of hospitalized children with acute gastroenteritis. METHODS The study involved the data analysis of 88 medical folders of children who were diagnosed with gastroenteritis from January to February 2020 (a period of gastroenteritis yearly outbreak) in Mile 4 Hospital Abakaliki, Ebonyi State, Nigeria. Socio-demographic data and administered antibiotics data were collected. RESULTS Out of the 88 children, a total of 54 (61%) children were males, while 34 (39%) were females. The ages of the children ranged between 1-51 months, while the mean age was seen at 14 months. About 58 (66%) were diagnosed with acute gastroenteritis alone, with children aged 7-12 months recording higher numbers [25 (28%)]. Severe dehydration was seen as the most common morbidity of children with acute gastroenteritis. The guardians/parents of these children stayed at home for an average of 3 days (1-6 days) before visiting the hospital. The children were treated for an average of 5 days (2-9 days) in the hospital. The most singly used antibiotics was ciprofloxacin [31 (35%)] followed by a combination of ciprofloxacin and ceftriaxone [21 (24%)]. About 12 (14%) of the children were treated using a single dose of the antimalarial drug while 10 (11%) were treated in double combination therapy. The lowest duration in hospitalization (4 days) was seen in the use of a single dose regimen, while the highest hospitalization time (6 days) was seen in the use of a triple dose regimen. CONCLUSION The best empirical treatment of acute gastroenteritis may involve the use of ciprofloxacin alone and its combination with ceftriaxone. The severity of gastroenteritis may also be exacerbated with malaria.
Collapse
Affiliation(s)
- Ebuka E David
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Ikechuku O Igwenyi
- Department of Biochemistry, Ebonyi State University, Ebonyi State,Nigeria
| | | | - Chidinma N David
- Department of Microbiology, Ebonyi State University, Ebonyi State,Nigeria
| | - Precious C Mbah
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Ogochukwu F Okpala
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Nkemdirim U Ukeh
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Oluchukwu Ogbaji
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Chinecherem E Ugwurauma
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| | - Goodness C Chukwuma
- Department of Chemistry/Biochemistry, Alex-Ekwueme Federal University Ndufu-Alike, Ikwo, Ebonyi State,Nigeria
| |
Collapse
|
24
|
Molecular Epidemiology of Enteroaggregative Escherichia coli (EAEC) Isolates of Hospitalized Children from Bolivia Reveal High Heterogeneity and Multidrug-Resistance. Int J Mol Sci 2020; 21:ijms21249543. [PMID: 33334000 PMCID: PMC7765457 DOI: 10.3390/ijms21249543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 12/16/2022] Open
Abstract
Enteroaggregative Escherichia coli (EAEC) is an emerging pathogen frequently associated with acute diarrhea in children and travelers to endemic regions. EAEC was found the most prevalent bacterial diarrheal pathogen from hospitalized Bolivian children less than five years of age with acute diarrhea from 2007 to 2010. Here, we further characterized the epidemiology of EAEC infection, virulence genes, and antimicrobial susceptibility of EAEC isolated from 414 diarrheal and 74 non-diarrheal cases. EAEC isolates were collected and subjected to a PCR-based virulence gene screening of seven virulence genes and a phenotypic resistance test to nine different antimicrobials. Our results showed that atypical EAEC (a-EAEC, AggR-negative) was significantly associated with diarrhea (OR, 1.62, 95% CI, 1.25 to 2.09, p < 0.001) in contrast to typical EAEC (t-EAEC, AggR-positive). EAEC infection was most prevalent among children between 7–12 months of age. The number of cases exhibited a biannual cycle with a major peak during the transition from warm to cold (April–June). Both typical and a-EAEC infections were graded as equally severe; however, t-EAEC harbored more virulence genes. aap, irp2 and pic were the most prevalent genes. Surprisingly, we detected 60% and 52.6% of multidrug resistance (MDR) EAEC among diarrheal and non-diarrheal cases. Resistance to ampicillin, sulfonamides, and tetracyclines was most common, being the corresponding antibiotics, the ones that are frequently used in Bolivia. Our work is the first study that provides comprehensive information on the high heterogenicity of virulence genes in t-EAEC and a- EAEC and the large prevalence of MDR EAEC in Bolivia.
Collapse
|
25
|
Assar A, Abdelraoof MI, Abdel-Maboud M, Shaker KH, Menshawy A, Swelam AH, Eid M, Khalid R, Mogahed M, Abushouk AI, Aleya L, Abdel-Daim M. Knowledge, attitudes, and practices of Egypt's future physicians towards antimicrobial resistance (KAP-AMR study): a multicenter cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:21292-21298. [PMID: 32270452 DOI: 10.1007/s11356-020-08534-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
Antimicrobial resistance (AMR) is a growing threat that causes over 700,000 deaths per year worldwide. The goal of the current multicenter, cross-sectional study was to identify the knowledge and practice gaps in antimicrobial stewardship among Egypt's undergraduate medical students. Nine-hundred and sixty-three participants (375 male) from 25 medical schools responded to our self-administered questionnaire. Overall, the majority of students (96%) exhibited fair/satisfactory knowledge and attitude scores towards AMR. However, the most common misconceptions were that skipping one or two antimicrobial doses does not contribute to AMR (43%) and that antimicrobials are the drug of choice for the treatment of sore throat (38.8%). About 36% of the students thought that bacteria cause common cold and influenza. In terms of practices, about 62% of the students reported taking antibiotics when they have cough or sore throat and saving the remaining antibiotic for the next time. About 48% of the students reported that when they start feeling better, they stop the antibiotic course, and 41% stated that they often/sometimes discard the remaining leftover or share the leftover antibiotics with their friends. Interestingly, males had more frequently poorer levels of knowledge than females (p = 0.02). Moreover, students in the clinical science years (p < 0.001), living in urban areas (p = 0.02) or Cairo (p < 0.01) reported better practices than their counterparts. Educational programs about antimicrobial stewardship and the role of healthcare professionals in preventing AMR should be introduced early in medical curricula. Further, active educational techniques as clinical scenarios that simulate clinical settings and interactive learning workshops would be more efficient teaching methods.
Collapse
Affiliation(s)
- Ahmed Assar
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Ibrahim Abdelraoof
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Abdel-Maboud
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Kerollos H Shaker
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Amr Menshawy
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Asia Hamdy Swelam
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Benha University, Benha, Egypt
| | - Muhammad Eid
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Radwa Khalid
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed Mogahed
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | | | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, F-25030 11, Besançon Cedex, France
| | - Mohamed Abdel-Daim
- Department of Pharmacology, Suez Canal University, Ismailia, Egypt
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| |
Collapse
|
26
|
Ugboko HU, Nwinyi OC, Oranusi SU, Oyewale JO. Childhood diarrhoeal diseases in developing countries. Heliyon 2020; 6:e03690. [PMID: 32322707 PMCID: PMC7160433 DOI: 10.1016/j.heliyon.2020.e03690] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/03/2019] [Accepted: 03/25/2020] [Indexed: 12/27/2022] Open
Abstract
Diarrhoeal diseases collectively constitute a serious public health challenge globally, especially as the leading cause of death in children (after respiratory diseases). Childhood diarrhoea affecting children under the age of five accounts for approximately 63% of the global burden. Accurate and timely detection of the aetiology of these diseases is very crucial; but conventional methods, apart from being laborious and time-consuming, often fail to identify difficult-to-culture pathogens. The aetiological agent of an average of up to 40% of cases of diarrhoea cannot be identified. This review gives an overview of the recent trends in the epidemiology and treatment of diarrhoea and aims at highlighting the potentials of metagenomics technique as a diagnostic method for enteric infections.
Collapse
Affiliation(s)
- Harriet U Ugboko
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - Obinna C Nwinyi
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - Solomon U Oranusi
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| | - John O Oyewale
- Microbiology Research Unit, Department of Biological Sciences, Covenant University, Canaanland, KM 10, Idiroko Road, P.M.B, 1023, Ota, Ogun State, Nigeria
| |
Collapse
|
27
|
Efunshile MA, Onwakpu KO, Robertson LJ, Jokelainen P. Opinions and knowledge on globally important foodborne parasites among healthcare professionals at a tertiary teaching hospital in Nigeria. Food Waterborne Parasitol 2020; 18:e00075. [PMID: 32154397 PMCID: PMC7058820 DOI: 10.1016/j.fawpar.2020.e00075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/12/2022] Open
Abstract
Foodborne diseases are important everywhere in the world, but the level of attention they receive varies by region. We surveyed the current opinions and knowledge regarding the globally most important foodborne parasites (FBP) among healthcare professionals in Abakaliki, Ebonyi State, Nigeria, by conducting a questionnaire survey among healthcare professionals in a tertiary hospital. We focused on the FBP ranked as the top five globally: Taenia solium, Echinococcus granulosus, Echinococcus multilocularis, Toxoplasma gondii, and Cryptosporidium spp., and gathered local expert opinions regarding their importance in Nigeria. Moreover, we surveyed the extent of healthcare community knowledge on transmission, manifestations and pathologies, and prevention of infections with these five FBP. Among the 205 healthcare professionals completing the survey, T. solium was selected as important in Nigeria by 143 (70%), E. granulosus by 91 (44%), E. multilocularis by 62 (30%), T. gondii by 132 (64%), and Cryptosporidium spp. by 123 (60%). Only 44 (21%) of the participants selected at least 15 of the 25 answers to knowledge questions that we considered as correct to select. The proportion selecting at least 15 of the correct answers was not statistically significantly associated with gender nor with experience level. Our results suggest that further education about FBP should target healthcare professionals at all levels.
Collapse
Affiliation(s)
- Michael Akinwale Efunshile
- Department of Medical Microbiology, Ebonyi State University, Abakaliki, Nigeria
- Department of Medical Microbiology, Alex Ekweme Federal University Teaching Hospital, Abakaliki, Nigeria
| | | | - Lucy J. Robertson
- Norwegian University of Life Sciences, Department of Food Safety and Infection Biology, Section for Microbiology, Immunology, and Parasitology, Parasitology Lab, Adamstuen Campus, Ullevålsveien 72, 0454 Oslo, Norway
| | - Pikka Jokelainen
- Laboratory of Parasitology, Department of Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| |
Collapse
|
28
|
Jumani RS, Spector JM, Izadnegahdar R, Kelly P, Diagana TT, Manjunatha UH. Innovations in Addressing Pediatric Diarrhea in Low Resource Settings. ACS Infect Dis 2020; 6:14-24. [PMID: 31612701 DOI: 10.1021/acsinfecdis.9b00315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Diarrhea has long been recognized as an important cause of mortality during childhood. In parallel with ensuring access to proven care practices is the imperative to apply modern advances in medicine, science, and technology to accelerate progress against diarrheal disease, particularly in developing countries where the burden of avoidable harm is the greatest. In order to highlight achievements and identify outstanding areas of need, we reviewed the landscape of recent innovations that have significance for the study and clinical management of pediatric diarrhea in low resource settings.
Collapse
Affiliation(s)
- Rajiv S. Jumani
- Novartis Institute for Tropical Diseases, 5300 Chiron Way, Emeryville, California 94608, United States
| | - Jonathan M. Spector
- Novartis Institute for Tropical Diseases, 5300 Chiron Way, Emeryville, California 94608, United States
| | - Rasa Izadnegahdar
- Bill and Melinda Gates Foundation, 440 5th Ave N, Seattle, Washington 98109, United States
| | - Paul Kelly
- Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, Turner Street, London E1 2AD, United Kingdom
- Tropical Gastroenterology and Nutrition group, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia
| | - Thierry T. Diagana
- Novartis Institute for Tropical Diseases, 5300 Chiron Way, Emeryville, California 94608, United States
| | - Ujjini H. Manjunatha
- Novartis Institute for Tropical Diseases, 5300 Chiron Way, Emeryville, California 94608, United States
| |
Collapse
|