| 1. |
- Do, Nga T. T., et al.
(författare)
-
Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach
- 2021
-
Ingår i: The Lancet Global Health. - : Elsevier. - 2214-109X. ; 9:5, s. e610-e619
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices.Methods: We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016–Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions.Findings: Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia.Interpretation: Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance.
|
|
| 2. |
- Cambaco, Olga, et al.
(författare)
-
Community knowledge and practices regarding antibiotic use in rural Mozambique : where is the starting point for prevention of antibiotic resistance?
- 2020
-
Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundAntibiotic misuse and other types of unnecessary use of antibiotics can contribute to accelerate the process of antibiotic resistance, which is considered a global concern, mostly affecting low-and middle-income countries (LMICs). In Mozambique there is limited evidence on community knowledge and practices regarding antibiotics and antibiotic resistance. As part of the ABACUS project, this paper describes knowledge and practices of antibiotic use among the general population in the semi-rural district of Manhica to inform evidence-based communication intervention strategies for safer antibiotic use.MethodsThe study was conducted in Manhica, a semi-rural district of Southern Mozambique. Sixteen in-depth interviews and four focus group discussions (FGDs) were conducted with community members to explore lay knowledge and practices regarding antibiotics and awareness of antibiotic resistance. The qualitative data was analysed using a combination of content and thematic analysis. The SRQR guidelines for reporting qualitative studies was performed.ResultsAlthough participants did not hold any consistent knowledge of antibiotics, their visual recognition of amoxicillin (distinct red yellow capsule) was acceptable, but less so for different types and brands of antibiotics. The majority of participants were aware of the term 'antibiotic', yet the definition they gave was rarely backed by biomedical knowledge. Participants associated antibiotics with certain colours, shapes and health conditions. Participants reported common habits that may contribute to resistance: not buying the full course, self-medication, sharing medicines and interruption of treatment. Most had never heard of the term 'antibiotic resistance' but were familiar with the phenomenon. They often understood the term 'resistance' as treatment failure and likened 'resistance' to non-compliance, ineffective medication, disease resistance or to an inability of the physical body to respond to it.ConclusionThere is a broad understanding of the importance of medication compliance but not specifically of antibiotic resistance. In addition, there is a recognized gap between knowledge of responsible drug compliance and actual behaviour. Future qualitative research is required to further explore what determines this behaviour. The existing ability to visually identify amoxicillin by its distinct red and yellow appearance is informative for future awareness and behavioural change campaigns that may incorporate visual aids of antibiotics.
|
|
| 3. |
- Kinsman, John, et al.
(författare)
-
Case studies on preparedness planning for polio in Poland and Cyprus
- 2016
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The last cases of poliomyelitis due to wild poliovirus in Poland and Cyprus were registered in 1984 and 1995, respectively. Current efforts against polio are therefore aimed at maintaining the two countries’ polio-free status. The overall objective of this report is to support these two EU Member States in updating their polio preparedness planning. The specific aims of the case study were to: critically review implemented actions and identify gaps in order to propose approaches for strengthening the national polio plans; identify health system elements that are important in polio preparedness planning; and provide examples of collaborative efforts between these sectors in planning measures for outbreak response to polio as a cross-border health threat.
|
|
| 4. |
- Kinsman, John, et al.
(författare)
-
Preparedness and response against diseases with epidemic potential in the European Union : a qualitative case study of Middle East Respiratory Syndrome (MERS) and poliomyelitis in five member states
- 2018
-
Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 18:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. The Decision provides a context for the present study, which aims to identify good practices and lessons learned in preparedness and response to Middle East Respiratory Syndrome (MERS) (in UK, Greece, and Spain) and poliomyelitis (in Poland and Cyprus).METHODS: Based on a documentary review, followed by five week-long country visits involving a total of 61 interviews and group discussions with experts from both the health and non-health sectors, this qualitative case study has investigated six issues related to preparedness and response to MERS and poliomyelitis: national plans and overall preparedness capacity; training and exercises; risk communication; linking policy and implementation; interoperability between the health and non-health sectors; and cross-border collaboration.RESULTS: Preparedness and response plans for MERS and poliomyelitis were in place in the participating countries, with a high level of technical expertise available to implement them. Nevertheless, formal evaluation of the responses to previous public health emergencies have sometimes been limited, so lessons learned may not be reflected in updated plans, thereby risking mistakes being repeated in future. The nature and extent of inter-sectoral collaboration varied according to the sectors involved, with those sectors that have traditionally had good collaboration (e.g. animal health and food safety), as well as those that have a financial incentive for controlling infectious diseases (e.g. agriculture, tourism, and air travel) seen as most likely to have integrated public health preparedness and response plans. Although the formal protocols for inter-sectoral collaboration were not always up to date, good personal relations were reported within the relevant professional networks, which could be brought into play in the event of a public health emergency. Cross-border collaboration was greatly facilitated if the neighbouring country was a fellow EU Member State.CONCLUSIONS: Infectious disease outbreaks remain as an ongoing threat. Efforts are required to ensure that core public health capacities for the full range of preparedness and response activities are sustained.
|
|
| 5. |
- Kinsman, John, et al.
(författare)
-
Synergies in community and institutional public health emergency preparedness for tick-borne diseases in Spain and the Netherlands
- 2018
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Within the broad context of EU Decision 1082/2013/EU on serious cross-border threats to health, the European Centre for Disease Prevention and Control (ECDC) has initiated a case study project to investigate the synergies between communities affected by serious public health threats and the institutions (both health- and non-healthrelated) mandated to prepare for and respond to them. The premise for the project is that affected communities are increasingly recognised as key resources that can be used during public health emergencies, and that the concerns and experience of ordinary people should be harnessed as an important part of the response. The aim of this qualitative comparative case study project is to identify good practices related to community preparedness for tick-borne diseases. Two EU countries, Spain and the Netherlands, were selected for inclusion. Work in Spain focused around two cases of autochthonous infection with Crimean-Congo haemorrhagic fever (CCHF) virus that emerged in the Autonomous Community of Castilla y León in August 2016. Work in the Netherlands focussed on the first two endemic cases of tick-borne encephalitis (TBE) in the country, appearing in July 2016 in the Utrecht and Twente regions. The response to the TBE cases was undertaken within the wider context of prevention work on lyme borreliosis (LB) in the country. Specifically, the study aims to: - Identify good practices and patterns of cooperation between affected communities and the official institutions mandated to address tick-borne diseases; - Identify inter-sectoral collaboration between health and non-health-related sectors with regard to tick-borne diseases; - Identify practices that could be of use for other EU countries in the area of public health preparedness.
|
|
| 6. |
- Kinsman, John, et al.
(författare)
-
Synergies in community and institutional public health emergency preparedness for tick-borne diseases in Spain : a case study on Crimean-Congo haemorrhagic fever
- 2018
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Within the broad context of EU Decision 1082/2013/EU on serious cross-border health threats, the European Centre for Disease Prevention and Control (ECDC) has initiated a case study project to investigate the synergies between communities affected by serious public health threats and the institutions (both health- and non-healthrelated) that are mandated to prepare for and respond to them. The premise for the project is that affected communities are increasingly being recognised as key resources that can be used during public health emergencies, and that the concerns, understanding and experience of ordinary people should be harnessed as an important part of the response. The aim of this case study project is to identify good practices related to community preparedness for tick-borne diseases. This report focuses on two cases of Crimean-Congo Haemorrhagic Fever (CCHF) that emerged in Spain in August– September 2016, the first autochthonous clinical cases of CCHF in south-western Europe. Specifically, the study aims: - to identify good practices and patterns of cooperation between affected communities and the official institutions mandated to address tick-borne diseases such as CCHF; - to identify inter-sectoral collaboration between health and non-health-related sectors with regard to tickborne diseases, such as CCHF; - to identify actions that could be taken by other EU countries.
|
|
| 7. |
- Matin, Mohammad Abdul, et al.
(författare)
-
What influences antibiotic sales in rural Bangladesh? : A drug dispensers' perspective
- 2020
-
Ingår i: Journal of Pharmaceutical Policy and Practice. - : Springer Nature. - 2052-3211. ; 13:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Antibiotic resistance poses a great threat to global health, especially in low- and middle-income countries with a high infectious disease burden and limited resources. In spite of regulations, antibiotics are sold in many settings as non-prescription medicines, resulting in inappropriate use and resistance.Objective: This study aimed to investigate the current status of access and use of antibiotics in rural Bangladesh, by exploring the perspectives and sales practices of antibiotic drug dispensers.Methods: We used a mixed methods approach (qualitative and quantitative). We mapped and characterized antibiotic purchasing and dispensing sites in the Matlab Health and Demographic Surveillance System catchment area. Furthermore, we investigated the volume of provision of systemic antibiotics in 10 drug outlets. We held 16 in-depth interviews with randomly selected antibiotics dispensers. Interviews explored factors associated with antibiotic selling. Responses were transcribed, coded for themes, and summarized. We used ATLAS.ti 5.2 for conducting a thematic analysis.Results: A total of 301 antibiotic dispensers were identified, of whom 92% (n = 278) were private and 8% (n = 23) public. 52% (n = 155) operated informally (i.e. without legal authorization). In order to promote and survive in their business, dispensers sell antibiotics for a range of conditions without a qualified physician's prescription. Factors that facilitate these inappropriate sales include lack of access to healthcare in the rural community, inadequate doctor: population ratio, limited dispenser knowledge, poor pharmacovigilance concerning safety of self medication, lack of enforcement of policies, financial benefits for both customers and dispensers, and high dependency on pharmaceutical companies' information.Conclusion: Dispensers in rural Bangladesh sell antibiotics inappropriately by ignoring existing national regulations. They operate the antibiotic sales without facing any legal barriers and primarily with a view to sustain their business, resulting in inappropriate sales of antibiotics to the rural community. The influence of the drug industry needs to be replaced with evidence-based, not commercially driven information. Awareness programs for antibiotic providers that promote understanding of antibiotics and antibiotic resistance through tailored interventions may be helpful in changing current antibiotic sales practices.
|
|
| 8. |
- Micklesfield, Lisa K, et al.
(författare)
-
Physical activity and sedentary behavior among adolescents in rural South Africa : levels, patterns and correlates
- 2014
-
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14, s. 40-
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Physical inactivity is increasing among children and adolescents and may be contributing to the increasing prevalence of overweight and obesity. This study examines physical activity and sedentary behavior patterns, and explores associations with individual, maternal, household, and community factors amongst rural South African adolescents.Methods: In 2009, 381 subjects, stratified by ages 11-12-years and 14-15-years, were randomly selected from 3511 children and adolescents who had participated in a growth survey two years previously. Weight and height were measured and self-reported Tanner pubertal stage was collected. A questionnaire quantifying frequency and duration of physical activity (PA) domains and sedentary time for the previous 12 months was administered. Moderate-vigorous physical activity (MVPA mins/wk) was calculated for time spent in school and club sport. Socio-demographic and other related data were included from the Agincourt health and socio-demographic system (HDSS). The Agincourt HDSS was established in 1992 and collects prospective data on the community living in the Agincourt sub-district of Mpumalanga Province in rural north-east South Africa.Results: Puberty, maternal education and socio-economic status (SES) contributed significantly to the mulitiple linear regression model for sedentary behavior (R-2=0.199; adjusted R-2=0.139; p < 0.000), and sex, SES and maternal education contributed to the tobit regression model for school and club sport MVPA (p < 0.000). MVPA, calculated from school and club sport, was higher in boys than girls (p < 0.001), and informal activity was lower (boys: p < 0.05 and girls: p < 0.01) while sedentary time was higher (girls: p < 0.01) in the older than the younger groups. Ninety-two percent (92%) of the sample reported walking for transport.Conclusions: In this study of rural South African adolescent boys and girls, SES at the maternal, household and community level independently predicted time spent in sedentary behaviors, and school and club MVPA. This study provides local data that can be used to develop health promotion strategies specific to this community, and other similar communities in developing countries.
|
|
| 9. |
- Welbourn, Richard, et al.
(författare)
-
Bariatric-Metabolic Surgery Utilisation in Patients With and Without Diabetes : Data from the IFSO Global Registry 2015-2018
- 2021
-
Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 31:6, s. 2391-2400
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Comparative international practice of patients undergoing bariatric-metabolic surgery for type 2 diabetes mellitus (T2DM) is unknown. We aimed to ascertain baseline age, sex, body mass index (BMI) and types of operations performed for patients with T2DM submitted to the IFSO Global Registry.MATERIALS AND METHODS: Cross-sectional analysis of patients having primary surgery in 2015-2018 for countries with ≥90% T2DM data completion and ≥ 1000 submitted records.RESULTS: , OR 2.76 (2.52-3.03), p < 0.001. This was not seen in women, OR 0.78 (0.73-0.83), p < 0.001. Sleeve gastrectomy was the commonest operation overall, but less frequent for patients with T2DM, patients with T2DM 54.9% vs without T2DM 65.8%, OR 0.63 (0.63-0.64), p < 0.001. Twelve out of 15 countries had higher proportions of gastric bypass compared to non-bypass operations for T2DM, OR 1.70 (1.67-1.72), p < 0.001.CONCLUSION: Patients with T2DM had different characteristics to those without T2DM. Older men were more likely to have T2DM, with higher rates of BMI <35 kg/m(2) and increased likelihood of food rerouting operations.
|
|
| 10. |
- Wertheim, Herman, et al.
(författare)
-
Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use : an observational multi-centre study
- 2017
-
Ingår i: Wellcome Open Research. - : Wellcome Trust. - 2398-502X. ; 2
-
Tidskriftsartikel (refereegranskat)abstract
- In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.
|
|
