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- Emgård, Matilda, 1984
(författare)
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Antibiotic use and respiratory pathogens with focus on Streptococcus pneumoniae in Tanzanian children
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis describes the epidemiology of Streptococcus pneumoniae (pneumococci) and other respiratory pathogens after introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) and further portrays antibiotic use in Tanzanian children. Pneumococci are a leading cause of pneumonia in children. However, respiratory infections among children may be associated with over-use of antibiotics leading to bacterial resistance, a significant threat to global child health. In a quantitative study, conducted in urban Moshi, Northern Tanzania 2013-2015, 775 children <2 years of age attending public primary healthcare facilities for routine care were sampled from the nasopharynx. Structured interviews with the parent/guardian revealed that more than half of the children had received antibiotics in the past 3 months. Isolated pneumococci (n=244) showed increasing resistance to phenoxy-methylpenicillin from 35% in 2013 to 60% in 2015, but resistance to amoxicillin, the first line pneumonia treatment, remained low (1%). Although vaccine-type pneumococci decreased significantly during the study period, the prevalence of residual vaccine-types remained high (21%). Detection of respiratory syncytial virus or adenovirus were associated with parent-reported rapid or difficult breathing and antibiotic treatment in the past week. A qualitative phenomenographic study was subsequently conducted in urban and rural Moshi in 2019. Individual in-depth interviews with primary healthcare workers showed a reliance on physical examination of the child and history from the mother when deciding whether to prescribe an antibiotic. However, their confidence in providing advice as to non-antibiotic treatment varied. Most mothers attending the focus group preferred seeking care for their sick child at healthcare facilities, but they faced barriers including unforeseen costs, travel, and lack of support from their husbands. Pharmacies were often perceived as cheap and convenient place to obtain antibiotics for children, whilst some mothers sought health advice from a trusted neighbour. Conclusions: Increasing resistance to antibiotics and residual vaccine-types require continued epidemiological surveillance of pneumococci in the post PCV13 era. Healthcare workers need support to develop their clinical and consultation skills, meanwhile mothers should be supported in seeking appropriate healthcare for their children. For this, improved equity and increased presence of community health workers are necessary.
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| 2. |
- Emgård, Matilda, 1984, et al.
(författare)
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Antibiotic use in children under 5 years of age in Northern Tanzania: a qualitative study exploring the experiences of the caring mothers
- 2022
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Ingår i: Antimicrobial Resistance and Infection Control. - : Springer Science and Business Media LLC. - 2047-2994. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Antimicrobial resistance is a serious threat to the global achievements in child health thus far. Previous studies have found high use of antibiotics in children in Northern Tanzania, but the experiences of the primary care-givers, who play a key role in accessing and administering antibiotics for the sick child, have remained largely unknown. Therefore, the aim of this study was to understand mothers' conceptions of antibiotic use in their children, which is of importance when forming strategies to improve antibiotic use in the community. Method A qualitative study including eight focus group discussions with mothers of under-five children in Moshi urban and rural districts, Northern Tanzania, was performed during 2019. The discussions were recorded, transcribed verbatim, translated into English and analysed according to the phenomenographic approach. Findings Three conceptual themes emerged during analysis; (1) conceptions of disease and antibiotics, (2) accessing treatment and (3) administering antibiotics. Antibiotics were often perceived as a universal treatment for common symptoms or diseases in children with few side-effects. Although mothers preferred to attend a healthcare facility, unforeseen costs, long waits and lack of financial support from their husbands, posed barriers for healthcare seeking. However, pharmacies were perceived as a cheap and convenient option to access previously used or prescribed antibiotics. Some mothers sought advice from a trusted neighbour regarding when to seek healthcare, thus resembling the function of the community health worker. Conclusions To improve antibiotic use in children under 5 years of age in Northern Tanzania, the precarious situation that women often find themselves in as they access treatment for their sick children needs to be taken into consideration. It is necessary to improve structures, including the healthcare system, socioeconomic inequalities and promoting gender equality both in the household and in the public arena to reduce misuse of antibiotics. Meanwhile, equipping community health workers to support Tanzanian women in appropriate healthcare seeking for their children, may be a feasible target for intervention.
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| 3. |
- Emgård, Matilda, 1984, et al.
(författare)
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Co-occurrence of bacteria and viruses and serotype distribution of Streptococcus pneumoniae in the nasopharynx of Tanzanian children below 2 years of age following introduction of the PCV13
- 2024
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Ingår i: FRONTIERS IN PUBLIC HEALTH. - 2296-2565. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Pneumococcal conjugate vaccines have reduced severe disease attributed to vaccine-type pneumococci in children. However, the effect is dependent on serotype distribution in the population and disease development may be influenced by co-occurrence of viral and bacterial pathogens in the nasopharynx. Methods: Following introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in Tanzania we performed repeated cross-sectional surveys, including 775 children below 2 years of age attending primary healthcare centers. All children were sampled from nasopharynx and pneumococci were detected by single-target PCR. Pneumococcal serotypes/groups and presence of viruses and other bacteria were determined by two multiplex PCR assays. Results: The prevalence of PCV13 vaccine-type pneumococci decreased by 50%, but residual vaccine-types were still detected in 21% of the children 2 years after PCV13 introduction. An increase in the non-vaccine-type 15 BC was observed. Pneumococci were often co-occurring with Haemophilus influenzae, and detection of rhino/enterovirus was associated with higher pneumococcal load. Discussion: We conclude that presence of residual vaccine-type and emerging non-vaccine-type pneumococci in Tanzanian children demand continued pneumococcal surveillance. High co-occurrence of viral and bacterial pathogens may contribute to the disease burden and indicate the need of multiple public health interventions to improve child health in Tanzania.
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| 4. |
- Emgård, Matilda, 1984, et al.
(författare)
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Tanzanian primary healthcare workers’ experiences of antibiotic prescription and understanding of antibiotic resistance in common childhood infections: a qualitative phenomenographic study
- 2021
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Ingår i: Antimicrobial Resistance and Infection Control. - : Springer Science and Business Media LLC. - 2047-2994. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Antibiotic resistance is a threat to global child health. Primary healthcare workers play a key role in antibiotic stewardship in the community, but few studies in low-income countries have described their experiences of initiating antibiotic treatment in children. Thus, the present study aimed to describe primary healthcare workers’ experiences of antibiotic prescription for children under 5 years of age and their conceptions of antibiotic resistance in Northern Tanzania. Methods: A qualitative study involving individual in-depth interviews with 20 prescribing primary healthcare workers in Moshi urban and rural districts, Northern Tanzania, was performed in 2019. Interviews were transcribed verbatim, translated from Kiswahili into English and analysed according to the phenomenographic approach. Findings: Four conceptual themes emerged during the analysis; conceptions in relation to the prescriber, the mother and child, other healthcare actors and in relation to outcome. The healthcare workers relied mainly on clinical examination and medical history provided by the mother to determine the need for antibiotics. Confidence in giving advice concerning non-antibiotic treatment varied among the participants and expectations of antibiotic treatment were perceived to be common among the mothers. Antibiotic resistance was mainly perceived as a problem for the individual patient who was misusing the antibiotics. Conclusions: To increase rational antibiotic prescription, an awareness needs to be raised among Tanzanian primary healthcare workers of the threat of antibiotic resistance, not only to a few individuals, but to public health. Guidelines on childhood illnesses should be updated with advice concerning symptomatic treatment when antibiotics are not necessary, to support rational prescribing practices and promote trust in the clinician and mother relationship. © 2021, The Author(s).
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