Factors influencing non-prescription sales of antibiotics among patent and proprietary medicine vendors in Kano, Nigeria: a cross-sectional study

The use of complexity theory to inform antimicrobial stewardship: a scoping review

BACKGROUND

Complexity theory has previously been used as a conceptual lens in human healthcare research. Antimicrobial stewardship (AMS) is an inherently complex healthcare intervention; however, the extent to which complexity has been operationalized in AMS is currently unclear.

AIM

To investigate if, and how, complexity theory has been used to inform AMS in human healthcare.

METHODS

Scoping review methodology. Empirical research or policy specifically referencing complexity in relation to AMS were considered in any human healthcare setting and geographical location. Databases searched were: Cinahl, Cochrane Library, Embase, Medline, National Institute for Health and Care Excellence, PsycInfo, Scopus and Web of Science from inception to June 2020. Grey literature and other databases searched: EVIPNet, Google, Mednar, Proquest Theses, and the World Health Organization library of national antimicrobial resistance action plans. Non-English language articles were excluded.

RESULTS

Of 612 records retrieved, 8 articles were included. Heterogeneity in study design and geographical location were noted. Three interventional studies evaluated AMS in hospital (n = 2) and long-term care (n = 1) settings. Remaining studies were non-interventional and proposed AMS strategies conceptualized through complexity theory. The importance of close engagement between researchers or policy administrators and the target population was emphasized in all studies, as a means of ensuring AMS relevance and success.

CONCLUSIONS

There is a paucity of AMS research informed by complexity theory, and no policy documents could be located using complexity as a guiding theory. Mixed methods, informed by complexity theory, is a potentially suitable strategy to develop, implement and evaluate AMS as a complex intervention.

A cross-sectional questionnaire survey on knowledge of anti-protozoal drug use and resistance among AHPs in Kwara State, Nigeria

Antimicrobial resistance is a global public health crisis. However, there is a paucity of data on anti-protozoal resistance (APR), especially in animals. Hence, we assessed the knowledge of prudent antiprotozoal drug usage (APU) and resistance among animal health practitioners (AHPs) in Kwara State, Nigeria.

A cross-sectional survey of 435 AHPs was performed in Kwara State from the 5th of March to the 31st of July 2020 using a structured and validated questionnaire. We used logistic regression analysis to identify socio-demographic factors that are associated with the satisfactory perception of prudent APU and good knowledge of APR among AHPs.

Our findings showed that 80.2% (n = 349) of the AHPs in Kwara state had a good knowledge of APR with a mean knowledge score of 5.8 ± 1.2. In the same vein, 75.6% (n = 329) of the AHPs had a satisfactory perception of prudent APU with a mean score of 3.84 ± 1.21. Only 10.1% of the AHPs had observed treatment failures after the use of anti-protozoal drugs. Most of the AHPs (75.6%) believed that APR poses a significant threat to animal production and health globally. Logistic regression analysis showed that female AHPs were more likely (OR: 2.17; 95% CI: 0.91, 5.20; p < 0.005) to have better knowledge of APR than their male counterparts. AHPs with tertiary education were likely (OR: 2.77; 95% CI: 0.96, 4.99; p < 0.05) to be more knowledgeable about APR and have satisfactory perceptions of APU (OR: 1.57; 95% CI: 1.16, 2.99; p = 0.07) respectively. Finally, veterinarians were 3.76 times (95% CI:1.26, 9.25; p < 0.001) more likely to have good knowledge of APR and better perceptions of APU (OR: 3.28; 95% CI: 1.89, 5.68; p < 0.001) than other AHPs respectively.

To control antimicrobial resistance, continuous training of AHPs especially para-veterinary officers is essential to update their knowledge on prudent antimicrobial usage and prevent the emergence of resistant protozoan parasites.