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Koroma AT, Bundu PM, Sheriff M, Baryon B, Gamaga B, Sillah F, Lebbie M, Ngobeh D, Moiwo MM, Morrison J, Sesay ADD, Kamara S, Jalloh M, Nyandemoh H, Massaquoi M, Kamara KN, Kanu JS, Squire JS, Hakizimana JL, Elduma AH, Gebru GN. Behavioral practices towards antibiotic use among health care workers - Sierra Leone, 2021: a facility-based cross-sectional study. Pan Afr Med J 2024; 47:63. [PMID: 38681099 PMCID: PMC11055189 DOI: 10.11604/pamj.2024.47.63.39287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction globally, antimicrobial resistance (AMR) kills around 1.27 million 700,000 people each year. In Sierra Leone, there is limited information on antibiotic use among healthcare workers (HCWs). We assessed antibiotic prescribing practices and associated factors among HCWs in Sierra Leone. Methods we conducted a cross-sectional survey among HCWs. We collected data using a questionnaire containing a Likert scale for antibiotic prescribing practices. We categorized prescribing practices into good and poor practices. We calculated adjusted odds ratios (aOR) to identify risk factors. Results out of 337 (100%) HCWs, 45% scored good practice. Out of the total, 131 (39%) of HCWS considered fever as an indication of antibiotic resistance and 280 (83%) HCWs prescribed antibiotics without performing microbiological tests and 114 (34%) prescribed a shorter course of antibiotics. Factors associated with good practice were being a doctor (aOR=1.95; CI: 1.07, 3.56), the internet as a source of information (aOR=2.00; CI: 1.10, 3.66), having a high perception that AMR is a problem in the health-facility (aOR=1.80; CI: 1.01, 3.23) and there is a connection between one´s prescription and AMR (aOR=2.15; CI: 1.07, 4.32). Conclusion this study identified a low level of good practice toward antibiotic prescription. We initiated health education campaigns and recommended continuous professional development programs on antibiotic use.
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Affiliation(s)
| | | | - Musa Sheriff
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Brima Baryon
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Brima Gamaga
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Foday Sillah
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Munis Lebbie
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Daniel Ngobeh
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | | | - Jefery Morrison
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Abu Dim Din Sesay
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Samba Kamara
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Mustapha Jalloh
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Haurace Nyandemoh
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Momoh Massaquoi
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Kadijatu Nabie Kamara
- African Field Epidemiology Network, Field Epidemiology Training Program, Freetown, Sierra Leone
| | - Joseph Sam Kanu
- African Field Epidemiology Network, Field Epidemiology Training Program, Freetown, Sierra Leone
- Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - James Sylvester Squire
- African Field Epidemiology Network, Field Epidemiology Training Program, Freetown, Sierra Leone
- Department of Community Health, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jean Leonard Hakizimana
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Adel Hussein Elduma
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gebrekrstos Negash Gebru
- Sierra Leone Field Epidemiology Training Program, Freetown, Sierra Leone
- National Disease Surveillance Program, Ministry of Health and Sanitation, Freetown, Sierra Leone
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Mittal N, Goel P, Goel K, Sharma R, Nath B, Singh S, Thangaraju P, Mittal R, Kahkasha K, Mithra P, Sahu R, Priyadarshini RP, Sharma N, Pala S, Rohilla SK, Kaushal J, Sah S, Rustagi S, Sah R, Barboza JJ. Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India. Antibiotics (Basel) 2023; 12:1496. [PMID: 37887197 DOI: 10.3390/antibiotics12101496] [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: 08/26/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Parul Goel
- Department of Biochemistry, Shri Atal Bihari Vajpayee Government Medical College, Chhainsa, Faridabad 121004, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rashmi Sharma
- Department of Community Medicine, GMERS Medical College Sola, Ahmedabad 380060, India
| | - Bhola Nath
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raebareli 229405, India
| | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur 342001, India
| | | | - Rakesh Mittal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Kahkasha Kahkasha
- Department of Biochemistry, All India Institute of Medical Sciences, Deoghar 814152, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal 575001, India
| | - Rajesh Sahu
- Department of Community Medicine, Armed Forces Medical College, Pune 411040, India
| | - Raman P Priyadarshini
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal 609602, India
| | - Nikita Sharma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bilaspur 174037, India
| | - Star Pala
- Department of Community Medicine, NEIGRIHMS, Shillong 793018, India
| | - Suneel Kumar Rohilla
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Jyoti Kaushal
- Department of Pharmacology, Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, India
| | - Sanjit Sah
- Global Consortium for Public Health and Research, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha 442001, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun 248007, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Kathmandu 46000, Nepal
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Truppa C, Alonso B, Clezy K, Deglise C, Dromer C, Garelli S, Jimenez C, Kanapathipillai R, Khalife M, Repetto E. Antimicrobial stewardship in primary health care programs in humanitarian settings: the time to act is now. Antimicrob Resist Infect Control 2023; 12:89. [PMID: 37667372 PMCID: PMC10476422 DOI: 10.1186/s13756-023-01301-4] [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: 12/09/2022] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
Fragile and conflict-affected settings bear a disproportionate burden of antimicrobial resistance, due to the compounding effects of weak health policies, disrupted medical supply chains, and lack of knowledge and awareness about antibiotic stewardship both among health care providers and health service users. Until now, humanitarian organizations intervening in these contexts have confronted the threat of complex multidrug resistant infections mainly in their surgical projects at the secondary and tertiary levels of care, but there has been limited focus on ensuring the implementation of adequate antimicrobial stewardship in primary health care, which is known to be setting where the highest proportion of antibiotics are prescribed. In this paper, we present the experience of two humanitarian organizations, Médecins sans Frontières and the International Committee of the Red Cross, in responding to antimicrobial resistance in their medical interventions, and we draw from their experience to formulate practical recommendations to include antimicrobial stewardship among the standards of primary health care service delivery in conflict settings. We believe that expanding the focus of humanitarian interventions in unstable and fragile contexts to include antimicrobial stewardship in primary care will strengthen the global response to antimicrobial resistance and will decrease its burden where it is posing the highest toll in terms of mortality.
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Affiliation(s)
- Claudia Truppa
- International Committee of the Red Cross, Geneva, Switzerland.
- CRIMEDIM Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, University of Eastern Piedmont, Novara, Italy.
| | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | - Carole Dromer
- International Committee of the Red Cross, Geneva, Switzerland
| | - Silvia Garelli
- International Committee of the Red Cross, Geneva, Switzerland
| | | | | | | | - Ernestina Repetto
- Médecins Sans Frontières, Geneva, Switzerland
- Service des Maladies Infectieuses, Clinique Hospitalière Universitaire Saint Pierre, Bruxelles, Belgium
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Farooqui M, Iqbal Z, Sadiq A, Raziq A, Alshammari MS, Iqbal Q, Haider S, Saleem F. Hospital Pharmacists' Viewpoint on Quality Use of Antibiotics and Resistance: A Qualitative Exploration from a Tertiary Care Hospital of Quetta City, Pakistan. Antibiotics (Basel) 2023; 12:1343. [PMID: 37627763 PMCID: PMC10451787 DOI: 10.3390/antibiotics12081343] [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: 06/26/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/27/2023] Open
Abstract
Suboptimal antibiotics use and the development of antibiotic resistance is a universal calamity. The theoretical model of therapeutic efficacy correlates quality use of antibiotics with healthcare practitioners' understanding of antibiotic use and resistance. Keeping this phenomenon in mind, we aimed to evaluate hospital pharmacists' understanding of antibiotic use and resistance at a public healthcare institute in Quetta city, Pakistan. This was a qualitative study that employed a semi-structured interview guide for data extraction. The phenomenology-based approach commissioned in-depth, face-to-face interviews with hospital pharmacists stationed at the surgical unit of Sandeman Provincial Hospital, Quetta. The interviews were audio taped followed by transcribed verbatim and were then analyzed for thematic contents by the standard content analysis framework. Although the saturation was reached after the 10th interview, we conducted two additional interviews for definite validation. Content analysis revealed five major themes: (1) Defining antibiotics, quality use of antibiotics and resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. The knowledge of quality use of antibiotics and resistance was promising, and the respondents were eager to address the drastic situation. The respondents were aware of the critical situation and provided valuable insights that can offer valued input while promoting the quality use of antibiotics in a developing country. The current study managed to identify an adequate understanding of antibiotic use and resistance among hospital pharmacists. Additionally, prospective concerns and possible predictors of antibiotic resistance were also highlighted. The current findings must be disseminated to the policymakers and prescribers to take prompt restorative actions to address antibiotic use and the development of antibiotic resistance in a developing country like Pakistan.
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Affiliation(s)
- Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia; (M.F.); (M.S.A.)
| | - Zaffar Iqbal
- Health Department, Government of Balochistan, Quetta 87100, Pakistan;
| | - Abdul Sadiq
- Jhalawan Medical College Khuzdar, Khuzdar 89100, Pakistan;
| | - Abdul Raziq
- Department of Statistics, University of Balochistan, Quetta 87300, Pakistan;
| | - Mohammed Salem Alshammari
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia; (M.F.); (M.S.A.)
| | - Qaiser Iqbal
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta 87300, Pakistan; (Q.I.); (S.H.)
| | - Sajjad Haider
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta 87300, Pakistan; (Q.I.); (S.H.)
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta 87300, Pakistan; (Q.I.); (S.H.)
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Niyomyart A, Chow SKY, Bualoy W, Butsing N, Tao X, Zhu X. Antibiotic Knowledge, Antibiotic Resistance Knowledge, and Antibiotic Use: A Cross-Sectional Study among Community Members of Bangkok in Thailand. Antibiotics (Basel) 2023; 12:1312. [PMID: 37627731 PMCID: PMC10451775 DOI: 10.3390/antibiotics12081312] [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: 07/15/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
This study aimed to explore antibiotic knowledge, antibiotic resistance knowledge, and antibiotic use among adults in Bangkok, Thailand. This is a secondary analysis of cross-sectional data generated from a sample of 161 individuals living in Bangkok. Participants completed an online self-administered questionnaire developed by the World Health Organization. Descriptive analysis, the chi-square test, and multiple logistic regression analyses were performed. The sample comprised more females (56.5%) than males (42.2%). The majority of responders (67.7%) were between the ages of 18 and 40. More than half of the respondents mistakenly believed that antibiotics could treat colds and flu (54.7% and 47.2%, respectively). About 54.7% were aware that antibiotic resistance could harm them and their families. The chi-square test results showed that the levels of education were associated with antibiotic knowledge (p = 0.012), antibiotic resistance knowledge (p < 0.001), and antibiotic use (p = 0.023). Multiple logistic regressions showed that respondents with at least a bachelor's degree or higher had better knowledge of antibiotics. Respondents who worked in the profession had better knowledge of antibiotic resistance. Respondents with sufficient incomes were more likely to use antibiotics. Baseline data from the study will be useful in antibiotic stewardship and public health campaigns among Bangkok residents.
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Affiliation(s)
- Atsadaporn Niyomyart
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.B.); (N.B.)
| | - Susan Ka Yee Chow
- Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China;
| | - Wunwisa Bualoy
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.B.); (N.B.)
| | - Nipaporn Butsing
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.B.); (N.B.)
| | - Xingjuan Tao
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China;
| | - Xuejiao Zhu
- School of Nursing, Hangzhou Normal University, Hangzhou 311121, China;
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Bepari AK, Rabbi G, Shaon HR, Khan SI, Zahid ZI, Dalal K, Reza HM. Factors Driving Antimicrobial Resistance in Rural Bangladesh: A Cross-Sectional Study on Antibiotic Use-Related Knowledge, Attitude, and Practice Among Unqualified Village Medical Practitioners and Pharmacy Shopkeepers. Adv Ther 2023; 40:3478-3494. [PMID: 37291375 PMCID: PMC10329962 DOI: 10.1007/s12325-023-02547-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Inappropriate antibiotic use in community settings significantly contributes to antimicrobial resistance (AMR) globally, compromising the quality of life and threatening public health. This study aimed to identify AMR contributing factors by analyzing the knowledge, attitude, and practice (KAP) of the unqualified village medical practitioners and pharmacy shopkeepers in rural Bangladesh. METHODS We performed a cross-sectional study where the participants were pharmacy shopkeepers and unqualified village medical practitioners aged ≥ 18 years and living in Sylhet and Jashore districts in Bangladesh. Primary outcome variables were knowledge, attitude, and practice of antibiotic use and AMR. RESULTS Among the 396 participants, all were male aged between 18 and 70 years, 247 were unqualified village medical practitioners, and 149 were pharmacy shopkeepers, and the response rate was 79%. Participants showed moderate to poor knowledge (unqualified village medical practitioners, 62.59%; pharmacy shopkeepers, 54.73%), positive to neutral attitude (unqualified village medical practitioners, 80.37%, pharmacy shopkeepers, 75.30%), and moderate practice (unqualified village medical practitioners, 71.44%; pharmacy shopkeepers, 68.65%) scores regarding antibiotic use and AMR. The KAP score range was 40.95-87.62%, and the mean score was statistically significantly higher for unqualified village medical practitioners than pharmacy shopkeepers. Multiple linear regression analysis suggested that having a bachelor's degree, pharmacy training, and medical training were associated with higher KAP scores. CONCLUSION Our survey results demonstrated that unqualified village medical practitioners and pharmacy shopkeepers in Bangladesh possess moderate to poor knowledge and practice scores on antibiotic use and AMR. Therefore, awareness campaigns and training programs targeting unqualified village medical practitioners and pharmacy shopkeepers should be prioritized, antibiotic sales by pharmacy shopkeepers without prescriptions should be strictly monitored, and relevant national policies should be updated and implemented.
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Affiliation(s)
- Asim Kumar Bepari
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Golam Rabbi
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Habibur Rahman Shaon
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Sabrin Islam Khan
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Zahidul Islam Zahid
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh
| | - Koustuv Dalal
- Division of Public Health Science, Institute of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
| | - Hasan Mahmud Reza
- Department of Pharmaceutical Sciences, North South University, Dhaka, Bangladesh.
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Taylor W, Whittaker LM, Fletcher T, Collins A, Grant R, Gossell-Williams M. Awareness of inappropriate use related to antimicrobial resistance among medical doctors by country economic status: A systematic review. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2023; 34:227-242. [PMID: 36530092 DOI: 10.3233/jrs-220044] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is promoted by inappropriate use and is a greater burden for low to middle income countries (LMIC) than high income countries (HIC). OBJECTIVE This systematic review aimed to compare the awareness of inappropriate use related to AMR among medical doctors from LMIC and HIC using published knowledge, attitude and practice (KAP) studies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, sequential systematic literature search of PubMed and Web of Science databases for articles published since inception up to June 1, 2022 for KAP studies involving medical doctors. Using fifteen KAP items related to promoting AMR, data on proportion of participants responding affirmatively was extracted and reported using means, ranges and 95% confidence intervals (CI). RESULTS Forty-two studies met the inclusion criteria and involved 13,089 medical doctors from 11HIC and 21LMIC. All were cross-sectional studies, 71.4% involved non-probability sampling and 78.6% were of satisfactory quality. Knowledge items showed mean proportion of more medical doctors responding correctly. Similar affirmation trends were observed for attitude and prescribing practice items. Awareness appeared similar between medical doctors of the economic groups, except for a greater interest in training for LMIC (95.4%; 95%CI 93.0%, 97.9%) versus HIC (81.7%; 95%CI 65.6%, 97.9%). Countries with poor proportions were identified in both economic groups. CONCLUSION For identified studies, trends suggest good awareness among medical doctors of the known inappropriate use and perceived threat of AMR, as well as prescribing practices to reduce the risk of AMR. Trends were similar across HIC and LMIC; however, countries with evidence of poor awareness exist in both economic groups.
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Affiliation(s)
- Winthrop Taylor
- Section of Pharmacology & Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Lisa-Marie Whittaker
- Section of Pharmacology & Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Trevon Fletcher
- Section of Pharmacology & Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Anthony Collins
- Section of Pharmacology & Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Ryan Grant
- Section of Pharmacology & Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Maxine Gossell-Williams
- Section of Pharmacology & Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
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Montoya-Urrego D, Velasco-Castaño JJ, Quintero Velez JC, Jiménez Quiceno JN. Knowledge, Attitudes, and Practices (KAP) About Antibiotic Use in Hemodialysis Patients with Chronic Kidney Disease and Their Household Contacts, Medellín-Colombia. Infect Drug Resist 2023; 16:1725-1736. [PMID: 36999128 PMCID: PMC10046125 DOI: 10.2147/idr.s392680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/16/2023] [Indexed: 04/01/2023] Open
Abstract
Purpose The lack of knowledge and the excessive and inappropriate use of antibiotics are some of the causes of bacterial resistance. Hemodialysis patients have a high consumption of antibiotics and are constantly cared by their household contacts. This population circulates between hospital and community and are a model to study knowledge regarding bacterial resistance and antibiotic use in these settings. This study describes the knowledge, attitudes and practices (KAP) about antibiotic use and bacterial resistance in hemodialysis patients and their household contacts in Medellín-Colombia. Patients and Methods A cross-sectional descriptive study was conducted on hemodialysis patients from a renal unit associated with a hospital in Medellín-Colombia, and their household contacts between May 2019 and March 2020. A KAP instrument was applied to participants during home visits. The KAP regarding antibiotic use were characterized, and a content analysis of open questions was made. Results A total of 35 hemodialysis patients and 95 of their household contacts were included. Of participants, 83.1% (108/130) did not correctly identify the situations in which antibiotics should be used. Likewise, a gap in knowledge about antibacterial resistance was evidenced thanks to the emerging categories in content analysis. Regarding attitudes, 36.9% (48/130) of the participants discontinued antibiotic treatment when they felt better. Additionally, 43.8% (57/130) agree to keep antibiotics in their home. Finally, it was found that it is usual for pharmacists and family members to recommend or sell antibiotics without prescription; likewise, pharmacies were the most popular place to acquire these medications. Conclusion This study identified gaps in KAP regarding the use of antibiotics and bacterial resistance in hemodialysis patients and their household contacts. This allows focusing education strategies in this regard, in order to increase awareness about the correct use of antibiotics and the consequences of bacterial resistance and to improve prevention actions in this vulnerable population.
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Affiliation(s)
- Daniela Montoya-Urrego
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Juan José Velasco-Castaño
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Juan C Quintero Velez
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación Ciencias Veterinarias Centauro, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia
- Grupo de Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - J Natalia Jiménez Quiceno
- Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
- Correspondence: J Natalia Jiménez Quiceno, Universidad de Antioquia, Escuela de Microbiología, Calle 67 No. 53-108, Medellín, Antioquia, 050010, Colombia, Tel +57 604 219 54 97; +574-219-5481, Email
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Armas Freire PI, Gaspar GG, Zurita J, Salazar G, Velez JW, Bollela VR. E-Learning versus Face-to-Face Methodology for Learning Antimicrobial Resistance and Prescription Practice in a Tertiary Hospital of a Middle-Income Country. Antibiotics (Basel) 2022; 11:antibiotics11121829. [PMID: 36551486 PMCID: PMC9774894 DOI: 10.3390/antibiotics11121829] [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: 11/07/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Antimicrobial resistance is a growing health problem worldwide. One strategy to face this problem in a reasonable way is training health personnel for the rational use of antimicrobials. There are some difficulties associated with medical staff to receiving training with E-learning education, but there is a lack of studies and insufficient evidence of the effectiveness of this method compared to face-to-face learning. Methods: An educational intervention on antimicrobial resistance (AMR) and antimicrobial prescription practice (APP) was designed and implemented using two approaches: face-to-face and E-learning among physicians of the intensive care unit (ICU) and internal medicine ward (IMW) at Eugenio Espejo Hospital in Quito. Modalities of interventions were compared to propose a strategy of continuous professional development (CPD) for all hospital staff. An interventional study was proposed using a quasi-experimental approach that included 91 physicians, of which 49 belong to the IMW and 42 to the ICU. All of them received training on AMR—half in a face-to-face mode and the other half in an asynchronous E-learning mode. They then all participated on APP training but with switched groups; those who previously participated in the face-to-face experience participated in an E-learning module and vice-versa. We evaluated self-perception about basic knowledge, attitudes and referred practices towards AMR and APP before and after the intervention. A review of medical records was conducted before and after training by checking antimicrobial prescriptions for all patients in the ICU and IMW with bacteremia, urinary tract infection (UTI), pneumonia, and skin and soft tissue infection. The study received IRB clearance, and we used SPSS for statistical analysis. Results: No statistically significant difference was observed between the E-learning and the face-to-face methodology for AMR and APP. Both methodologies improved knowledge, attitudes and referred practices. In the case of E-learning, there was a self-perception of improved attitudes (p < 0.05) and practices (p < 0.001) for both AMR and APP. In face-to-face, there was a perception of improvement only in attitudes (p < 0.001) for APP. In clinical practice, the use of antimicrobials significantly improved in all domains after training, including empirical and targeted treatment of bacteremia and pneumonia (p < 0.001) and targeted treatment of UTI (p < 0.05). For the empirical treatment of pneumonia, the mean number of antibiotics was reduced from 1.87 before to 1.05 after the intervention (p = 0.003), whereas in the targeted management of bacteremia, the number of antibiotics was reduced from 2.19 to 1.53 (p = 0.010). Conclusions: There was no statistically significant difference between the effect of E-learning and face-to-face strategy in terms of teaching AMR and APP. Adequate self-reported attitudes and practices in E-learning exceed those of the face-to-face approach. The empiric and targeted use of antimicrobials improved in all reviewed cases, and we observed an overall decrease in antibiotic use. Satisfaction with training was high for both methods, and participants valued the flexibility and accessibility of E-learning.
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Affiliation(s)
| | - Gilberto Gambero Gaspar
- Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | - Jeannete Zurita
- Biomedical Research Unit, Zurita & Zurita Laboratories and Medical School, Pontifical Catholic University of Ecuador, Quito 170104, Ecuador
| | - Grace Salazar
- Infection Service, Oncologic Solca Hospital, Quito 170138, Ecuador
| | - Jorge Washington Velez
- Division of Education and Research, Hospital de Especialidades Eugenio Espejo, Central University of Ecuador, Quito 170136, Ecuador
| | - Valdes Roberto Bollela
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
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Debsarma D. Exploring the strategies for upgrading the Rural Unqualified Health Practitioners in West Bengal, India: A Knowledge, Attitude and Practices assessment-based approach. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Salcedo S, Mora L, Fernandez D, Marín A, Berrío-Medina I, Mendoza-Charris H, Viana-Cárdenas E, Polo-Rodríguez M, Muñoz-Garcia L, Alvarez-Herrera J, Olivares-Goenaga G, Jimenez-Castro Y, Castro del Portillo V, Chiquillo-Gómez S, Barrios-Matute L, Villa-García J, Gonzalez-Mattos Y, Torres-Barraza J, Jaraba-Coronado R, Maestre-Serrano R. Knowledge, attitudes, and behavior regarding antibiotics, antibiotic use, and antibiotic resistance in students and health care professionals of the district of Barranquilla (Colombia): A cross-sectional survey. Heliyon 2022; 8:e11378. [DOI: 10.1016/j.heliyon.2022.e11378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/17/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
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12
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Dohou AM, Buda VO, Anagonou S, Van Bambeke F, Van Hees T, Dossou FM, Dalleur O. Healthcare Professionals’ Knowledge and Beliefs on Antibiotic Prophylaxis in Cesarean Section: A Mixed-Methods Study in Benin. Antibiotics (Basel) 2022; 11:antibiotics11070872. [PMID: 35884126 PMCID: PMC9312278 DOI: 10.3390/antibiotics11070872] [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: 05/10/2022] [Revised: 06/16/2022] [Accepted: 06/25/2022] [Indexed: 02/01/2023] Open
Abstract
A low adherence to recommendations on antibiotic prophylaxis has been reported worldwide. Since 2009, cesarean sections have been performed under user fee exemption in Benin with a free kit containing the required supplies and antibiotics for prophylaxis. Despite the kit, the level of antibiotic prophylaxis achievement remains low. We conducted a convergent parallel design study in 2017 using a self-administered questionnaire and interviews to assess the knowledge and explore the beliefs of healthcare professionals regarding antibiotic prophylaxis in three hospitals. Of the 35 participants, 33 filled out the questionnaire. Based on the five conventional criteria of antibiotic prophylaxis, the mean level of knowledge was 3.3 out of 5, and only 15.2% scored 5 out of 5. From the verbatim of 19 interviewees, determinants such as suboptimal patient status health, low confidence in antibiotics, some disagreement with the policy, inappropriate infrastructures and limited financial resources in hospitals, poor management of the policy in the central level, and patient refusal to buy antibiotics can explain poor practices. Because of the dysfunction at these levels, the patient becomes the major determinant of adequate antibiotic prophylaxis. Policymakers have to consider these determinants for improving antibiotic prophylaxis in a way that ensures patient safety and reduces the incidence of antimicrobial resistance.
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Affiliation(s)
- Angèle Modupè Dohou
- Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium; (F.V.B.); (O.D.)
- Faculté des Sciences de la Santé, Université d’Abomey Calavi, Cotonou 01 BP 188, Benin; (S.A.); (F.M.D.)
- Correspondence: or ; Tel.: +229-66652575
| | - Valentina Oana Buda
- Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania;
| | - Severin Anagonou
- Faculté des Sciences de la Santé, Université d’Abomey Calavi, Cotonou 01 BP 188, Benin; (S.A.); (F.M.D.)
| | - Françoise Van Bambeke
- Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium; (F.V.B.); (O.D.)
| | - Thierry Van Hees
- Center for Interdisciplinary Research on Medicines, Université de Liège, Place du 20 Août 7, 4000 Liège, Belgium;
| | - Francis Moïse Dossou
- Faculté des Sciences de la Santé, Université d’Abomey Calavi, Cotonou 01 BP 188, Benin; (S.A.); (F.M.D.)
| | - Olivia Dalleur
- Louvain Drug Research Institute, Université Catholique de Louvain, Avenue Emmanuel Mounier 73, 1200 Brussels, Belgium; (F.V.B.); (O.D.)
- Service de Pharmacie Clinique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
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13
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Lalithabai DS, Hababeh MO, Wani TA, Aboshaiqah AE. Knowledge, Attitude and Beliefs of Nurses Regarding Antibiotic use and Prevention of Antibiotic Resistance. SAGE Open Nurs 2022; 8:23779608221076821. [PMID: 35600006 PMCID: PMC9118425 DOI: 10.1177/23779608221076821] [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: 08/19/2020] [Revised: 11/04/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Resistance to antibiotics is a threat confronting health care system worldwide. Nurses play a significant role in combating this threat. Objectives The present study examined the knowledge and attitude of nurses towards antibiotic use and prevention of antibiotic resistance. Methods The research involved a cross-sectional study conducted in a multi-cultural tertiary healthcare setting. The participants were 341 nurses. A structured self-administered questionnaire with a good validity and reliability (α = 0.7) was used. Results The nurses surveyed showed moderate awareness of antibiotic resistance and a fair attitude towards its prevention. There was no significant correlation of demographic features with their overall knowledge and attitude ( p > 0.05). Conclusions Nurses perform a crucial part in infection control, but often lack knowledge of methods to prevent antibiotic resistance. This paucity highlights the importance of tailored interventions to help nurses improve their awareness of antibiotic resistance and create a favorable attitude towards its prevention.
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14
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Gautham M, Miller R, Rego S, Goodman C. Availability, Prices and Affordability of Antibiotics Stocked by Informal Providers in Rural India: A Cross-Sectional Survey. Antibiotics (Basel) 2022; 11:antibiotics11040523. [PMID: 35453278 PMCID: PMC9026796 DOI: 10.3390/antibiotics11040523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/04/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
Providers without formal training deliver healthcare and antibiotics across rural India, but little is known about the antibiotics that they stock. We conducted a cross-sectional survey of such informal providers (IPs) in two districts of West Bengal, and assessed the availability of the antibiotics, as well as their sales volumes, retail prices, percentage markups for IPs and affordability. Of the 196 IPs that stocked antibiotics, 85% stocked tablets, 74% stocked syrups/suspensions/drops and 18% stocked injections. Across all the IPs, 42 antibiotic active ingredients were stocked, which comprised 278 branded generics from 74 manufacturers. The top five active ingredients that were stocked were amoxicillin potassium clavulanate (52% of the IPs), cefixime (39%), amoxicillin (33%), azithromycin (25%) and ciprofloxacin (21%). By the WHO's AWaRe classification, 71% of the IPs stocked an ACCESS antibiotic and 84% stocked a WATCH antibiotic. The median prices were in line with the government ceiling prices, but with substantial variation between the lowest and highest priced brands. The most affordable among the top five tablets were ciprofloxacin, azithromycin, cefixime and amoxicillin (US$ 0.8, 0.9, 1.9 and 1.9 per course), and the most affordable among the syrups/suspensions/drops were azithromycin and ofloxacin (US$ 1.7 and 4.5 per course, respectively), which are mostly WATCH antibiotics. IPs are a key source of healthcare and antibiotics in rural communities; practical interventions that target IPs need to balance restricting WATCH antibiotics and expanding the basket of affordable ACCESS antibiotics.
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15
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Mutagonda RF, Marealle AI, Nkinda L, Kibwana U, Maganda BA, Njiro BJ, Ndumwa HP, Kilonzi M, Mikomangwa WP, Mlyuka HJ, Felix FF, Myemba DT, Mwakawanga DL, Sambayi G, Kunambi PP, Ndayishimiye P, Sirili N, Mfaume R, Nshau A, Nyankesha E, Scherpbier R, Bwire GM. Determinants of misuse of antibiotics among parents of children attending clinics in regional referral hospitals in Tanzania. Sci Rep 2022; 12:4836. [PMID: 35318386 PMCID: PMC8941073 DOI: 10.1038/s41598-022-08895-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/14/2022] [Indexed: 01/10/2023] Open
Abstract
Parents are the important implementers on appropriate/inappropriate use of antibiotics, especially in the pediatric population. Limited studies have associated poor knowledge, attitude, and practice (KAP) among parents with antibiotics misuse. Therefore, this study was conducted to determine the parents' KAP and factors associated with inappropriate use of antibiotics among Tanzanian children. A hospital-based cross-sectional study was conducted in 14 regional referral hospitals (RRHs) in Tanzania between June and September 2020. KAP was estimated using a Likert scale, whereas KAP factors were determined using logistic regression models. A total of 2802 parents were enrolled in the study. The median age (interquartile range) of parents was 30.0 (25-36) years where 82.4% (n = 2305) were female parents. The majority of the parents had primary education, 56.1% (n = 1567). Of 2802 parents, only 10.9% (n = 298) had good knowledge about antibiotics, 16.4% (n = 455) had positive attitude whereas 82.0% (n = 2275) had poor practice on the appropriate use of antibiotics. Parents' education level, i.e., having a university degree (aOR: 3.27 95% CI 1.62-6.63, p = 0.001), good knowledge (aOR: 1.70, 95% CI 1.19-2.23, p = 0.003) and positive attitudes (aOR: 5.56, 95% CI 4.09-7.56, p < 0.001) were significantly associated with the appropriate use of antibiotics in children. Most parents had poor knowledge, negative attitude, and poor practice towards antibiotics use in children. Parents' education level, employment status, knowledge on antibiotic use, and good attitude contributed to the appropriate use of antibiotics in children attending clinics at RRHs.
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Affiliation(s)
- Ritah F Mutagonda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Alphonce I Marealle
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Lilian Nkinda
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Upendo Kibwana
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Betty A Maganda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Harrieth P Ndumwa
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Fatuma F Felix
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - David T Myemba
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Godfrey Sambayi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Peter P Kunambi
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | | | - Nathanael Sirili
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Rashid Mfaume
- Regional Administrative Secretary, Dar Es Salaam Region, P.O. Box 5429, Dar es Salaam, Tanzania
| | - Arapha Nshau
- Pharmacy Council, Ministry of Health, Community Development, Gender, Elderly and Children, P.O. Box 31818, Dar es Salaam, Tanzania
| | - Elevanie Nyankesha
- United Nations Children's Fund, New York Head Quarter, 3 United Nations Plaza, New York, NY, 10017, USA
| | - Robert Scherpbier
- United Nations Children's Fund, Bâtiment BIT, Route des Morillons 4, 1211, Geneva 22, Switzerland
| | - George M Bwire
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Marketing and Distribution System Foster Misuse of Antibiotics in the Community: Insights from Drugs Wholesalers in India. Antibiotics (Basel) 2022; 11:antibiotics11010095. [PMID: 35052974 PMCID: PMC8773092 DOI: 10.3390/antibiotics11010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
Antibiotic misuse is one of the major drivers of antimicrobial resistance (AMR). In India, evidence of antibiotic misuse comes largely from retailers as well as formal and informal healthcare providers (IHCPs). This paper presents the practices and perspectives of drug wholesalers, a critical link between manufacturers and last-mile dispensers. Four experienced wholesalers and an ex-State Drug Controller (ex-SDC) were interviewed in depth, using semi-structured guides in the National Capital Region of Delhi, India, between November 2020 and January 2021. Four main findings were that wholesalers (i) have limited knowledge about wholesale licensing and practice regulations, as well as a limited understanding of AMR; (ii) directly supply and sell antibiotics to IHCPs; (iii) facilitate medical representatives (MRs) of pharmaceutical companies and manufacturers in their strategies to promote antibiotics use in the community; and (iv) blame other stakeholders for unlawful sale and overuse of antibiotics. Some of the potential solutions aimed at wholesalers include having a minimum education qualification for licensing and mandatory Good Distribution Practices certification programs. Decoupling incentives by pharmaceutical companies from sales targets to improve ethical sales practices for MRs and optimize antibiotic use by IHCPs could alleviate wholesalers’ indirect actions in promoting antibiotic misuse.
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Akodu B, Bisola R, Temitope LA, Abdulrazzaq L, Philip O, Ibukunoluwa B, Patrick O, Olufunmilayo OA, Ganiya O, Chioma O, Oyinlola O. Knowledge, attitude, and prescribing practices of antimicrobials among doctors in the outpatient departments of Lagos university teaching hospital Idi-Araba: A cross sectional study. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_32_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Salameh B, Aboamash AEM. Predictors of Knowledge, Attitudes, Practices and Barriers Regarding Sepsis and Sepsis Management Among Emergency Nurses and Physicians in Palestine: A Cross-Sectional Analysis. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221115265. [PMID: 35932110 PMCID: PMC9364222 DOI: 10.1177/00469580221115265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sepsis is a widespread problem that can create clinical and economic
difficulties. This study aimed to determine the knowledge, attitudes, practices,
and barriers related to the sepsis and sepsis management among emergency nurses
and physicians. Data was collected using a self-questionnaire completed by the
participating nurses and physicians (n = 243), with a 61% response rate. The
study found that both emergency nurses and physicians had poor-to-moderate
levels of sepsis knowledge, with emergency physicians having better attitudes
regarding sepsis and sepsis management than emergency nurses. However, moderate
knowledge levels of sepsis practice and management were shown among both nurses
and physicians. It is evident that for emergency nurses and physicians, the
biggest barrier to providing quality care to patients with sepsis is the lack of
monitoring equipment. Both nurses and physicians need consistent sepsis
management information provided by continual education programs. Development of
an approved protocol can improve nurses’ knowledge, attitudes, and
practices.
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19
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Kumar G, Singh D, Hazarika S, Barman D, Dash P, Swain P. Knowledge and attitude of antibiotic resistance in the time of COVID-19 among patients attending a dental hospital in Bhubaneswar city. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2022. [DOI: 10.4103/ijam.ijam_93_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Palanisamy P, Ananthy V, Subramanian U. Perception of health professionals and the general population regarding the use of antibiotics and antibiotic resistance in Puducherry, South India. J Res Pharm Pract 2022; 11:8-12. [PMID: 36277971 PMCID: PMC9585803 DOI: 10.4103/jrpp.jrpp_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/19/2022] [Indexed: 11/04/2022] Open
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Muradyan D, Demirchyan A, Petrosyan V. Knowledge, Attitude, And Practice Towards Antibiotic Resistance Among General Practitioners in Polyclinics in Yerevan, Armenia. EURASIAN JOURNAL OF FAMILY MEDICINE 2021. [DOI: 10.33880/ejfm.2021100402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The objectives of the study were measuring knowledge, attitude, and practice scores among general practitioners on antibiotic resistance; exploring associations between antibiotics prescribing practice score among general practitioners and their knowledge and attitude scores after adjusting for other factors; and identifying barriers for rational antibiotics prescription by general practitioners.
Methods: A cross-sectional study design was used. A self-administered survey was conducted among general practitioners employed in private and public polyclinics in Yerevan, Armenia. All general practitioners, working in Yerevan polyclinics and fluent in the Armenian language, were eligible for the study. The study was conducted in primary healthcare facilities of Yerevan, Armenia. All polyclinics (n=18) serving 30,000 or more populations were included in the study. All general practitioners available in selected polyclinics at the time of the survey were invited to take part in the survey, to target 20 general practitioners from each polyclinic.
Results: Overall, 291 general practitioners participated in the study. Knowledge, attitude, and practice mean percent scores were 58.3%, 67.5%, and 63.0%, respectively. In the adjusted analysis, the practice percent score was significantly associated with the attitude percent score, though the relationship between the practice and knowledge scores was insignificant. The main barriers reported by general practitioners: lack of rapid diagnostic tests, high costs of laboratory tests, high costs of some antibiotics, and lack of guidelines.
Conclusion: Identified low knowledge, attitude, and practice mean percent scores suggest a need for improvements in these areas. Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions could potentially prevent the development of antibiotic resistance.
Keywords: drug resistance, general practitioners, polyclinics, prescribing
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Affiliation(s)
- Diana Muradyan
- Turpanjian College of Health Sciences, American University of Armenia
| | - Anahit Demirchyan
- Turpanjian College of Health Sciences, American University of Armenia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia
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22
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Carvalho HEF, Schneider G, dos Santos Junior AG, Batista OMA, Mondlane J, Ferreira AM, de Andrade D, da Costa Valle ARM. Prescription of Antimicrobials in Primary Health Care: Scoping Review. Open Nurs J 2021. [DOI: 10.2174/1874434602115010343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
To map the available evidence about the prescription of antimicrobials in Primary Health Care.
Methods:
A Scoping Review has been proposed based on the procedures recommended by the Joanna Briggs Institute.
Results:
This review included a total of 16 studies. The articles compiled demonstrated that this theme is the center of discussion, in a linear manner, over the past 12 years. Among the studies, 37.5% occurred in Brazil, and regarding the prescription of antimicrobials analyzed in studies, amoxicillin was the most prescribed, the physician was the prescribing professional in 12 studies, and the prescriptions were mostly intended for the general population (children, adolescents, adults and the elderly).
Conclusion:
This review ratifies the premise of rational use of antimicrobials promoted by the World Health Organization through the goals of sustainable development when understanding that these drugs have been considerably prescribed in the daily routine of Primary Health Care and there is no specific system to control and monitor their rational use.
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Pereira B, Kulkarni S. Antibiotic misuse and improper practices in India: Identifying the scope to improve through a narrative review. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 33:357-364. [PMID: 34924401 DOI: 10.3233/jrs-210020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In India, antibiotic resistance is high and by 2050, two million people will be affected. OBJECTIVE To review antibiotic practices in India and the variables that impact them. METHODS For this narrative review, research articles on antibiotic awareness, perception and practices were retrieved from PubMed and Google Scholar using search terms such as 'India AND antibiotic use AND cross sectional AND awareness'. A total of 1730 results were found on 30 June 2020, of which 35 articles were eligible for summarizing the common antibiotic practices. RESULTS We found that there are deficiencies in the implementation of existing policies in India. Several issues such as overprescribing of antibiotics, use without prescription and non-adherence to treatment regimens are contributing to irrational antibiotic practices in the country. CONCLUSION There is a need for policies at the institute level to help curb the problem of antibiotic resistance.
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Affiliation(s)
- Brinal Pereira
- Vivekanand Education Society's College of Pharmacy, Mumbai, India
| | - Shruti Kulkarni
- Vivekanand Education Society's College of Pharmacy, Mumbai, India
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Sychareun V, Sihavong A, Machowska A, Onthongdee X, Chaleunvong K, Keohavong B, Eriksen J, Hanson C, Vongsouvath M, Marrone G, Brauner A, Mayxay M, Kounnavong S, Lundborg CS. Knowledge, Attitudes, Perception and Reported Practices of Healthcare Providers on Antibiotic Use and Resistance in Pregnancy, Childbirth and Children under Two in Lao PDR: A Mixed Methods Study. Antibiotics (Basel) 2021; 10:antibiotics10121462. [PMID: 34943674 PMCID: PMC8698782 DOI: 10.3390/antibiotics10121462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Overuse and misuse of antibiotics contribute unnecessarily to antibiotic resistance (ABR), and are thereby global health threats. Inappropriate prescriptions of antibiotics during pregnancy, delivery and early childhood are widespread across the world. This study aimed to assess knowledge, attitudes, and reported practices of healthcare providers (HCPs) and to explore their perceptions regarding antibiotic use and ABR related to pregnancy, childbirth, and children under two in Lao PDR. Methods: This is a mixed methods study with data collection in 2019 via structured interviews among 217 HCPs (medical doctors/assistant doctors, midwives/nurses, pharmacists/assistant pharmacists and drug sellers), who prescribed/dispensed antibiotics in one rural and one urban district in Vientiane province and individual qualitative interviews with 30 HCPs and stakeholders. Results: Of the HCPs, 36% had below average knowledge regarding antibiotic use and ABR, and 67% reported prescribing antibiotics for uncomplicated vaginal delivery. Half of the HCPs did not believe that their prescribing contributed to ABR, and only 9% had participated in antibiotic education. Conclusion: A substantial number of HCPs had suboptimal knowledge and prescribed antibiotics unnecessarily, thereby contributing to ABR. Continuous education and regular supervision of HCPs is recommended to improve the use of antibiotics related to pregnancy, childbirth, and young children.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane 7444, Laos;
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane 01030, Laos;
| | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
- Correspondence:
| | - Xanded Onthongdee
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos; (X.O.); (S.K.)
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
| | - Bounxou Keohavong
- Food and Drug Department, Ministry of Health, Vientiane 01030, Laos;
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
- Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital, 11883 Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden;
- Division of Clinical Microbiology, Karolinska University Hospital, 17164 Solna, Sweden
| | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos; (X.O.); (S.K.)
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
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25
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Gandra S. Improving antimicrobial prescribing among healthcare professional trainees in India. Indian J Med Microbiol 2021; 39:423-424. [PMID: 34674873 DOI: 10.1016/j.ijmmb.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Sumanth Gandra
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, MO, USA.
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26
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Cheoun ML, Heo J, Kim WH. Antimicrobial Resistance: KAP of Healthcare Professionals at a Tertiary-Level Hospital in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10062. [PMID: 34639365 PMCID: PMC8532001 DOI: 10.3390/ijerph181910062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Although increasing antimicrobial resistance (AMR) is a substantial threat worldwide, low- and middle-income countries, including Nepal, are especially vulnerable. It is also known that healthcare providers (HCPs) are the major determinants of antimicrobial misuse. A cross-sectional, self-administered survey was conducted among 160 HCPs to assess the knowledge, attitudes, and practices (KAP) of Nepali HCPs regarding AMR and its use. Descriptive statistics and nonparametric tests were performed to evaluate KAP dimensions and investigate subgroup differences. HCPs scored higher on theoretical than practical knowledge. Regarding practical knowledge, men scored higher than women (p < 0.01), and physicians scored higher than nurses (p < 0.001). Participants aged < 25 years scored lower on practical knowledge than older participants (p < 0.001), while those with <3 years work experience scored lower than those with >6 years (p < 0.05). Participants from the medical department scored higher on practical knowledge than those from the surgical department (p < 0.01). AMR control was more accepted in the medical than in the surgical department (p < 0.001). Regarding practices, women and nurses scored higher than men (p < 0.001) and physicians (p < 0.01), respectively. An educational intervention that is tailored to the sociodemographic and professional characteristics of HCPs is necessary to reduce the gap between theoretical and practical knowledge and improve their attitudes and practices.
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Affiliation(s)
- Mee-Lang Cheoun
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Korea;
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Korea;
- National Assembly Futures Institute, 1 Uisadang-daero, Seoul 07233, Korea
| | - Woong-Han Kim
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, 71 Ihwajang-gil, Jongno-gu, Seoul 03087, Korea;
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
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27
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Anwar M, Raziq A, Shoaib M, Baloch NS, Raza S, Sajjad B, Sadaf N, Iqbal Z, Ishaq R, Haider S, Iqbal Q, Ahmad N, Haque N, Saleem F. Exploring Nurses' Perception of Antibiotic Use and Resistance: A Qualitative Inquiry. J Multidiscip Healthc 2021; 14:1599-1608. [PMID: 34234448 PMCID: PMC8254422 DOI: 10.2147/jmdh.s309020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Quality use of antibiotics and the development of antibiotic resistance is a global catastrophe. In the conceptual context, the phenomenon is correlated with the healthcare practitioners’ understanding of antibiotic use and resistance. Therefore, the study aimed to highlight nurses’ perception of antibiotic use and resistance at a public healthcare institute in Quetta City, Pakistan. Respondents and Methods By using a semi-structured interview guide through the phenomenology-based approach, in-depth, face-to-face interviews were conducted. Nurses practicing at the surgical and medical units of Sandeman Provincial Hospital (SPH), Quetta, were approached for the study. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results Although the saturation was reached after the 13th interview, an additional two were interviewed for absolute validation. Content analysis revealed five major themes: (1) defining antibiotics and antibiotic resistance, (2) antibiotic use: awareness and concern, (3) antimicrobial resistance: awareness and concern, (4) responding to antibiotic use and resistance, and (5) barriers to quality use of antibiotics and prevention of antibiotic resistance. Even though the understanding of nurses regarding antibiotic use and resistance was promising, certain apprehensions were also observed. The respondents were aware of the critical situation and provided valuable insights that can offer significant input while promoting the quality use of antibiotics in a developing country. Conclusion While the perception towards antibiotics appeared positive, potential areas of concern and contributing factors regarding antibiotic resistance were also identified. Importantly, nurses too highlighted possible solutions to address the issue of irrational antibiotic use and the development of antibiotic resistance.
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Affiliation(s)
- Muhammad Anwar
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Abdul Raziq
- Department of Statistics, University of Balochistan, Quetta, Pakistan
| | | | | | - Shanaz Raza
- Sardar Bahadur Khan Womens' University, Quetta, Pakistan
| | - Bisma Sajjad
- Sardar Bahadur Khan Womens' University, Quetta, Pakistan
| | - Nabila Sadaf
- Sardar Bahadur Khan Womens' University, Quetta, Pakistan
| | - Zaffar Iqbal
- Health Department, Government of Balochistan, Quetta, Pakistan
| | - Rabia Ishaq
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Sajjad Haider
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Qaiser Iqbal
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Nafees Ahmad
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Naheed Haque
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
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Rijal KR, Banjara MR, Dhungel B, Kafle S, Gautam K, Ghimire B, Ghimire P, Dhungel S, Adhikari N, Shrestha UT, Sunuwar DR, Adhikari B, Ghimire P. Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey. Sci Rep 2021; 11:11554. [PMID: 34078956 PMCID: PMC8172831 DOI: 10.1038/s41598-021-90812-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/18/2021] [Indexed: 01/21/2023] Open
Abstract
Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6-4.4)], versus secondary education (8-10 grade) [AOR = 1.8 (95% Cl = 1.0-3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.
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Affiliation(s)
- Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Samarpan Kafle
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Kedar Gautam
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Bindu Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | | | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Dev Ram Sunuwar
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
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Herawati F, Jaelani AK, Wijono H, Rahem A, Setiasih, Yulia R, Andrajati R, Soemantri D. Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study. Heliyon 2021; 7:e07377. [PMID: 34222701 PMCID: PMC8243519 DOI: 10.1016/j.heliyon.2021.e07377] [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: 02/03/2021] [Revised: 05/25/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Collaborative practice in healthcare has been recommended to improve the quality of antimicrobial stewardship interventions, a behavioral change in antimicrobial use. Insufficient knowledge regarding antibiotic resistance, the fear of complications from infections, and how providers perceive antibiotic use and resistance are likely to influence prescribing behavior. This study's objective was to identify the knowledge and belief healthcare professionals' differences about antibiotic stewardship. METHODS This cross-sectional survey study of three hospitals in the East Java province, Indonesia utilized a 43-item questionnaire to assess antimicrobial stewardship knowledge and belief. There were 12 knowledge questions (total possible score: 12) and 31 belief questions (total possible score: 155). The Kuder Richardson 20 (KR-20) and Cronbach alpha values of the questionnaire were 0.54 and 0.92, respectively. RESULTS Out of the 257 respondents, 19% (48/257) had a low scores of knowledge, and 39% (101/257) had low scores on belief about antibiotic stewardship (101/257). Most midwives had a low scores on knowledge (25/61) and low scores on belief (46/61). Respondents with high scores on belief were 17% (10/59) physicians, 15% (4/27) pharmacists, 8% (5/65) nurses, and 3% (2/61) midwives. CONCLUSION Among healthcare professionals, knowledge and belief differences concerning antibiotic stewardship vary widely. These differences will affect their capability, behavior, and contribution to the healthcare team collaboration and performance. Further studies are needed to evaluate the correlation between the level of inter-professional collaboration and the quality of the antibiotic stewardship implementation.
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Affiliation(s)
- Fauna Herawati
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, 60293, Indonesia
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia
| | | | - Heru Wijono
- Faculty of Medicine, Universitas Surabaya, Surabaya, 60293, Indonesia
| | - Abdul Rahem
- Community Pharmacy Department, Faculty of Pharmacy, Airlangga University, Surabaya, 60115, Indonesia
| | - Setiasih
- Laboratory for Developmental Psychology, Faculty of Psychology, Universitas Surabaya, Surabaya, 60293, Indonesia
| | - Rika Yulia
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, 60293, Indonesia
| | - Retnosari Andrajati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Depok, 16424, Indonesia
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Unicomb LE, Nizame FA, Uddin MR, Nahar P, Lucas PJ, Khisa N, Akter SMS, Islam MA, Rahman M, Rousham EK. Motivating antibiotic stewardship in Bangladesh: identifying audiences and target behaviours using the behaviour change wheel. BMC Public Health 2021; 21:968. [PMID: 34022819 PMCID: PMC8140425 DOI: 10.1186/s12889-021-10973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals and from a lack of policy compliance among healthcare providers. Additionally, there is high population density and high infectious disease burden. This paper describes the development of social and behavioural change communication (SBCC) to increase the appropriate use of antibiotics. METHODS We used formative research to explore contextual drivers of antibiotic sales, purchase, consumption/use and promotion among four groups: 1) households, 2) drug shop staff, 3) registered physicians and 4) pharmaceutical companies/medical sales representatives. We used formative research findings and an intervention design workshop with stakeholders to select target behaviours, prioritise audiences and develop SBCC messages, in consultation with a creative agency, and through pilots and feedback. The behaviour change wheel was used to summarise findings. RESULTS Workshop participants identified behaviours considered amenable to change for all four groups. Household members and drug shop staff were prioritised as target audiences, both of which could be reached at drug shops. Among household members, there were two behaviours to change: suboptimal health seeking and ceasing antibiotic courses early. Thus, SBCC target behaviours included: seek registered physician consultations; ask whether the medicine provided is an antibiotic; ask for instructions on use and timing. Among drug shop staff, important antibiotic dispensing practices needed to change. SBCC target behaviours included: asking customers for prescriptions, referring them to registered physicians and increasing customer awareness by instructing that they were receiving antibiotics to take as a full course. CONCLUSIONS We prioritised drug shops for intervention delivery to all drug shop staff and their customers to improve antibiotic stewardship. Knowledge deficits among these groups were notable and considered amenable to change using a SBCC intervention addressing improved health seeking behaviours, improved health literacy on antibiotic use, and provision of information on policy governing shops. Further intervention refinement should consider using participatory methods and address the impact on profit and livelihoods for drug shop staff for optimal compliance.
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Affiliation(s)
- Leanne E Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Fosiul Alam Nizame
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Rofi Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Papreen Nahar
- Department of Global Health and Infection, Brighton and Sussex Medical School, Sussex University, Brighton, UK
| | | | - Nirnita Khisa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S M Salim Akter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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31
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Gautham M, Spicer N, Chatterjee S, Goodman C. What are the challenges for antibiotic stewardship at the community level? An analysis of the drivers of antibiotic provision by informal healthcare providers in rural India. Soc Sci Med 2021; 275:113813. [PMID: 33721743 PMCID: PMC8164106 DOI: 10.1016/j.socscimed.2021.113813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022]
Abstract
In many low- and middle-income countries, providers without formal training are an important source of antibiotics, but may provide these inappropriately, contributing to the rising burden of drug resistant infections. Informal providers (IPs) who practise allopathic medicine are part of India's pluralistic health system legacy. They outnumber formal providers but operate in a policy environment of unclear legitimacy, creating unique challenges for antibiotic stewardship. Using a systems approach we analysed the multiple intrinsic (provider specific) and extrinsic (community, health and regulatory system and pharmaceutical industry) drivers of antibiotic provision by IPs in rural West Bengal, to inform the design of community stewardship interventions. We surveyed 291 IPs in randomly selected village clusters in two contrasting districts and conducted in-depth interviews with 30 IPs and 17 key informants including pharmaceutical sales representatives, managers and wholesalers/retailers; medically qualified private and public doctors and health and regulatory officials. Eight focus group discussions were conducted with community members. We found a mosaic or bricolage of informal practices conducted by IPs, qualified doctors and industry stakeholders that sustained private enterprise and supplemented the weak public health sector. IPs' intrinsic drivers included misconceptions about the therapeutic necessity of antibiotics, and direct and indirect economic benefits, though antibiotics were not the most profitable category of drug sales. Private doctors were a key source of IPs' learning, often in exchange for referrals. IPs constituted a substantial market for local and global pharmaceutical companies that adopted aggressive business strategies to exploit less-saturated rural markets. Paradoxically, the top-down nature of regulations produced a regulatory impasse wherein regulators were reluctant to enforce heavy sanctions for illegal sales, fearing an adverse impact on rural healthcare, but could not implement enabling strategies to improve antibiotic provision due to legal barriers. We discuss the implications for a multi-stakeholder antibiotic stewardship strategy in this setting.
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Affiliation(s)
- Meenakshi Gautham
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17, Tavistock Place, London, WC1H 9SH, UK.
| | - Neil Spicer
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17, Tavistock Place, London, WC1H 9SH, UK.
| | | | - Catherine Goodman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17, Tavistock Place, London, WC1H 9SH, UK.
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Chapot L, Sarker MS, Begum R, Hossain D, Akter R, Hasan MM, Bupasha ZB, Bayzid M, Salauddin M, Parvej MS, Uddin AHMM, Hoque F, Chowdhury J, Ullah MN, Rahman MK, Siddiky NA, Fournié G, Samad MA. Knowledge, Attitudes and Practices Regarding Antibiotic Use and Resistance among Veterinary Students in Bangladesh. Antibiotics (Basel) 2021; 10:332. [PMID: 33809932 PMCID: PMC8004205 DOI: 10.3390/antibiotics10030332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/17/2022] Open
Abstract
The use of antibiotics in animals for both therapeutic and non-therapeutic purposes is a major driver of the emergence and spread of antimicrobial resistance (AMR). While several studies have investigated prescription and consumption patterns in humans, little attention has been paid to the veterinary sector. A cross-sectional study was conducted in 3002 veterinary students (VS) and non-medical students (NMS) from 12 universities in Bangladesh to explore their knowledge, attitudes and practices (KAP) about antibiotics and AMR using a self-administered questionnaire, and assess the influence of the veterinary curriculum. KAP regarding antibiotic use and AMR was significantly higher in veterinary than non-medical students, and in first-year than final-year students. However, gaps in knowledge and practices were highlighted, suggesting deficiencies in training. Moreover, final-year veterinary students were found to be more likely than first-year students to use antibiotics without instructions, which could indicate deficiencies in their curriculum. Although the study suggested a positive impact of the veterinary curriculum on KAP about antibiotics and AMR in Bangladesh, critical gaps remain that are likely to contribute to inadequate use in their future practice. Therefore, there is scope for improving educational programs on AMR in professional curricula.
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Affiliation(s)
- Lorraine Chapot
- Pathobiology and Population Sciences, Royal Veterinary College, London NW1 0TU, UK; (L.C.); (G.F.)
| | - Md Samun Sarker
- Antimicrobial Resistance Action Center (ARAC), Bangladesh Livestock Research Institute (BLRI), Dhaka 1341, Bangladesh; (M.S.S.); (R.B.); (N.A.S.)
| | - Ruhena Begum
- Antimicrobial Resistance Action Center (ARAC), Bangladesh Livestock Research Institute (BLRI), Dhaka 1341, Bangladesh; (M.S.S.); (R.B.); (N.A.S.)
| | - Delower Hossain
- Department of Medicine and Public Health, Sher-e-Bangla Agricultural University, Dhaka 1207, Bangladesh;
| | - Rahima Akter
- Department of Pharmacy, World University of Bangladesh, Dhaka 1205, Bangladesh;
| | - Md Mehedi Hasan
- Department of Medicine, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh;
| | - Zamila Bueaza Bupasha
- Department of Microbiology and Veterinary Public Health, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh;
| | - Md Bayzid
- Department of Pathology and Parasitology, Chattogram Veterinary and Animal Sciences University, Chattogram 4225, Bangladesh;
| | - Md Salauddin
- Department of Microbiology, Hajee Mohammad Danesh Science and Technology University, Dinajpur 5200, Bangladesh;
| | | | - AHM Musleh Uddin
- Department of Surgery and Theriogenology, Sylhet Agricultural University, Sylhet 3100, Bangladesh;
| | - Fazlul Hoque
- Veterinary Medicine, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur 1706, Bangladesh;
| | - Joya Chowdhury
- Gono Bishwabidyalay, Dhaka 1344, Bangladesh; (M.S.P.); (J.C.)
| | - Md Niyamat Ullah
- Department of Veterinary and Animal Sciences, University of Rajshahi, Rajshahi 6205, Bangladesh;
| | | | - Nure Alam Siddiky
- Antimicrobial Resistance Action Center (ARAC), Bangladesh Livestock Research Institute (BLRI), Dhaka 1341, Bangladesh; (M.S.S.); (R.B.); (N.A.S.)
| | - Guillaume Fournié
- Pathobiology and Population Sciences, Royal Veterinary College, London NW1 0TU, UK; (L.C.); (G.F.)
| | - Mohammed A. Samad
- Antimicrobial Resistance Action Center (ARAC), Bangladesh Livestock Research Institute (BLRI), Dhaka 1341, Bangladesh; (M.S.S.); (R.B.); (N.A.S.)
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Nair MM, Mahajan R, Burza S, Zeegers MP. Behavioural interventions to address rational use of antibiotics in outpatient settings of low-income and lower-middle-income countries. Trop Med Int Health 2021; 26:504-517. [PMID: 33452857 PMCID: PMC8248115 DOI: 10.1111/tmi.13550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives To explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low‐income and lower‐middle‐income countries, an underrepresented area in the literature. Methods The systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low‐income and lower‐middle‐income countries. Behavioural interventions were classified as persuasive, enabling, restrictive, structural or bundle (mix of different interventions). In total, 3,514 abstracts were screened and 42 studies were selected for full‐text review, with 13 studies included in the final narrative synthesis. Results Of the 13 included studies, five were conducted in Vietnam, two in Sudan, two in Tanzania, two in India and two in Kenya. All studies were conducted in the outpatient or ambulatory setting: eight took place in primary health centres, two in private clinics and three in pharmacies. Our review found that enabling or educational interventions alone may not be sufficient to overcome the ingrained incentives to link revenue generation to sales of antibiotics, and hence, their inappropriate prescription or misuse. Bundle interventions appear to be very effective at changing prescription behaviour among healthcare providers, including drug sellers and pharmacists. Conclusions Multi‐faceted bundle interventions that combine regulation enforcement with face‐to‐face education and peer influence may be more effective than educational interventions alone at curbing inappropriate antibiotic use.
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Affiliation(s)
- Mohit M Nair
- Nutrition and Translational Research in Metabolism, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | | | - Maurice P Zeegers
- Nutrition and Translational Research in Metabolism, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Chatterjee S, Hazra A, Chakraverty R, Shafiq N, Pathak A, Trivedi N, Sadasivam B, Kakkar A, Jhaj R, Kaul R, Kshirsagar N. Knowledge, attitude, and practice survey on antimicrobial use and resistance among Indian clinicians: A multicentric, cross-sectional study. Perspect Clin Res 2021; 13:99-105. [PMID: 35573450 PMCID: PMC9106129 DOI: 10.4103/picr.picr_21_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/07/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022] Open
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Self-medication practices with antibiotics among nursing students: A cross-sectional descriptive survey at tertiary care teaching hospital in Uttarakhand. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Eibs T, Koscalova A, Nair M, Grohma P, Kohler G, Bakhit RG, Thurashvili M, Lasry E, Bauer SW, Jimenez C. Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo. BMJ Open 2020; 10:e036530. [PMID: 32973055 PMCID: PMC7517544 DOI: 10.1136/bmjopen-2019-036530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The objective of this study was to address the knowledge gap regarding antibiotic use in Medecins Sans Frontiéres (MSF) projects located in Africa by exploring antibiotic prescription and consumption habits and their drivers at different healthcare levels. DESIGN This study used an exploratory study design through thematic analysis of semistructured, in-depth interviews, focus group discussions (FGDs) and field observations in order to understand the main drivers influencing current antibiotics prescription habits and consumption habits of patients in different geographical settings. SETTING The study took place in MSF centres and towns across four countries: Guinea-Bissau, Central African Republic (CAR), Democratic Republic of Congo (DRC) and Sudan. PARTICIPANTS 384 respondents participated in the study, which includes project staff, prescribers, community members, patients, among other groups. RESULTS Treatment protocols were physically present in all countries except DRC, but compliance to protocols varied across contexts. A failing health system and barriers to accessing healthcare were perceived as major drivers of overuse and inconsistent prescription practices. Patient demands influenced prescription decisions, and self-medication was commonly reported in the context of failing health systems. Additionally, there was a strong demand for quick cures and communities preferred injections over pills. Patients tended to stop antibiotic treatment once symptoms abated and had major gaps in understanding antibiotic intake instructions and functions. CONCLUSIONS While there were specific findings in each context, the larger trend from these four MSF projects in Africa indicates widespread use of antibiotics based on unclear assumptions, which are often influenced by patient demands. There needs to be a broader focus on the balance between access and excess, especially in such fragile contexts where access to healthcare is a real challenge.
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Affiliation(s)
- Tonka Eibs
- Vienna Evaluation Unit, Medecins Sans Frontieres, Vienna, Austria
| | - Alena Koscalova
- Vienna Evaluation Unit, Medecins Sans Frontieres, Vienna, Austria
| | - Mohit Nair
- Vienna Evaluation Unit, Medecins Sans Frontieres, Vienna, Austria
| | - Paul Grohma
- Infectious diseases departement, Slovak Medical University, Bratislava, Slovakia
| | - Gisa Kohler
- Vienna Evaluation Unit, Medecins Sans Frontieres, Vienna, Austria
| | | | - Mzia Thurashvili
- Vienna Evaluation Unit, Medecins Sans Frontieres, Vienna, Austria
| | - Estrella Lasry
- Medical departement, Medecins Sans Frontieres, Barcelona, Spain
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Trikha S, Dalpath SK, Sharma M, Shafiq N. Antibiotic prescribing patterns and knowledge of antibiotic resistance amongst the doctors working at public health facilities of a state in northern India: A cross sectional study. J Family Med Prim Care 2020; 9:3937-3943. [PMID: 33110790 PMCID: PMC7586578 DOI: 10.4103/jfmpc.jfmpc_367_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/29/2020] [Accepted: 05/02/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: The aim of the study is to understand antibiotic prescribing patterns and to understand knowledge of antibiotic resistance amongst the doctors working at public health facilities of a northern Indian state. Methodology: A cross-sectional study among doctors of the civil hospitals of Haryana state of India was conducted 2019. Data were collected by self-administered questionnaire from a total of 215 doctors posted at the 22 district hospitals. Results: The response rate was 98%. Doctors (66%) perceived antibiotic resistance as a very important global problem, a very important problem in India (68%) and as an important problem in their hospital (31%). Experience in years was significantly associated with considering hand hygiene (OR, 5.78; 95% CI, 1.6420.3; P = 0.005) and treatment of bacteria as per susceptibility report of the organism (OR, 0.54; 95% CI, 0.310.93; P = 0.03). Surgeons reported piperacillin-tazobactam (17%), cloxacillin (17%), and cephazolin (12.05%) and others (54.2%) as the first choice of antibiotics for infection after surgery. Doctors (52.3%) reported that they started antibiotics 12 hours before surgery; 15 (17%) prescribed antibiotics 6 hours before surgery; and 23 (27%) 1 day before the surgery. Time for stopping antibiotics after surgery, as reported by participants, was 1 day (15%), 23 days (35%), 57 days (44%), respectively. A total of 71 (83%) doctors thought that surgical incision could lead to post-surgical site infection. Conclusion: Findings of study can be utilized to enhance education on antimicrobial prescribing, antimicrobial surveillance, and prescribing patterns among doctors in our settings.
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Affiliation(s)
- Sonia Trikha
- Executive Director, State Health Systems Resource Centre, Haryana, India
| | - Suresh K Dalpath
- Deputy Director, State Health Systems Resource Centre, Haryana, India
| | - Meenakshi Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, PGIMER, Chandigarh, India
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Majumder MAA, Singh K, Hilaire MGS, Rahman S, Sa B, Haque M. Tackling Antimicrobial Resistance by promoting Antimicrobial stewardship in Medical and Allied Health Professional Curricula. Expert Rev Anti Infect Ther 2020; 18:1245-1258. [PMID: 32684048 DOI: 10.1080/14787210.2020.1796638] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Antimicrobial resistance poses a serious threat to global health with significantly higher morbidity, mortality, and economic burden. This review aims to discuss the importance of the promotion of antimicrobial stewardship in medical and allied health professional curricula and training/educating tomorrow's doctors in combatting antimicrobial resistance. A narrative literature review was conducted to retrieve relevant information related to antimicrobial resistance and stewardship and their implications on medical and allied health professional education and training from searches of computerized databases, hand searches, and authoritative texts. AREAS COVERED Antimicrobial stewardship programs improve rational antibiotic use, reduce antimicrobial resistance, decrease complications of antibiotic use, and improve patient outcomes. Though health professional students recognize the importance and impact of antibiotic prescribing knowledge, many studies have consistently demonstrated low levels of confidence and competencies amongst students, highlighting that health professional schools failed to prepare them to prescribe antibiotics accurately. EXPERT OPINION There is an urgent call for the integration of antimicrobial stewardship teaching at the undergraduate level of medical education to train future prescribers on this critical aspect of public health. Proper undergraduate education on rational antibiotics use would enable health professional graduates to enter clinical practice with adequate competencies to become rational prescribers.
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Affiliation(s)
- Md Anwarul Azim Majumder
- Director of Medical Education, Faculty of Medical Sciences, The University of the West Indies , Cave Hill Campus, Barbados
| | - Keerti Singh
- Lecturer in Anatomy, Faculty of Medical Sciences, The University of the West Indies , Cave Hill Campus, Barbados
| | - Marquita Gittens-St Hilaire
- Lecturer in Microbiology, Faculty of Medical Sciences, The University of the West Indies , Cave Hill Campus, Barbados.,Department of Microbiology, Queen Elizabeth Hospital , Bridgetown, Barbados
| | - Sayeeda Rahman
- Associate Professor of Pharmacology and Public Health, School of Medicine, American University of Integrative Sciences , Bridgetown, Barbados
| | - Bidyadhar Sa
- The University of the West Indies , St. Augustine Campus, Trinidad and Tobago
| | - Mainul Haque
- Professor of the Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia) , Kuala Lumpur, Malaysia
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Nahar P, Unicomb L, Lucas PJ, Uddin MR, Islam MA, Nizame FA, Khisa N, Akter SMS, Rousham EK. What contributes to inappropriate antibiotic dispensing among qualified and unqualified healthcare providers in Bangladesh? A qualitative study. BMC Health Serv Res 2020; 20:656. [PMID: 32669092 PMCID: PMC7362537 DOI: 10.1186/s12913-020-05512-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Over-prescribing and inappropriate use of antibiotics contributes to the emergence of antimicrobial resistance (AMR). Few studies in low and middle-income settings have employed qualitative approaches to examine the drivers of antibiotic sale and dispensing across the full range of healthcare providers (HCPs). We aimed to explore understandings of the use and functions of antibiotics; awareness of AMR and perceived patient or customer demand and adherence among HCPs for human and animal medicine in Bangladesh. Methods We used an ethnographic approach to conduct face-to-face, in-depth interviews with 46 community HCPs in one urban and one rural area (Gazipur and Mirzapur districts respectively). We purposefully selected participants from four categories of provider in human and veterinary medicine: qualified; semi-qualified; auxiliary and unqualified. Using a grounded theory approach, thematic analysis was conducted using a framework method. Results Antibiotics were considered a medicine of power that gives quick results and works against almost all diseases, including viruses. The price of antibiotics was equated with power such that expensive antibiotics were considered the most powerful medicines. Antibiotics were also seen as preventative medicines. While some providers were well informed about antibiotic resistance and its causes, others were completely unaware. Many providers mistook antibiotic resistance as the side effects of antibiotics, both in human and animal medicine. Despite varied knowledge, providers showed concern about antibiotic resistance but responsibility for inappropriate antibiotic use was shifted to the patients and clients including owners of livestock and animals. Conclusions Misconceptions and misinformation led to a wide range of inappropriate uses of antibiotics across the different categories of human and animal healthcare providers. Low awareness of antibiotic action and antibiotic resistance were apparent among healthcare providers, particularly those with little or no training and those in rural areas. Specific and targeted interventions to address AMR in Bangladesh should include educational messages on the rational use of antibiotics and how they work, targeting all types of healthcare providers. While tailored training for providers may increase understanding of antibiotic action and improve practices, more far-reaching structural changes are required to influence and increase responsibility for optimising antibiotic dispensing among all HCPs.
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Affiliation(s)
- Papreen Nahar
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | | | - Mohammad Rofi Uddin
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
| | - Fosiul Alam Nizame
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - Nirnita Khisa
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - S M Salim Akter
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University
- , Loughborough, UK.
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Gupta MK, Vohra C, Raghav P. Assessment of knowledge, attitudes, and practices about antibiotic resistance among medical students in India. J Family Med Prim Care 2019; 8:2864-2869. [PMID: 31681657 PMCID: PMC6820394 DOI: 10.4103/jfmpc.jfmpc_504_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 11/06/2022] Open
Abstract
Context: To reduce the magnitude of antimicrobial resistance, there is a need to strengthen the knowledge for future prescribers regarding use and prescription of antibiotics. Before that, it is required to have a conclusive evidence about knowledge, attitude, and practices of that group. Aim: To assess the knowledge, attitudes, and the practices of medical students in India with respect to antibiotic resistance and usage. Settings and Design: It was a cross-sectional study which was done online through Google forms for a period of 4 months from July to October 2018. Materials and Methods: A structured questionnaire containing a five-point Likert scale was sent to medical students across India by sharing link through contacts of Medical Students Association of India. Respondent-driven sampling technique was also adopted for the study. Statistical Analysis Used: Descriptive statistics, parametric (Chi-square), and nonparametric (Kruskal--Wallis and Mann--Whitney U) tests. Results: A total of 474 responses were received from 103 medical colleges across 22 states of India. The mean score of knowledge was 4.36 ± 0.39. As compared to first year students, knowledge was significantly higher among students of all the years. As much as 83.3% students have consumed antibiotics in previous year of the survey. Around 45% of medical students accepted that they buy antibiotics without a medical prescription. Conclusion: The knowledge level of medical students was quite satisfactory. As far as attitude and practices are concerned, there is a substantial need for improvements.
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Affiliation(s)
- Manoj K Gupta
- Department of Community Medicine and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
| | - Chirag Vohra
- Medical Student, AIIMS, Jodhpur, Rajasthan, India
| | - Pankaja Raghav
- Department of Community Medicine and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
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Nair M, Tripathi S, Mazumdar S, Mahajan R, Harshana A, Pereira A, Jimenez C, Halder D, Burza S. "Without antibiotics, I cannot treat": A qualitative study of antibiotic use in Paschim Bardhaman district of West Bengal, India. PLoS One 2019; 14:e0219002. [PMID: 31247028 PMCID: PMC6597109 DOI: 10.1371/journal.pone.0219002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Misuse of antibiotics is a well-known driver of antibiotic resistance. Given the decentralized model of the Indian health system and the shortage of allopathic doctors in rural areas, a wide variety of healthcare providers cater to the needs of patients in urban and rural settings. This qualitative study explores the drivers of antibiotic use among formal and informal healthcare providers as well as patients accessing care at primary health centers across Paschim Bardhaman district in West Bengal. MATERIALS AND METHODS We conducted 28 semi-structured, in-depth interviews with four groups of healthcare providers (allopathic doctors, informal health providers, nurses, and pharmacy shopkeepers) as well as patients accessing care at primary health centers and hospitals across Paschim Bardhaman district. Qualitative data was analyzed using the framework method in an inductive and deductive manner. RESULTS Our results indicate that patients demand antibiotics from healthcare providers and seek the fastest cure possible, which influences the prescription choices of healthcare providers, particularly informal health providers. Many allopathic doctors provide antibiotics without any clinical indication due to inconsistent follow up, lack of testing facilities, risk of secondary infections, and unhygienic living conditions. Pharmaceutical company representatives actively network with informal health providers and formal healthcare providers alike, and regularly visit providers even in remote areas to market newer antibiotics. Allopathic doctors and informal health providers frequently blame the other party for being responsible for antibiotic resistance, and yet both display interdependence in referring patients to one another. CONCLUSIONS A holistic approach to curbing antibiotic resistance in West Bengal and other parts of India should focus on strengthening the capacity of the existing public health system to deliver on its promises, improving patient education and counseling, and including informal providers and pharmaceutical company representatives in community-level antibiotic stewardship efforts.
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Affiliation(s)
- Mohit Nair
- Medecins Sans Frontieres, New Delhi, India
| | | | - Sumit Mazumdar
- Centre for Health Economics, University of York, York, United Kingdom
| | | | | | | | | | | | - Sakib Burza
- Medecins Sans Frontieres, New Delhi, India
- * E-mail:
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