scholarly journals Antimicrobial resistance challenging professional learning in three LMICs

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Heli Kaatrakoski ◽  
Allison Littlejohn ◽  
Koula Charitonos
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Professional Learning ◽  
National Level ◽  
Individual Responsibility ◽  
Middle Income ◽  
Holistic View ◽  
Content Type ◽  
Global Challenge ◽  
Health Objectives

Purpose Antimicrobial resistance (AMR) is a huge global challenge calling for changes in learning and working in health-care settings. The purpose of this study is to examine tensions expressed by professionals involved in AMR in three low- and middle-income countries (LMIC) in Asia and Africa. Design/methodology/approach The qualitative study was based on 60 face-to-face or online interviews in three LMICs. The interviews were analyzed by thematic analysis and analysis of elements of an activity system. Findings A number of tensions within activity systems were analyzed revealing key issues inhibiting reconceptualization of object of work and moving toward new activity. The study suggests four opposing forces: (1) cost efficiency and good public health objectives; (2) historically and culturally developed hierarchies and good public health objectives; (3) individual responsibility and institutional responsibility; and (4) fragmented set ups and holistic view of activity as critical when developing learning and work activities in analyzed settings. Originality/value This study expands the analysis of learning needs beyond individual skills and knowledge by taking a systemic approach using the cultural-historical activity theory framework. It shows that learning around AMR is needed at individual, organizational and national level.

scholarly journals A case of neck abscess caused by rare hypervirulent Klebsiella pneumoniae, capsular type K20 and sequence type 420

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
John Alexander McHardy ◽  
Vathshalan Selvaganeshapillai ◽  
Priya Khanna ◽  
Ashley Michael Whittington ◽  
Jane Turton ◽  
...  
Keyword(s):  
Public Health ◽  
Case Report ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
East Asia ◽  
South East Asia ◽  
Neck Abscess ◽  
Global Challenge ◽  
Life Threatening ◽  
The Uk

Abstract Background This case report describes a neck abscess caused by a strain of Hypervirulent Klebsiella pneumoniae in a middle aged man with diabetes without a history of travel to East and South East Asia. This case report is of notable significance as Hypervirulent Klebsiella pneumoniae neck abscesses are rarely seen in the UK and are very infrequently documented in individuals who have not first travelled to the high prevalence areas of East and South East Asia. Case presentation This case report describes a 53 year old diabetic man who contracted a Hypervirulent Klebsiella pneumoniae neck abscess which led to the development of sepsis. Klebsiella pneumoniae was cultured from blood cultures and fluid aspirated from the abscess grew the pathogen with same antimicrobial susceptibility. Hypervirulence was demonstrated after the samples were analysed, at the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit Public Health England Colindale, and found to contain the K20 (rmp)A and rmpA2 virulence genes. Discussion Hypervirulent Klebsiella pneumoniae is a Gram-negative, encapsulated, non-motile bacillus notable for its ability to metastatically spread and cause potentially life threatening infections in otherwise healthy adults, but especially in those with diabetes. Genes responsible for the production of hyperviscous mucoid polysaccharide capsules and siderophores, such as those isolated in this case, enable the bacteria to more efficiently evade the hosts immune system and disseminate and invade surrounding and distant tissues. Data from Public Health England shows Hypervirulent Klebsiella pneumoniae are rare in the UK. A review of current literature also showed Hypervirulent Klebsiella pneumoniae almost exclusively occur in those who have traveled to East and South East Asia. Conclusions This case reported a rare Hypervirulent Klebsiella pneumoniae neck abscess outside of, and without travel to, East and South East Asia. This raises concerns about future, potentially life threatening, Hypervirulent Klebsiella pneumoniae infections becoming more widespread without the need for endemic travel. This concern is further exacerbated by the growing global challenge of antimicrobial resistance.

scholarly journals A road-map for addressing antimicrobial resistance in low- and middle-income countries: lessons learnt from the public private participation and co-designed antimicrobial stewardship programme in the State of Kerala, India

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sanjeev Singh ◽  
Esmita Charani ◽  
Sarada Devi ◽  
Anuj Sharma ◽  
Fabia Edathadathil ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
The State ◽  
Action Plans ◽  
Public And Private ◽  
Middle Income ◽  
Middle Income Countries ◽  
Public Health Threat

Abstract Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

scholarly journals Evaluation of Whole-Genome Sequencing for Identification and Typing of Vibrio cholerae

2018 ◽  
Vol 56 (11) ◽  
Author(s):  
David R. Greig ◽  
Ulf Schaefer ◽  
Sophie Octavia ◽  
Ebony Hunter ◽  
Marie A. Chattaway ◽  
...  
Keyword(s):  
Public Health ◽  
Whole Genome Sequencing ◽  
Vibrio Cholerae ◽  
Species Identification ◽  
Genome Sequencing ◽  
National Level ◽  
Whole Genome ◽  
Content Type ◽  
El Tor ◽  
The Impact

ABSTRACT Epidemiological and microbiological data on Vibrio cholerae strains isolated between April 2004 and March 2018 (n = 836) and held at the Public Health England culture archive were reviewed. The traditional biochemical species identification and serological typing results were compared with the genome-derived species identification and serotype for a subset of isolates (n = 152). Of the 836 isolates, 750 (89.7%) were from a fecal specimen, 206 (24.6%) belonged to serogroup O1, and 7 (0.8%) were serogroup O139; 792 (94.7%) isolates were from patients reporting recent travel abroad, most commonly to India (n = 209) and Pakistan (n = 104). Of the 152 V. cholerae isolates identified by use of kmer, 149 (98.1%) were concordant with those identified using the traditional biochemical approach. Traditional serotyping results were 100% concordant with those of the whole-genome sequencing (WGS) analysis for the identification of serogroups O1 and O139 and classical and El Tor biotypes. ctxA was detected in all isolates of V. cholerae O1 El Tor and O139 belonging to sequence type 69 (ST69) and in V. cholerae O1 classical variants belonging to ST73. A phylogeny of isolates belonging to ST69 from U.K. travelers clustered geographically, with isolates from India and Pakistan located on separate branches. Moving forward, WGS data from U.K. travelers will contribute to global surveillance programs and the monitoring of emerging threats to public health and the global dissemination of pathogenic lineages. At the national level, these WGS data will inform the timely reinforcement of direct public health messaging to travelers and mitigate the impact of imported infections and the associated risks to public health.

UK initiatives to reduce antimicrobial resistant infections, 2013-2018

2016 ◽  
Vol 21 (3) ◽  
pp. 131-138 ◽  
Author(s):  
Susan Hopkins
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Government Policy ◽  
Design Methodology ◽  
Antibiotic Use ◽  
Content Type ◽  
Uk Government ◽  
The Many ◽  
The Uk ◽  
The Impact

Purpose – The purpose of this paper is to highlight the local, national and global actions from the UK to reduce the impact of antimicrobial resistance (AMR) on human health. Design/methodology/approach – Synthesis of UK government policy, surveillance and research on AMR. Findings – Activities that are taking place by the UK government, public health and professional organisations are highlighted. Originality/value – This paper describes the development and areas for action of the UK AMR strategy. It highlights the many interventions that are being delivered to reduce antibiotic use and antimicrobial resistant infections.

scholarly journals Lack of Antimicrobial Resistance in Yersinia pestis Isolates from 17 Countries in the Americas, Africa, and Asia

2011 ◽  
Vol 56 (1) ◽  
pp. 555-558 ◽  
Author(s):  
Sandra K. Urich ◽  
Linda Chalcraft ◽  
Martin E. Schriefer ◽  
Brook M. Yockey ◽  
Jeannine M. Petersen
Keyword(s):  
Public Health ◽  
Multidrug Resistance ◽  
Antimicrobial Resistance ◽  
Yersinia Pestis ◽  
Causative Agent ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Health Concern ◽  
Public Health Concern ◽  
Content Type

ABSTRACTYersinia pestisis the causative agent of plague, a fulminant disease that is often fatal without antimicrobial treatment. Plasmid (IncA/C)-mediated multidrug resistance inY. pestiswas reported in 1995 in Madagascar and has generated considerable public health concern, most recently because of the identification of IncA/C multidrug-resistant plasmids in other zoonotic pathogens. Here, we demonstrate no resistance in 392Y. pestisisolates from 17 countries to eight antimicrobials used for treatment or prophylaxis of plague.

Rwandan agriculture strategy unlikely to be replicated

2017 ◽  
Keyword(s):  
Agricultural Sector ◽  
National Level ◽  
National Development ◽  
Severe Drought ◽  
Vision 2020 ◽  
East African ◽  
Middle Income ◽  
Content Type ◽  
East African Community ◽  
Income Status

Subject Rwandan agricultural interventions. Significance On May 15, the IMF completed its latest Article IV consultation and review with Kigali, predicting a return to growth of 6.2% per annum. According to the Fund, the main driver of this rebound is the agricultural sector, which is rapidly recovering from a severe drought in 2015-16. President Paul Kagame’s ambitious national development plan, Vision 2020, aims for the country to achieve middle income status by 2025, with transformation of the agricultural sector crucial to this. Impacts The government’s drought response will boost Kagame’s popularity among poorer rural households. However, if Kagame steps down after his next term in office, this could create disorder across many sectors. National-level disaster responses will prove more effective than their East African Community (EAC) equivalent.

Understanding national barriers to climate change adaptation for public health: a mixed-methods survey of national public health representatives

2020 ◽  
Vol 25 (4) ◽  
pp. 287-306
Author(s):  
Hannah Marcus ◽  
Liz Hanna
Keyword(s):  
Public Health ◽  
Climate Change ◽  
Mixed Methods ◽  
Adaptive Capacity ◽  
Climate Change Adaptation ◽  
Online Survey ◽  
National Level ◽  
Content Type ◽  
Knowledge Resources ◽  
National Public Health

PurposeTo uncover the major government constraints to enactment and implementation of public health-targeted climate change adaptation (CCA) strategies in order to equip public health stakeholders and health advocates with the knowledge resources necessary to more effectively mobilize and support CCA for public health responses at the national level.Design/methodology/approachA mixed-methods online survey was distributed to the representatives of national public health associations and societies of 82 countries. The survey comprised 15 questions assessing national progress on CCA for public health and the effects of various institutional, economic/financial, technical and sociopolitical barriers on national adaptive capacity.FindingsSurvey responses from 11 countries indicated that national commitments to CCA for public health have increased markedly since prior assessments but significant shortcomings remain. The largest apparent barriers to progress in this domain were poor government coordination, lack of political will and inadequate adaptation finances.Originality/valueThis study is unique in relation to the prior literature on the topic in that it effectively captures an array of country-specific yet cross-cutting adaptation constraints across diverse national contexts. With a deepened understanding of the major determinants of national adaptive capacity, international actors can devise more effective, evidence-informed strategies to support national governments in responding to the health impacts of climate change.

Quali health: creating access to quality healthcare for South Africa’s excluded majority

2020 ◽  
Vol 10 (3) ◽  
pp. 1-34
Author(s):  
Adrian David Saville ◽  
Philip Powell ◽  
Tashmia Ismail-Saville ◽  
Morris Mthombeni
Keyword(s):  
Public Health ◽  
Emerging Markets ◽  
Informal Sector ◽  
Social Entrepreneurship ◽  
Healthcare Delivery ◽  
Working Poor ◽  
Middle Income ◽  
Content Type ◽  
Academic Level ◽  
Entrepreneurial Activities

Learning outcomes For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector. Case overview/synopsis South Africa’s primary health outcomes do not correspond to the country’s spending on public health, with South Africa ranking among the worst globally in the incidence of tuberculosis, HIV prevalence, infant mortality and life expectancy. In part, this poor outcome can be explained by high inequality in access to healthcare, which reflects South Africa’s grossly skewed income and wealth distributions, with the bulk of the country’s population reliant upon an underfunded, inefficient and poorly managed public health system. This substandard service for the working poor in South Africa’s townships with high population densities offered a profitable entrepreneurial opportunity to provide affordable and effective primary care with vast gains in quality and outcomes improved dignity for patients. After receiving her MBA, physician and entrepreneur Dr Nthabiseng Legoete self-funded the launch of Quali Health in 2017. The business model set out to disrupt healthcare delivery for South Africa’s poorest citizens. Drawing patients from the working poor in Diepsloot, Quali Health’s inaugural site was cash flow positive within five months when the facility hit only 30% of installed service capacity. With quick success, Dr Legoete faced the strategic question of how fast to scale and finance the expansion. She also considered a new micro-insurance product for her clientele. Complexity academic level For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector. Supplementary materials Teaching notes are available for educators only. Subject code CSS: 3 Entrepreneurship.

scholarly journals Drivers of antibiotic use in Vietnam: implications for designing community interventions

2021 ◽  
Vol 6 (7) ◽  
pp. e005875
Author(s):  
Shannon McKinn ◽  
Duy Hoang Trinh ◽  
Dorothy Drabarek ◽  
Thao Thu Trieu ◽  
Phuong Thi Lan Nguyen ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Symptom Control ◽  
Antibiotic Use ◽  
Structural Factors ◽  
Community Members ◽  
Community Based Interventions ◽  
Community Based ◽  
Health Security ◽  
Global Challenge

IntroductionAntimicrobial resistance is a global challenge that threatens our ability to prevent and treat common infectious diseases. Vietnam is affected by high rates of antimicrobial resistant infections, driven by the overuse of antibiotics and the Vietnamese government has recognised antimicrobial resistance as a health security priority. This study aimed to understand how people in Vietnam use antibiotics in community settings, and the factors that impact their practices and decision-making regarding antibiotics.MethodsWe conducted 43 qualitative in-depth interviews with 50 community members in two urban and two rural sites in Vietnam. We conducted iterative, inductive thematic analysis alongside data collection through a process of systematic debriefings based on detailed interview summaries. Through this process, we developed a coding framework that was then applied to transcribed interview data.ResultsFrequent and indiscriminate use of antibiotics was driven by the powerful appeal that antibiotics held for many Vietnamese consumers. Consumers were discerning in making decisions in their purchase and use of antibiotics. Consumers’ decisions were affected by perceptions of what constitutes high-quality medicine (effective, strong, accessible and affordable); privileging symptom control over diagnosis; social constructions of antibiotics as a trusted remedy with embodied evidence of prior efficacy, which is reinforced by advice from trusted sources in their community; and varied, generally incomplete, understanding of the concept of antibiotic resistance and its implications for individuals and for public health.ConclusionAntibiotic use at the community and primary care level in Vietnam is driven by community members’ social and economic response to what constitutes effective healthcare, rather than biomedical logic. Community-based interventions to reduce unnecessary antibiotic use need to engage with the entangled socio-structural factors that ‘resist’ current public health efforts to ration antibiotic use, alongside biomedical drivers. This study has informed the design of a community-based trial to reduce unnecessary antibiotic use.

scholarly journals Genomic Analysis of a Pan-Resistant Isolate ofKlebsiella pneumoniae, United States 2016

mBio ◽  
2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Tom J. B. de Man ◽  
Joseph D. Lutgring ◽  
David R. Lonsway ◽  
Karen F. Anderson ◽  
Julia A. Kiehlbauch ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
The United States ◽  
Whole Genome ◽  
Beta Lactams ◽  
Content Type

ABSTRACTAntimicrobial resistance is a threat to public health globally and leads to an estimated 23,000 deaths annually in the United States alone. Here, we report the genomic characterization of an unusualKlebsiella pneumoniae, nonsusceptible to all 26 antibiotics tested, that was isolated from a U.S. patient. The isolate harbored four known beta-lactamase genes, including plasmid-mediatedblaNDM-1andblaCMY-6, as well as chromosomalblaCTX-M-15andblaSHV-28, which accounted for resistance to all beta-lactams tested. In addition, sequence analysis identified mechanisms that could explain all other reported nonsusceptibility results, including nonsusceptibility to colistin, tigecycline, and chloramphenicol. Two plasmids, IncA/C2 and IncFIB, were closely related to mobile elements described previously and isolated from Gram-negative bacteria from China, Nepal, India, the United States, and Kenya, suggesting possible origins of the isolate and plasmids. This is one of the firstK. pneumoniaeisolates in the United States to have been reported to the Centers for Disease Control and Prevention (CDC) as nonsusceptible to all drugs tested, including all beta-lactams, colistin, and tigecycline.IMPORTANCEAntimicrobial resistance is a major public health threat worldwide. Bacteria that are nonsusceptible or resistant to all antimicrobials available are of major concern to patients and the public because of lack of treatment options and potential for spread. AKlebsiella pneumoniaestrain that was nonsusceptible to all tested antibiotics was isolated from a U.S. patient. Mechanisms that could explain all observed phenotypic antimicrobial resistance phenotypes, including resistance to colistin and beta-lactams, were identified through whole-genome sequencing. The large variety of resistance determinants identified demonstrates the usefulness of whole-genome sequencing for detecting these genes in an outbreak response. Sequencing of isolates with rare and unusual phenotypes can provide information on how these extremely resistant isolates develop, including whether resistance is acquired on mobile elements or accumulated through chromosomal mutations. Moreover, this provides further insight into not only detecting these highly resistant organisms but also preventing their spread.

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