How antibiotics are used in pig farming: a mixed-methods study of pig farmers, feed mills and veterinarians in Thailand

BackgroundRising global concern about antimicrobial resistance has drawn attention to the use of antibiotics in livestock. Understanding the current usage of antibiotics in these animals is essential for effective interventions on the optimisation of antibiotic use. However, to date few studies have been conducted in low- and middle-income countries. This study aimed to explore the use of antibiotics and estimate the total amount of antibiotics used in pig production in Thailand.MethodsThis was a mixed-methods study including a cross-sectional questionnaire-based survey of 84 pig farmers, secondary analysis of data from a survey of 31 feed mills to estimate the amount of antibiotics mixed in pig feed and interviews with five veterinarians involved in the feed mill industry to gain an understanding of medicated feed production.FindingsHalf of the farmers reported using antibiotics for disease prevention. Use was significantly associated with farmers’ experience in raising pigs, farm income, having received advice on animal health and belonging to a farm cooperative. The estimated total amount of active ingredients mixed into medicated feed for pigs for the whole country was 843 tonnes in 2017. Amoxicillin was the most commonly used antibiotic reported by both pig farms and feed mills. The use of Critically Important Antimicrobials including colistin was common, with one-third of farmers reporting their use as oral or as injectable medication, and accounting for nearly two-thirds of antibiotics contained in medicated feed.ConclusionA majority of antibiotics used in Thai pig farms belonged to the category of Critically Important Antimicrobials. Progressive restriction in the use of antibiotics in pigs is recommended through using prescriptions to control the distribution of certain antibiotics. The government should strengthen veterinary services to improve access of farmers to animal health advice and explore alternative interventions.

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Contextualizing Evidence for Action on Diabetes in Low-Resource Settings—Project CEAD Part I: A Mixed-Methods Study Protocol

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020569 ◽

2020 ◽

Vol 17 (2) ◽

pp. 569

Author(s):

Elisa Chilet-Rosell ◽

Nora Piay ◽

Ildefonso Hernández-Aguado ◽

Blanca Lumbreras ◽

Francisco Barrera-Guarderas ◽

...

Keyword(s):

Mixed Methods ◽

Local Knowledge ◽

Health Workers ◽

Epidemiological Data ◽

Diabetes Risk ◽

Mixed Methods Study ◽

Cross Sectional ◽

Middle Income ◽

Low Resource Settings ◽

Low Resource

Challenges remain for policy adoption and implementation to tackle the unprecedented and relentless increase in obesity, diabetes and other non-communicable diseases (NCDs), especially in low- and middle-income countries. The aim of this mixed-methods study is to analyse the contextual relevance and applicability to low-resource settings of a sample of evidence-based healthy public policies, using local knowledge, perceptions and pertinent epidemiological data. Firstly, we will identify and prioritise policies that have the potential to reduce the burden of diabetes in low-resource settings with a scoping review and modified Delphi method. In parallel, we will undertake two cross-sectional population surveys on diabetes risk and morbidity in two low-resource settings in Ecuador. Patients, community members, health workers and policy makers will analyse the contextual relevance and applicability of the policy actions and discuss their potential for the reduction in inequities in diabetes risk and morbidity in their population. This study tackles one of the greatest challenges in global health today: how to drive the implementation of population-wide preventative measures to fight NCDs in low resource settings. The findings will demonstrate how local knowledge, perceptions and pertinent epidemiological data can be used to analyse the contextual relevance and applicability of potential policy actions.

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Understanding Antibiotic Residues and Pathogens Flow in Wastewater from Smallholder Pig Farms to Agriculture Field in Ha Nam Province, Vietnam

Environmental Health Insights ◽

10.1177/1178630220943206 ◽

2020 ◽

Vol 14 ◽

pp. 117863022094320

Author(s):

Phuc Pham-Duc ◽

Hung Nguyen-Viet ◽

Toan Luu-Quoc ◽

Meghan A Cook ◽

Phuong Trinh-Thi-Minh ◽

...

Keyword(s):

Animal Health ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Antibiotic Residues ◽

Livestock Waste ◽

Salmonella Spp ◽

Livestock Wastewater ◽

Cross Sectional ◽

Pig Farms ◽

Wastewater Samples

Background: Contact with livestock wastewater on farms and in communities can pose a risk to human and animal health. Methods: This cross-sectional study was conducted in 180 households and 24 pig farms (96 wastewater samples) to explore information about pig production, livestock waste management, antibiotic use, and to analyze antibiotic residues and microbial contamination, respectively. Results: Of the 120 households raising pigs, biogas systems were the most commonly used to treat animal waste (70%), followed by compositing (19%), and the remaining respondents discharged waste directly into drains or ponds (11%). The majority of respondents (78%) used antibiotics to treat and prevent disease in pigs, but 32% of them did not know of any disadvantages of antibiotic abuse. ELISA assays were performed on half of the wastewater samples (n = 48), demonstrating that residues of flouroquinolones and sulfonamides were present in 6.3% (3/48) and 22.9% (11/48) of tested samples, respectively. The average residual level of sulfamethazine was 27.8 ug/l. Further, E. coli concentrations exceeding regulatory levels in Vietnam were found in nearly all samples. Salmonella spp. was also found in 57.3% of samples, though prevalence rates varied across the different sites. Finally, G. lamblia was found in 8.4% of samples, and C. parvum was found in 5.2% of samples. Conclusions: This study suggests that livestock wastewater carried potential harmful pathogens and antibiotic residues that could come into contact with humans in the community. Thus, appropriate operation and application of livestock wastewater treatment (such as biogas or composting) and management should be a continued focused.

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Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

British Journal of General Practice ◽

10.3399/bjgp18x697349 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697349

Author(s):

Anna Lalonde ◽

Emma Teasdale ◽

Ingrid Muller ◽

Joanne Chalmers ◽

Peter Smart ◽

...

Keyword(s):

Mixed Methods ◽

Information Needs ◽

Qualitative Data ◽

Information Provision ◽

Mixed Methods Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Face To Face ◽

Patient Information Needs ◽

History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

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Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

International Journal for Equity in Health ◽

10.1186/s12939-020-01327-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Christophe Millien ◽

Anatole Manzi ◽

Arlene M. Katz ◽

Hannah Gilbert ◽

Mary C. Smith Fawzi ◽

...

Keyword(s):

Risk Factors ◽

Mixed Methods ◽

Black Women ◽

Uterine Fibroids ◽

Mixed Methods Study ◽

University Hospital ◽

Gynecologic Surgery ◽

Cross Sectional ◽

Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

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The RUMA Alliance targets: an overview

Livestock ◽

10.12968/live.2021.26.4.176 ◽

2021 ◽

Vol 26 (4) ◽

pp. 176-179

Author(s):

Chris Lloyd

Keyword(s):

Task Force ◽

Animal Health ◽

Antibiotic Use ◽

Codes Of Practice ◽

The Government ◽

The Uk ◽

Ongoing Support ◽

The Impact ◽

Insight Into ◽

Roll Out

The Responsible Use of Medicines in Agriculture Alliance (RUMA) was established to promote the highest standards of food safety, animal health and animal welfare in the British livestock industry. It has a current focus to deliver on the Government objective of identifying sector-specific targets for the reduction, refinement or replacement of antibiotics in animal agriculture. The creation and roll out of sector specific targets in 2017 through the RUMA Targets Task Force, has helped focus activity across the UK livestock sectors to achieve a 50% reduction in antibiotic use since 2014. This has been realised principally through voluntary multi-sector collaboration, cross sector initiatives, codes of practice, industry body support and farm assurance schemes. This article provides an overview of RUMA's work to date providing insight into the methods used to create the targets, why they are so important, the impact they are having and how ongoing support and robust data are vital components in achieving the latest set of targets.

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Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study

BJGP Open ◽

10.3399/bjgpopen20x101008 ◽

2020 ◽

Vol 4 (1) ◽

pp. bjgpopen20X101008 ◽

Cited By ~ 1

Author(s):

Umar Chaudhry ◽

Judith Ibison ◽

Tess Harris ◽

Imran Rafi ◽

Miles Johnston ◽

...

Keyword(s):

Mixed Methods ◽

Clinical Information ◽

Mixed Methods Study ◽

Strong Positive Correlation ◽

Structured Interviews ◽

Cross Sectional ◽

Electronic Survey ◽

Positive Experiences ◽

Positive Correlations ◽

Observation Tools

BackgroundPrimary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees’ preparation for, or experiences and perceptions of, them.AimTo understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations.Design & settingA mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees.MethodA cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis.ResultsThe survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations.ConclusionThis project sheds light on GP trainees’ current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.

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Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries

PLoS ONE ◽

10.1371/journal.pone.0093763 ◽

2014 ◽

Vol 9 (4) ◽

pp. e93763 ◽

Cited By ~ 16

Author(s):

Benjamin Palafox ◽

Edith Patouillard ◽

Sarah Tougher ◽

Catherine Goodman ◽

Kara Hanson ◽

...

Keyword(s):

Mixed Methods ◽

Private Sector ◽

Mixed Methods Study ◽

Cross Sectional

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Integrated decision-making model for community-based rehabilitation service utilisation among persons with severe mental illness in China: protocol for a cross-sectional, mixed-methods study

BMJ Open ◽

10.1136/bmjopen-2018-021528 ◽

2018 ◽

Vol 8 (12) ◽

pp. e021528 ◽

Cited By ~ 2

Author(s):

Ruoxi Wang ◽

Shangfeng Tang ◽

Ian Shaw ◽

Zhanchun Feng ◽

Zhuo Chen ◽

...

Keyword(s):

Decision Making ◽

Mental Illness ◽

Mixed Methods ◽

Mixed Methods Study ◽

Service Utilisation ◽

Community Based ◽

Cross Sectional ◽

Community Based Rehabilitation ◽

Integrated Decision Making ◽

Different Levels

IntroductionA common problem low-income and middle-income countries face is the scarcity of community-based rehabilitation (CBR) resources and low service utilisation among persons with severe mental illness (SMI). Despite this problem, the factors and pathways followed influencing one’s decision on service utilisation in China have not been fully comprehended. This study aims to develop a theory-based model that systematically describes the integrated decision-making process of mental health CBR utilisation among persons with SMI in China.Methods/DesignThis cross-sectional, mixed-methods study involves three main stages and is expected to last 3 years, from January 2018 to December 2020. In stage 1, the Social Exchange Theory is deployed as an analytical framework to comprehensively capture factors associated with tendency to use CBR services in China using semistructured interview methodology involving patients with SMI, their primary caregivers and CBR service providers. In stage 2, interpretive structural modelling will be applied to analyse the relationships between factors in different dimensions, at different levels and with different levels of impact. Stage 3 involves a multiregion survey among at least 300 family decision-makers (either the patient or their caregivers) in six communities in three cities to statistically validate the initial model derived in stage 2 using a further structural equation modelling.Ethics and disseminationEthical approval was granted by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No 2017S319). All interviewees will be provided with written information about the study, and a signed consent will be retrieved prior to the interview. Rules on confidentiality and anonymity of data will be strictly followed. The findings of this study will be disseminated via international and domestic peer-reviewed journals, reports, conference presentations and symposium discussions. Reports will be submitted to the National Natural Science Foundation of China.

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Integrated Family Planning and Immunization Service Delivery at Health Facility and Community Sites in Dowa and Ntchisi Districts of Malawi: A Mixed Methods Process Evaluation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124530 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4530

Author(s):

Chelsea M. Cooper ◽

Jacqueline Wille ◽

Steven Shire ◽

Sheila Makoko ◽

Asnakew Tsega ◽

...

Keyword(s):

Mixed Methods ◽

Family Planning ◽

Service Providers ◽

Service Integration ◽

Secondary Analysis ◽

Health Sector ◽

Health Facilities ◽

Immunization Service ◽

Mothers And Fathers ◽

The Government

The Government of Malawi’s Health Sector Strategic Plan II highlights the importance of service integration; however, in practice, this has not been fully realized. We conducted a mixed methods evaluation of efforts to systematically implement integrated family planning and immunization services in all health facilities and associated community sites in Ntchisi and Dowa districts during June 2016–September 2017. Methods included secondary analysis of service statistics (pre- and postintervention), focus group discussions with mothers and fathers of children under age one, and in-depth interviews with service providers, supervisors, and managers. Results indicate statistically significant increases in family planning users and shifts in use of family planning services from health facilities to community sites. The intervention had no effect on immunization doses administered or dropout rates. According to mothers and fathers, benefits of service integration included time savings, convenience, and improved understanding of services. Provision and use of integrated services were affected by availability of human resources and commodities, community linkages, data collection procedures and availability, sociocultural barriers, organization of services, and supervision and commitment of health surveillance assistants. The integration approach was perceived to be feasible and beneficial by clients and providers.

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Health-related quality of life in adult CHD surgical patients in a low middle-income country: a mixed-methods study

Cardiology in the Young ◽

10.1017/s1047951120001663 ◽

2020 ◽

Vol 30 (8) ◽

pp. 1126-1137

Author(s):

Laila A. Ladak ◽

Robyn Gallagher ◽

Babar S. Hasan ◽

Khadija Awais ◽

Ahmed Abdullah ◽

...

Keyword(s):

Quality Of Life ◽

Mixed Methods ◽

Mixed Methods Study ◽

Income Country ◽

Surgical Patients ◽

Health Related Quality ◽

Middle Income ◽

Related Quality ◽

Health Related

AbstractBackground and objectives:This mixed-methods study aimed to assess health-related quality of life in young adults with CHD following surgery in a low middle-income country, Pakistan. Despite the knowledge that geographic, cultural and socio-economic factors may shape the way health and illness is experienced and managed and consequently determine a person’s health-related quality of life, few health-related quality of life studies are conducted in low middle-income countries. This deficit is pronounced in CHD, so there is little guidance for patient care.Methods:The study utilised concurrent, mixed methods. Adults with CHD (n = 59) completed health-related quality of life surveys (PedsQLTM 4.0 Generic Core Scale, PedsQLTM Cognitive Functioning Scale and PedsQLTM 3.0 Cardiac Module). Semi-structured interview data were collected from a nested sub-sample of 17 participants and analysed using qualitative content analysis, guided by the revised Wilson–Cleary model of health-related quality of life.Results:The lowest health-related quality of life domain was emotional with the mean score (71.61 ± 20.6), followed by physical (78.81 ± 21.18) and heart problem (79.41 ± 18.05). There was no statistical difference in general or cardiac-specific health-related quality of life between mild, moderate or complex CHD. Qualitative findings suggested low health-related quality of life arose from a reduced capacity to contribute to family life including family income and gender. A sense of reduced marriageability and fear of dependency were important socio-cultural considerations.Conclusions:CHD surgical patients in this low-income country experience poor health-related quality of life, and contributing factors differ to those reported for high-income countries. Socio-cultural understandings should underpin assessment, management and care-partnering with young adults with CHD following surgical correction.

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