scholarly journals Bacterial versus non-bacterial infections: a methodology to support use-case-driven product development of diagnostics

2020 ◽  
Vol 5 (10) ◽  
pp. e003141
Author(s):  
Camille Escadafal ◽  
Steffen Geis ◽  
A M Siqueira ◽  
Selidji T Agnandji ◽  
Techalew Shimelis ◽  
...  
Keyword(s):  
Low Income ◽  
Bacterial Infections ◽  
Healthcare Professionals ◽  
Febrile Illness ◽  
Antibiotic Use ◽  
Sample Collection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disease Aetiology ◽  
Sample Set

Acute febrile illness (AFI) is one of the most common reasons for seeking medical care in low-income and middle-income countries. Bacterial infections account for a relatively small proportion of AFIs; however, in the absence of a simple diagnostic test to guide clinical decisions, healthcare professionals often presume that a non-malarial febrile illness is bacterial in origin, potentially resulting in inappropriate antibiotic use. An accurate differential diagnostic tool for AFIs is thus essential, to both limit antibiotic use to bacterial infections and address the antimicrobial resistance crisis that is emerging globally, without resorting to multiple or complex pathogen-specific assays. The Biomarker for Fever-Diagnostic (BFF-Dx) study is one of the largest fever biomarker studies ever undertaken. We collected samples and classified disease aetiology in more than 1900 individuals, distributed among enrolment centres in three countries on two continents. Identical protocols were followed at each study site, and the same analyses were conducted in each setting, enabling like-with-like comparisons to be made among the large sample set generated. The BFF-Dx methodology can act as a model for other researchers, facilitating wider utility of the work in the future. The established sample collection is now accessible to researchers and companies and will facilitate the development of future fever-related diagnostic tests. Here, we outline the methodology used to determine the sample populations and to differentiate bacterial versus non-bacterial AFIs. Future publications will set out in more detail the study’s demographics, the causes of fever identified and the performance of selected biomarkers.

scholarly journals Understanding antimicrobial use in subsistence farmers in Chikwawa District Malawi, implications for public awareness campaigns

2021 ◽  
Author(s):  
Eleanor MacPherson ◽  
Joanna Reynolds ◽  
Esnart Sanudi ◽  
Alexander Nkaombe ◽  
John Mankhomwa ◽  
...  
Keyword(s):  
Low Income ◽  
Public Awareness ◽  
Antibiotic Use ◽  
Subsistence Farming ◽  
Formal Sector ◽  
Middle Income ◽  
The Public ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
The Right

Drug resistant infections are increasing across the world and urgent action is required to preserve current classes of antibiotics. Antibiotic use practices in low-and-middle-income countries have gained international attention, especially as antibiotics are often accessed beyond the formal health system. Public awareness campaigns have gained popularity, often conceptualising antimicrobial resistance (AMR) as a problem of excess, precipitated by irrational behaviour. Insufficient attention has been paid to people’s lived experiences of accessing medicines in low-income contexts. In Chikwawa District, Malawi, a place of extreme scarcity, our study aimed to understand the care and medicine use practices of households dependent on subsistence farming. Adopting an anthropological approach, we undertook medicine interviews (100), ethnographic fieldwork (six-month period) and key informant interviews (33) with a range of participants in two villages in rural Chikwawa. The most frequently used drugs were cotrimoxazole and amoxicillin, not considered to be of critical importance to human health. Participants recognised that keeping, sharing, and buying medicines informally was not the “right thing.” However, they described using antibiotics and other medicines in these ways due to conditions of extreme precarity, the costs and limitations of seeking formal care in the public sector, and the inevitability of future illness. Our findings emphasise the need in contexts of extreme scarcity to equip policy actors with interventions to address AMR through strengthening health systems, rather than public awareness campaigns that foreground overuse and the dangers of using antibiotics beyond the formal sector.

scholarly journals Protocol for process evaluation of CIVIC randomised controlled trial: Community-based InterVentions to prevent serIous Complications following spinal cord injury in Bangladesh

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e024226 ◽  
Author(s):  
Mohammad Sohrab Hossain ◽  
Lisa A Harvey ◽  
Hueiming Liu ◽  
Md. Shofiqul Islam ◽  
Md. Akhlasur Rahman ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Process Evaluation ◽  
Low Income ◽  
Quantitative Data ◽  
Healthcare Professionals ◽  
Controlled Trial ◽  
Ethics Committee ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomised Controlled

IntroductionPeople with spinal cord injuries in low-income and middle-income countries are highly vulnerable to life-threatening complications in the period immediately after discharge from hospital. We are conducting a randomised controlled trial in Bangladesh to determine whether all-cause mortality at 2 years can be reduced if health professionals regularly ring and visit participants in their homes following discharge. We will conduct a process evaluation alongside the trial to explain the trial results and determine the feasibility of scaling this intervention up in low-income and middle-income countries if it is found to be effective.Methods and analysisOur process evaluation is based on the Realist and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks. We will use a mixed methods approach that uses both qualitative and quantitative data. For example, we will audit a sample of telephone interactions between intervention participants and the healthcare professionals, and we will conduct semistructured interviews with people reflective of various interest groups. Quantitative data will also be collected to determine the number and length of interactions between the healthcare professionals and participants, the types of issues identified during each interaction and the nature of the support and advice provided by the healthcare professionals. All quantitative and qualitative data will be analysed iteratively before the final analysis of the trial results. These data will then be triangulated with the final results of the primary outcome.Ethics and disseminationEthics approval was obtained from the institutional ethics committee at the site in Bangladesh and from the University of Sydney, Australia. The study will be conducted in compliance with all stipulations of its protocol, the conditions of ethics committee approval and the relevant regulatory bodies. The results of the trial will be disseminated through publications in peer-reviewed scientific journals and presentations at scientific conferences.Trial registration numberACTRN12615000630516.

scholarly journals Use of WATCH antibiotics prior to presentation to the hospital in rural Burkina Faso

2021 ◽  
Author(s):  
Daniel VALIA ◽  
Brecht Ingelbeen ◽  
Bérenger Kaboré ◽  
Ibrahima Karama ◽  
Marjan Peeters ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Bacterial Infections ◽  
Antibiotic Use ◽  
Health Centers ◽  
Diagnostic Tools ◽  
Middle Income ◽  
Targeted Interventions ◽  
Middle Income Countries ◽  
Primary Health ◽  
Low And Middle Income

Abstract Background In low- and middle-income countries, the prevalence of antimicrobial resistance (AMR) is increasing. To control AMR, WHO recommends monitoring antibiotic use, in particular Watch antibiotics. These are critically important antibiotics, with restricted use because at risk of becoming ineffective due to increasing AMR. We investigated pre-hospital antibiotic use in rural Burkina Faso. Methods During 2016-2017, we collected data from patients aged >3 months presenting with severe acute fever to the rural hospital of Nanoro Health District, Burkina Faso, including antibiotic use in the two weeks prior to consultation or hospitalization. We analysed reported antibiotic use with the WHO Access, Watch, Reserve (AWaRe) classification. Results Of 920 febrile participants (63.0% ≤14 years), pre-hospital antibiotic use was reported by 363 (39.5%). Among these 363, microbiological diagnoses were confirmed for 275 (75.8%) patients, of which 162 (58.9%) were non-bacterial infections. Use of more than one antibiotic was reported by 58/363 (16.0%) participants. Of 491 patients who did not previously visit a primary health center, 131 (26.7%) reported antibiotic use. Of 424 antibiotics reported, 263 (62.0%) were Access and 159 (37.5%) Watch antibiotics. Watch antibiotic use was more frequent among patients >14 year olds (51.1%) compared to those 0-14 year old (30.7%) and among referrals from the primary health centers (42.2%) compared to self-referred patients (28.1%). Most frequently reported Watch antibiotics were ceftriaxone (114, 71.7%) and ciprofloxacin (32, 20.1%). Conclusion The reported frequent use of Watch group antibiotics among febrile patients prior to presentation to the hospital in rural Burkina Faso highlights the need to develop targeted interventions to improve antibiotic use in community settings as part of strengthening antibiotic stewardship in low- and middle-income countries. This should include facilitating referral, access to qualified prescribers and diagnostic tools in rural primary health centers. Trial registration : ClinicalTrials.gov identifier: NCT02669823. Registration date was February 1, 2016

scholarly journals A questionnaire study of the negative outcomes for UK health professional volunteers in low and middle income countries

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e037647
Author(s):  
Natasha Tyler ◽  
Helen Louise Ackers ◽  
Anya Ahmed ◽  
Ged Byrne ◽  
Lucie Byrne-Davis
Keyword(s):  
Health Professional ◽  
Low Income ◽  
Healthcare Professionals ◽  
Secondary Analysis ◽  
Past Research ◽  
Negative Outcomes ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Professional Volunteers

IntroductionPast research has reported considerable benefits of international health professional volunteering for British healthcare professionals; however, there are also some negative outcomes reported. Negative outcomes reportedly happen on a personal, professional and organisational level. However, there is little evidence of the frequency they might occur.MethodsWe aimed to understand what the negative outcomes of health professional volunteering in low-income and middle-income countries were, and how frequently they occurred, in an opportunistic sample of UK health professionals. We used a questionnaire developed using potential negative outcomes reported in the peer-reviewed papers. We conducted secondary analysis on cross-sectional questionnaire data from 222 healthcare professionals.ResultsThis research provides an indication of the frequency that negative outcomes might occur. Post hoc analyses revealed that some outcomes were experienced by the majority of health professional volunteers, for example, lack of formal recognition (131/169, 78%) and financial cost (92/169, 68%). While others happened less, for example, a reliance on agency or locum work (12/169, 7%) and loss of pension (31/169, 18%).ConclusionThe outcomes reported in this research quantify some of the concerns that have been raised in previous literature. Negative outcomes might be associated with certain features of volunteering and further research is needed to prospectively compare different features. Organisers of volunteering opportunities should be aware of the potential negative outcomes and engage with the research into negative outcomes to generate and apply findings about minimising potential negative outcomes, carefully balancing these against the needs of the host country.

scholarly journals Anticipating the future: prognostic tools as a complementary strategy to improve care for patients with febrile illnesses in resource-limited settings

2021 ◽  
Vol 6 (7) ◽  
pp. e006057
Author(s):  
Arjun Chandna ◽  
Jennifer Osborn ◽  
Quique Bassat ◽  
David Bell ◽  
Sakib Burza ◽  
...  
Keyword(s):  
Low Income ◽  
New Technologies ◽  
Febrile Illness ◽  
Use Cases ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Prognostic Research ◽  
Stakeholder Consultation ◽  
Middle Income Countries ◽  
Resource Limited

In low-income and middle-income countries, most patients with febrile illnesses present to peripheral levels of the health system where diagnostic capacity is very limited. In these contexts, accurate risk stratification can be particularly impactful, helping to guide allocation of scarce resources to ensure timely and tailored care. However, reporting of prognostic research is often imprecise and few prognostic tests or algorithms are translated into clinical practice.Here, we review the often-conflated concepts of prognosis and diagnosis, with a focus on patients with febrile illnesses. Drawing on a recent global stakeholder consultation, we apply these concepts to propose three use-cases for prognostic tools in the management of febrile illnesses in resource-limited settings: (1) guiding referrals from the community to higher-level care; (2) informing resource allocation for patients admitted to hospital and (3) identifying patients who may benefit from closer follow-up post-hospital discharge. We explore the practical implications for new technologies and reflect on the challenges and knowledge gaps that must be addressed before this approach could be incorporated into routine care settings.Our intention is that these use-cases, alongside other recent initiatives, will help to promote a harmonised yet contextualised approach for prognostic research in febrile illness. We argue that this is especially important given the heterogeneous settings in which care is often provided for patients with febrile illnesses living in low-income and middle-income countries.

Sign in / Sign up

Export Citation Format

Share Document