scholarly journals Combating antibiotic resistance using guidelines and enhanced stewardship in Kenya: a protocol for an implementation science approach

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e030823 ◽  
Author(s):  
Jesse Gitaka ◽  
Moses Kamita ◽  
Dominic Mureithi ◽  
Davies Ndegwa ◽  
Moses Masika ◽  
...  
Keyword(s):  
Implementation Science ◽  
Health Sector ◽  
Antibiotic Use ◽  
Economic Benefits ◽  
Antibiotic Usage ◽  
Sub Saharan Africa ◽  
Local Context ◽  
National Commission ◽  
Middle Income ◽  
Science Approach

IntroductionAntimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of the guideline is highly dependent on the settings in which they are rolled out. This study, employing an implementation science approach, aims to address the knowledge gap in this area and provide critical data as well as practical experiences when using antibiotic guidelines and stewardship programmes in the public health sector. This will provide evidence of ASP performance and potentially contribute to the county, national and regional policies on antibiotics use.Methods and analysisThe study will be conducted in three geographically diverse regions, each represented by two hospitals. A baseline study on antibiotic usage, resistance and de-escalation, duration of hospital stay, rates of readmission and costs will be carried out in the preimplementation phase. The intervention, that is, the use of antibiotic guidelines and ASPs will be instituted for 18 months using a stepwise implementation strategy that will facilitate learning and continuous improvement of stewardship activities and updating of guidelines to reflect the evolving antibiotic needs.Ethics and disseminationApprovals to carry out the study have been obtained from the National Commission for Science, Technology and Innovation and the Mount Kenya University Ethics Review Committee. The approvals from the two institutions were used to obtain permission to conduct the study at each of the participating hospitals. Study findings will be presented to policy stakeholders and published in peer-reviewed scientific journals. It is anticipated that the findings will inform the appropriate antibiotic use guidelines within our local context.

scholarly journals User experiences and perceptions of health wearables: an exploratory study in Cambodia

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Marco Liverani ◽  
Por Ir ◽  
Virginia Wiseman ◽  
Pablo Perel
Keyword(s):  
Technology Acceptance ◽  
New Technology ◽  
Health Sector ◽  
The Elderly ◽  
Local Context ◽  
Battery Life ◽  
User Experiences ◽  
Middle Income ◽  
Exact Test ◽  
Health Technologies

Abstract Background In many low- and middle-income countries (LMICs), health system capacities to address the burden of non-communicable diseases (NCDs) are often inadequate. In these countries, wearable health technologies such as smartbands and smartwatches could be used as part of public health programmes to improve the monitoring, prevention, and control of NCDs. Considering this potential, the purpose of this study was to explore user experiences and perceptions of a health wearable in Cambodia. Methods Data collection involved a survey, conducted between November 2019 and January 2020, among different categories of participants (including hypertensive participants, non-hypertensive participants, postgraduate students, and civil servants). All participants were given a sample of a watch-type wearable and advised to use it day and night. One month after product delivery, we conducted a survey to explore their views and experiences. Results were analysed by using descriptive statistics and Chi square or Fisher's exact test to compare responses from urban and rural participants. Results A total of 156 adult participants completed the study. Technology acceptance was positive overall. 89.1% of the participants said they would continue using the watch and 76.9% of them would recommend it to either friends or relatives, while 94% said the device stimulated them to think more frequently about their health. However, challenges to technology adoption were also identified, including concerns with the accuracy and quality of the device and unfamiliarity with the concept of health self-monitoring, especially among the elderly. Short battery life and cost were also identified as potential barriers to continued use. Conclusions Health wearables are a promising new technology that could be used in Cambodia and in other LMICs to strengthen health sector responses to the challenges of NCDs. However, this technology should be carefully adapted to the local context and the needs of less resourced population groups. In addition, further studies should examine if adequate health sector support and infrastructure are in place to implement and sustain the technology.

scholarly journals The Contribution of Absolute Income Towards Poverty Reduction in Sub-Saharan Africa: The Case of Rwanda

2020 ◽  
Vol 2 (1) ◽  
pp. 110-117
Author(s):  
Kabera Callixte ◽  
Jacob Niyoyita Mahina ◽  
Emmy Tushabe
Keyword(s):  
Developing Countries ◽  
Poverty Reduction ◽  
Research Work ◽  
Health Sector ◽  
Sub Saharan Africa ◽  
Absolute Poverty ◽  
Middle Income ◽  
Absolute Income ◽  
Sub Saharan ◽  
The Government

The study portrays current worldwide empirical facts on the progress of economic growth and poverty relief in developing countries of the world. It’s well known that in most developing countries, the lives of citizens are not always very pleasant. There are usually lots of inconveniences in the ways of life for the citizen of these countries. Whenever the government of such a country responds to the inconveniences of life by formulating developmental programs to alleviate the problems of the people, such programs in most cases, do not work, making such government to be frustrated and discouraged. However, the government of Rwanda plays an important role in a number of areas including agriculture, education, and the health sector in order to reduce the mortality rate to its citizens and promote entrepreneurship. The aim of this study is to evaluate the level of absolute poverty and the appropriate methods that Rwanda has applied to curb down poverty levels, at the same time, picking key lessons and guidelines that can be of assistance in curbing down poverty in parts of sub-Saharan countries, Rwanda inclusive. In order to achieve its aim, the paper was put into four sections. Section one explains the poverty profile of Rwanda before and immediately after the genocide while the second part describes the short strategies that Rwanda took to reduce poverty. Section three elaborates the work the country puts to ensure it achieves its goals of achieving long-term goals of becoming a middle-income country by 2020. The fourth section describes the environment that the state has created to ensure that its strategies work as planned. The research work also relies on other related secondary documents from the mentioned institutions.

scholarly journals Surveillance of antibiotic use in the private sector in Namibia using sales and claims data

2016 ◽  
Vol 10 (11) ◽  
pp. 1243-1249 ◽  
Author(s):  
Dawn Dineo Pereko ◽  
Martie S Lubbe ◽  
Sabiha Y Essack
Keyword(s):  
Private Sector ◽  
Claims Data ◽  
Action Plan ◽  
Health Sector ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
World Health ◽  
Defined Daily Dose ◽  
Development Of Resistance ◽  
Starting Point

Introduction: Antibiotics are among the most commonly used therapeutic agents for humans globally, and their use has been associated with the development of resistance. The objective of this study was to identify sources for quantifying antibiotic usage patterns and to assess such use in ambulatory patients in the private health sector of Namibia. Methodology: A retrospective analysis of prescription claims data and sales data for the period 2008 to 2011 was conducted. Antibiotic use was expressed in the number of antibiotic-containing prescriptions and volume of units sold and then standardized using defined daily dose per 1,000 inhabitants per day. Results: Antibiotic usage was highest in females (53%), in people 18–45 years of age (41%), and in Windhoek (34%). Overall, wholesale data showed higher antibiotic use than prescription claims data. However, both sources showed similar patterns of antibiotic use. Penicillins were the most used pharmacological group, with amoxicillin/clavulanic acid combination being the most used of the agents. Conclusion: Antibiotic use in the private sector of Namibia is comparable to that of high-consuming European countries such as Italy. A trend observed in this study was the decrease in the use of narrow-spectrum antibiotics in favour of broad-spectrum and newer antibiotics. Since this was the first study to assess antibiotic use in the private sector of Namibia, it could serve as a starting point for continued monitoring of antibiotic use in the whole of Namibia in the context of the World Health Organization’s Global Action Plan to contain antibiotic resistance.

Organizational Sensemaking in Pursuit of Legitimacy: Toward a Social Explanation of Medical Strikes in Kenya

2021 ◽  
Author(s):  
Adam D. Koon
Keyword(s):  
Health Workers ◽  
Health Sector ◽  
Interesting Case ◽  
Organizational Legitimacy ◽  
Sub Saharan Africa ◽  
Medical Community ◽  
Organizational Studies ◽  
Health Coverage ◽  
Middle Income ◽  
Sub Saharan

Abstract Little is known about how the health professions organize in low- and middle-income countries (LMICs). Recent strikes among health workers in many LMICs have directed interest toward measuring their impacts and understanding their causes. Yet, much of this literature belies a technical understanding of a social problem. By drawing on theoretical developments in organizational studies, this article proposes health sector movements be understood through attendant social processes of sensemaking as organizations seek to expand pragmatic, moral, and cognitive forms of legitimacy. Kenya, a lower middle-income country in sub-Saharan Africa, is an interesting case for such research. The intersubjective construction of meaning among medical doctors fashions narratives to order institutional change in the Kenyan health sector. This analysis shows how the strong legacy of colonial biomedicine shaped medical professionalism and inherent tensions with a deteriorating state following independence. In 2010, a new constitution and devolution of health services caused a fractured medical community to divide and pursue industrial action in its quest for organizational legitimacy. In this way, strike behavior, as a form of legitimation among union doctors in Kenya, is a risky path to universal health coverage.

scholarly journals Development of Antimicrobial Stewardship Programmes in Low and Middle-Income Countries: A Mixed-Methods Study in Nigerian Hospitals

Antibiotics ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 204 ◽  
Author(s):  
Eneyi E. Kpokiri ◽  
David G. Taylor ◽  
Felicity J. Smith
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
World Health ◽  
Local Context ◽  
Prescribing Practices ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Antimicrobial resistance (AMR) is a major concern facing global health today, with the greatest impact in developing countries where the burden of infectious diseases is much higher. The inappropriate prescribing and use of antibiotics are contributory factors to increasing antibiotic resistance. Antimicrobial stewardship programmes (AMS) are implemented to optimise use and promote behavioural change in the use of antimicrobials. AMS programmes have been widely employed and proven to improve antibiotic use in many high-income settings. However, strategies to contain antimicrobial resistance have yet to be successfully implemented in low-resource settings. A recent toolkit for AMS in low- and middle-income countries by the World Health Organisation (WHO) recognizes the importance of local context in the development of AMS programmes. This study employed a bottom-up approach to identify important local determinants of antimicrobial prescribing practices in a low-middle income setting, to inform the development of a local AMS programme. Analysis of prescribing practices and interviews with prescribers highlighted priorities for AMS, which include increasing awareness of antibiotic resistance, development and maintenance of guidelines for antibiotic use, monitoring and surveillance of antibiotic use, ensuring the quality of low-cost generic medicines, and improved laboratory services. The application of an established theoretical model for behaviour change guided the development of specific proposals for AMS. Finally, in a consultation with stakeholders, the feasibility of the plan was explored along with strategies for its implementation. This project provides an example of the design, and proposal for implementation of an AMS plan to improve antibiotic use in hospitals in low-middle income settings.

THE RELATION BETWEEN KNOWLEDGE AND ATTITUDE TOWARD BEHAVIOR OF ANTIBIOTIC USAGE ON SOCIETY IN TALANG JAWA HEALTH CENTER OF SOUTH LAMPUNG AUGUST PERIOD 2019

1970 ◽  
pp. 132-141
Author(s):  
Lilik Koernia Wahidah
Keyword(s):  
Health Center ◽  
Significant Relationship ◽  
Health Centre ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Bivariate Analysis ◽  
Chi Square ◽  
Public Health Centre ◽  
Knowledge And Attitude ◽  
Use Behavior

In developing countries, many antibiotics are used without a doctor's prescription, causing someone to use antibiotics incorrectly. Lack of knowledge about antibiotics is a major factor that triggers an increase in the rate of bacterial resistance to antibiotics. Knowledge and attitude become one of the social cognitive factors that influence antibiotic use behavior.This study aims to determine the relationship of knowladge and attitudes toward of antibiotic usage behavior in community of Talang jawa public health centre. The research is an observasional analytic research using cross sectional study design. sampling using non-probability sampling methode with type purposive sampling and instruments in the form of questionnaires. The data analysis was based univariate and bivariate analysis eqipped with chi square. The study was conducted on 100 community respondents in the Talang Jawa Health Center. The results showed respondents with good knowledge (25%), enough (27%) and less (48%). Respondents with positive attitudes (64%) and negative attitudes (35%). Respondents with positive behavior (43%) and negative behavior (57%). Chi square test result showed that there was a significant relationship between knowladge and antibiotic use behavior (p= 0,000) and there was a significant relationship between attitude and antibiotic use behavior (p= 0,000). This study has a meaningful relationship between and attitudes with antibiotic use behavior in Talang Jawa Health Center. Keywords: Antibiotics,Knowledge, Attitudes, Behavior

scholarly journals Population cluster data to assess the urban-rural split and electrification in Sub-Saharan Africa

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Babak Khavari ◽  
Alexandros Korkovelos ◽  
Andreas Sahlberg ◽  
Mark Howells ◽  
Francesco Fuso Nerini
Keyword(s):  
World Bank ◽  
Population Distribution ◽  
Population Data ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Middle Income ◽  
Disease Response ◽  
The World Bank ◽  
The World ◽  
Urban Rural

AbstractHuman settlements are usually nucleated around manmade central points or distinctive natural features, forming clusters that vary in shape and size. However, population distribution in geo-sciences is often represented in the form of pixelated rasters. Rasters indicate population density at predefined spatial resolutions, but are unable to capture the actual shape or size of settlements. Here we suggest a methodology that translates high-resolution raster population data into vector-based population clusters. We use open-source data and develop an open-access algorithm tailored for low and middle-income countries with data scarcity issues. Each cluster includes unique characteristics indicating population, electrification rate and urban-rural categorization. Results are validated against national electrification rates provided by the World Bank and data from selected Demographic and Health Surveys (DHS). We find that our modeled national electrification rates are consistent with the rates reported by the World Bank, while the modeled urban/rural classification has 88% accuracy. By delineating settlements, this dataset can complement existing raster population data in studies such as energy planning, urban planning and disease response.

scholarly journals BioLPG for Clean Cooking in Sub-Saharan Africa: Present and Future Feasibility of Technologies, Feedstocks, Enabling Conditions and Financing

Energies ◽  
2021 ◽  
Vol 14 (13) ◽  
pp. 3916
Author(s):  
Kimball C. Chen ◽  
Matthew Leach ◽  
Mairi J. Black ◽  
Meron Tesfamichael ◽  
Francis Kemausuor ◽  
...  
Keyword(s):  
Agricultural Waste ◽  
Sub Saharan Africa ◽  
Green Economy ◽  
Energy Access ◽  
Liquefied Petroleum Gas ◽  
Public And Private ◽  
Middle Income ◽  
Private Sector Investment ◽  
Sub Saharan ◽  
Public And Private Sector

Energy supply for clean cooking is a priority for Sub-Saharan Africa (SSA). Liquefied petroleum gas (LPG, i.e., propane or butane or a mixture of both) is an economically efficient, cooking energy solution used by over 2.5 billion people worldwide and scaled up in numerous low- and middle-income countries (LMICs). Investigation of the technical, policy, economic and physical requirements of producing LPG from renewable feedstocks (bioLPG) finds feasibility at scale in Africa. Biogas and syngas from the circular economic repurposing of municipal solid waste and agricultural waste can be used in two groundbreaking new chemical processes (Cool LPG or Integrated Hydropyrolysis and Hydroconversion (IH2)) to selectively produce bioLPG. Evidence about the nature and scale potential of bioLPG presented in this study justifies further investment in the development of bioLPG as a fuel that can make a major contribution toward enabling an SSA green economy and universal energy access. Techno-economic assessments of five potential projects from Ghana, Kenya and Rwanda illustrate what might be possible. BioLPG technology is in the early days of development, so normal technology piloting and de-risking need to be undertaken. However, fully developed bioLPG production could greatly reduce the public and private sector investment required to significantly increase SSA clean cooking capacity.

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