scholarly journals Quantification and Trends of Antimicrobial Use in Commercial Broiler Chicken Production in Pakistan

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 598
Author(s):  
Muhammad Umair ◽  
Muhammad Farooq Tahir ◽  
Riasat Wasee Ullah ◽  
Jabir Ali ◽  
Naila Siddique ◽  
...  
Keyword(s):  
Broiler Chicken ◽  
National Level ◽  
World Health ◽  
Baseline Survey ◽  
Antimicrobial Use ◽  
Contributing Factors ◽  
Antimicrobial Drugs ◽  
Prevalence Survey ◽  
Cross Sectional ◽  
Commercial Broiler

Antimicrobial resistance (AMR) is a global health challenge and antimicrobial use (AMU) in the livestock sector has been considered as one of the contributing factors towards the development of AMR in bacteria. This study summarizes the results of a point prevalence survey conducted to monitor farm-level AMU in commercial broiler chicken farms in Punjab and Khyber Pakhtunkhwa (KPK) provinces of Pakistan. A cross-sectional study was conducted to quantify AMU and to check seasonal variations of AMU in 12 commercial broiler chicken farms (six from each province) during the summer and winter seasons of the year 2020–2021. AMU was recorded using three AMU metrics: kg, mg per population correction unit (mg/PCU), and mg/kg of final flock weight. A total of 22 antimicrobial drugs (348.59 kg) were used for therapeutic or prophylactic purposes in surveyed broiler chicken farms. The total combined AMU for all the broiler chicken farms was 462.57 mg/PCU. The use of most of the antimicrobials increased during winter flocks compared to summer. The top three antimicrobial drugs used during the summer were neomycin (111.39 mg/PCU), doxycycline (91.91 mg/PCU), and tilmicosin (77.22 mg/PCU), whereas doxycycline (196.81 mg/PCU), neomycin (136.74 mg/PCU), and amoxicillin (115.04 mg/PCU) during the winter. Overall, 60% of the antibiotics used in broiler chicken were critically important antimicrobial classes (CIA) for human medicine as characterized by the World Health Organization. Our findings showed high AMU in broiler chicken production and a call for urgent actions to regulate CIA use in food animals in Pakistan. This baseline survey is critical for the design and implementation of a subsequent national level AMU surveys that can include additional farming types, animals’ species, and geographical locations over a longer period of time.

scholarly journals Geographic Inequalities in Accessing Improved Water and Sanitation Facilities in Nepal

2019 ◽  
Vol 16 (7) ◽  
pp. 1269 ◽  
Author(s):  
Chao Wang ◽  
Jing Pan ◽  
Sanni Yaya ◽  
Ram Bilash Yadav ◽  
Dechao Yao
Keyword(s):  
National Level ◽  
Water Sources ◽  
Wash Water ◽  
World Health ◽  
Demographic And Health Surveys ◽  
Cross Sectional ◽  
Water And Sanitation ◽  
Ecological Zones ◽  
Quality Of Water ◽  
Health Organization

In this study, we aimed to assess the geographic inequalities in access to improved water and sanitation facilities among Nepalese households. We conducted this study based on cross-sectional data obtained from Nepal Demographic and Health Surveys. The quality of water sources and sanitation were defined by World Health Organization (WHO) guidelines. The geographic categories used in the analyses included developmental region, ecological zone, and urbanicity. Percentages of households having access to improved toilet (5.6% in 1996 vs. 40.5% in 2016) and water (19.3% in 1996 vs. 27% in 2016) facilities has been increasing steadily since 1996 with a great proportion of the households still lacking access to these services. The number of households sharing the same toilet and traveling time to reach water sources have also decreased at the same time. Households in Far Western and Mountains had the lowest odds of having access to improved toilet and water facilities. Noticeable progress has been achieved in improving WASH (water, sanitation, and hygiene) coverage at national level, however, it is uneven across developmental and ecological zones. Households in the Far Western and Mountain regions appeared to be the most geographically disadvantaged in terms of having access to improved water and sanitation facilities.

scholarly journals Essential Medicines at the National Level: The Global Asthma Network’s Essential Asthma Medicines Survey 2014

2019 ◽  
Vol 16 (4) ◽  
pp. 605 ◽  
Author(s):  
Karen Bissell ◽  
Philippa Ellwood ◽  
Eamon Ellwood ◽  
Chen-Yuan Chiang ◽  
Guy Marks ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Communicable Disease ◽  
Action Plan ◽  
National Level ◽  
Essential Medicines ◽  
World Health ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Poor Access

Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013–2020 sets an 80% target for essential NCD medicines’ availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013–2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses—41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system’s capacity to address NCDs.

scholarly journals The Frequency and Causes of Unnecessary Medical Services in Urmia, Iran: Strategies and Control

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Zeinab Dindeh ◽  
Salah Eddin Karimi ◽  
Seyede Mahboobeh Hosseini ◽  
Ayoub Nafei
Keyword(s):  
Performance Appraisal ◽  
Diagnostic Criteria ◽  
National Level ◽  
Family Physicians ◽  
World Health ◽  
Medical Services ◽  
Chi Square ◽  
Medical File ◽  
Cross Sectional ◽  
The World

Background: Unnecessary prescription, diagnosis, and medical services are increasing various health problems in the world. According to the World Health Organization (WHO), over-prescription and unnecessary services are the measures that cause significant damages rather than benefits. Objectives: The present study aimed to evaluate the perspective of Urmia medical system members regarding the frequency and causes of unnecessary medical services and their control and prevention strategies in Urmia, Iran. Methods: This descriptive-analytical, cross-sectional research was performed on 102 specialist physicians selected from the Urmia Medical Association, and the selected individuals participated in the survey online. Outcome measures included the percentage of unnecessary medical care and common causes of overtreatment. Data were collected using Johns Hopkins University Unnecessary medical services checklist. Data analysis was performed in SPSS version 22 using descriptive statistics (frequency and mean) and chi-square. Results: In total, 41% of the participants (n = 43) were family physicians, and 59% (n = 59) were specialists of other medical fields. In terms of gender, 53% were male, and the others were female. The main causes of unnecessary medical services at a national level included pressure from patients (66.7%; n = 68), fear of medical malpractice (54.9%; n = 56), pressure from colleagues (23.5%; n = 24), and achieving a high rank in a performance appraisal (40.2%; n = 41). According to the participants, the development of more guidelines and instructions (47.1%; n = 48) and training residents on the appropriate use of diagnostic criteria (50%; n = 51) could be effective approaches to preventing unnecessary medical services. In addition, significant differences were observed between the perspective of the family physicians and the specialists in terms of the fear of malpractice (P = 0.002), lack of medical history (P = 0.17), pressure from patients (P = 0.25), training of residents on the use of diagnostic criteria (P = 0.001), and easier access to medical files (P = 0.001). Conclusions: From the physicians’ perspective, overtreatment is highly common in Iran. In order to solve this problem, efforts should be dedicated to areas such as medical file availability, diminishing the fear of malpractice, and more training of residents. Moreover, it is recommended that patients’ awareness be raised regarding the damages caused by unnecessary prescriptions so that they would not request frequent visits.

scholarly journals 2019. Multicentric Antimicrobial Point Prevalence Survey in Four Tertiary Care Hospitals in Southern India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S677-S678
Author(s):  
Shilpa Prakash ◽  
Arun Wilson ◽  
Anup R Warrier ◽  
Rachana Babu ◽  
Sonya Joy ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Point Prevalence ◽  
Antimicrobial Use ◽  
Prevalence Survey ◽  
Cross Sectional ◽  
Resource Limited ◽  
Defined Daily Doses ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
Tertiary Care Hospitals

Abstract Background Antibiotic consumption data are scarce in the subcontinent. Defined Daily Doses (Doses) and Days of Therapy (DOT)-based metrics both have inherent disadvantages limiting their application in resource-limited settings primarily in terms of resource hours.. Point Prevalence Study (PPS) offers an offer an initial feasible step for describing antimicrobial use and identifying targets to reduce inappropriate use. Aim of the present study was to use PPS to identify quantitative and qualitative aspects of antimicrobial consumption. Methods A cross-sectional hospital-based PPS was conducted in 4 tertiary care hospitals—Aster Medcity (Kochi, Kerala), Aster MIMS (Calicut, Kerala), Aster Ramesh (Guntur, Andhra Pradesh), and Aster CMI (Bengaluru, Karnataka)—based on a standardized format derived from the GLOBAL-PPS initiative and WHO resources. Results The total number of patients surveyed was 944.42.7% patients had a standing antibiotic order, out of which 19.80%patients were receiving reserve antimicrobials (WHO classification). 76.23% of prescriptions were used empirically, 16.08% were used as prophylaxis meanwhile 7.67% had a culture-based indication. The overall DOT (per 1000 patient-days) for all antimicrobials in the 4 centers were 86.54, 64.19, 93.71 and 85.93 respectively with a cumulative mean DOT of 82.59. Reserve antimicrobials DOT were 26.28, 14.83, 28.08 and 19.61, respectively, with a mean of 22.2. The most common class of antimicrobial prescribed was β lactam -β lactamase inhibitors (BL/BLI) 27.3% while Carbapenems (8.16%) was the most common amongst reserve antimicrobials. Out of all the prescriptions only 7.67% had indications documented. Documented errors of dosing were seen in 8 patients. Adherence to monitoring for ADE was done in 92.57%. Conclusion The study reveals antibiotic use in almost 40% of patients under survey with a DOT of 82.59 per 1000 patient-days. Improving empirical use of antimicrobials, BL/BLI focused intervention and improved documentation has been identified as potential areas for intervention based on this study.The study also highlights the scope of PPS as an effective tool in resource-limited setting to define and refine antimicrobial use and contribute toward antimicrobial stewardship as well as other activities aimed reducing antimicrobial resistance across a range of settings. Disclosures All authors: No reported disclosures.

scholarly journals Missed Opportunities in Tuberculosis Investigation and Associated Factors at Public Health Facilities in Uganda 

2020 ◽  
Author(s):  
Keith Kakame ◽  
Noel Namuhani ◽  
Andrew Kazibwe ◽  
Felix Bongomin ◽  
Joseph Baluku ◽  
...  
Keyword(s):  
Public Health ◽  
Health Workers ◽  
Health Facilities ◽  
World Health ◽  
Cross Sectional Survey ◽  
Prevalence Survey ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Public Health Facilities ◽  
Factors Associated

Abstract BackgroundThe incidence of tuberculosis (TB) is high in Uganda; yet, TB case detection is low. A recent national TB prevalence survey revealed that only 16% of presumptive TB patients seeking care at health facilities were offered sputum microscopy or chest-X ray (CXR). The objective of this study was to determine the magnitude of, and patient factors associated with missed opportunities in TB investigation at public health facilities of Wakiso District in Uganda.MethodsA facility-based cross-sectional survey was conducted at 10 high volume public health facilities offering comprehensive TB services in Wakiso, Uganda, among adults (≥18 years) with at least one symptom suggestive of TB predefined according to World Health Organisation criteria. Using exit interviews, data on demographics, TB symptoms, and clinical data relevant to TB were collected. A missed opportunity in TB investigation was defined as a patient with symptoms suggestive of TB who did not have sputum and/or CXR evaluation to rule out TB. Poisson regression analysis was performed to determine factors associated with missed opportunities in TB investigation using STATA 14.ResultsTwo hundred forty seven presumptive TB patients were recruited into this study exiting at antiretroviral therapy (ART) clinics (n=132) or general outpatient clinics (n=115) at public health facilities. Majority of participants were females (161/247, 65.2%) and the mean +SD age was 35.1 + 11.5 years. Sputum and/or CXR were not requested from 138 (55.9%) patients with symptoms suggestive of TB disease. Patients who did not inform health workers about TB related symptoms were more likely to miss a TB investigation (adjusted prevalence ratio: 1.68, 95%CI; 1.36-2.08, P<0.001). Conclusion; A large proportion of patients with symptoms suggestive of TB did not have sputum and/ or CXR requested for investigation. Patients who did not inform health workers about their TB related symptoms were more likely to miss having sputum and/ or CXR requested. We recommend studies to explore barriers and facilitators of disclosure of TB symptoms to enable formulation of effective interventions to empower people to improve likelihood of disclosing TB related symptoms.

scholarly journals The Availability of Improved Sanitation Facilities and Its Associated Factors in the 12th District of Kandahar City, Afghanistan

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Esmat Ullah Muslim ◽  
Muhammad Haroon Stanikzai ◽  
Abdul Wahed Wasiq ◽  
Ahmad Khan ◽  
Hadia Sayam
Keyword(s):  
National Level ◽  
Monitoring Program ◽  
World Health ◽  
Cross Sectional Survey ◽  
Multivariable Logistic Regression Model ◽  
Cross Sectional ◽  
Factors Associated ◽  
Improved Sanitation ◽  
Joint Monitoring ◽  
Sustainable Developmental Goals

Background. The majority of people practicing open defecation and utilizing unhealthy sanitation facilities are in the developing world. The utilization of unimproved sanitation facilities remains the primary risk factor for many diseases, including nutritional diseases, diarrheal diseases, typhoid, cholera, and dysentery, particularly among children. Objectives. This study was carried out to assess the availability of improved sanitation facilities and factors associated with it in the 12th district of Kandahar city, Kandahar Province, Afghanistan. Methods. The study is a cross-sectional survey, conducted between September and October 2019. A structured questionnaire was used to gather self-reported information of the respondents, including sociodemographic information, household characteristics, and behavioral and environmental characteristics of the available sanitation facilities. Factors associated with the availability of the improved sanitation facility were determined using a multivariable logistic regression model. Results. In this study, the availability of improved sanitation facilities was 85.7% (95% confidence interval (CI) = 77.6%–92.1%). It was significantly influenced by living in a private house (adjusted odds ratio (AOR) = 2.99 (95% CI; 1.43–6.26)); inside location of latrine (AOR = 14.31 (95% CI; 3.59–56.99)); individual household latrine (AOR = 2.03 (1.04–3.95)); and the number of latrines in the household (AOR = 5.04 (2.45–10.35)). Conclusion. The availability of improved sanitation facilities was higher compared to the national level in the study area. This study provides significant evidence on approaches in line with the World Health Organization’s (WHO) Joint Monitoring Program and Sustainable Developmental Goals (SDGs) for enhancing the availability of improved sanitation facilities in Kandahar city.

scholarly journals Prevalence of and rationale for antimicrobial prescription during ambulatory care visits in Japan: a prospective, multicentre, cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039329
Author(s):  
Junpei Komagamine ◽  
Masaki Kobayashi ◽  
Takahiro Mori
Keyword(s):  
Ambulatory Care ◽  
Drug Prescription ◽  
Cross Sectional Study ◽  
Antimicrobial Drug ◽  
Antimicrobial Use ◽  
Sectional Study ◽  
Antimicrobial Drugs ◽  
Cross Sectional ◽  
Infection Treatment ◽  
Antimicrobial Prescription

ObjectiveTo determine the rate of outpatient antimicrobial use and the rationale for antimicrobial prescription.DesignA prospective, multicentre, cross-sectional study.SettingAmbulatory care settings at community general hospitals.ParticipantsA total of 1972 consecutive ambulatory visits by 1952 patients were included from 2 February 2020 to 13 February 2020. Visits resulting in hospital admission and regularly scheduled visits were excluded.Main outcome measuresThe primary outcome was the proportion of ambulatory visits resulting in antimicrobial drug prescriptions. The secondary outcomes were the reasons for antimicrobial drug prescription and the proportion of unnecessary antimicrobial prescriptions among all antimicrobial drugs used for treatment.ResultsThe mean patient age was 53.8 (SD 25.8) years old, and the proportion of women was 52.6%. A total of 162 antimicrobial drugs were prescribed in 153 (7.8%) visits. The most common antimicrobial drugs were penicillins (n=48, 29.6%), followed by third-generation cephalosporins (n=35, 21.6%) and quinolones (n=20, 12.4%). Among all the antimicrobial drugs prescribed, 125 (77.2%), 18 (11.1%) and 11 (6.8%) were used for infection treatment, wound prophylaxis and surgical prophylaxis, respectively. Of the 125 antimicrobial drugs used for infection treatment, 60 (48.0%) were judged to be unnecessary.ConclusionsOne in every 13 ambulatory visits resulted in antimicrobial use in Japan. Three-fourths of the prescribed antimicrobial drugs were used for infection treatment, but approximately half of those drugs may have been unnecessary. Further efforts to reduce unnecessary antimicrobial drug use are needed.Trial registration numberUMIN000039360.

scholarly journals P156 Global sleep health surveillance of adults: A scoping review

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A72-A72
Author(s):  
J Way ◽  
P Cistulli ◽  
Y Bin
Keyword(s):  
Scoping Review ◽  
Health Surveys ◽  
National Level ◽  
Health Surveillance ◽  
Social Outcomes ◽  
World Health ◽  
Current Status ◽  
Surveillance Systems ◽  
Sleep Health ◽  
Cross Sectional

Abstract Introduction The monitoring of sleep health is an emerging but globally under-recognised public health opportunity to help address poor health and social outcomes in the general population. This scoping review aims to identify the existing national surveillance systems monitoring sleep health and to describe the sleep indicators used in the questionnaires. Methods We systematically searched the grey and peer-reviewed literature for cross-sectional national health surveys that included measurement of the sleep of adults aged 18+. Countries screened were the 194 Member States of the World Health Organization (WHO). Searches included 1) targeted searches of the websites of national and international health agencies and statistics departments, 2) customised internet search, and 3) search of electronic databases (PubMed and EMBASE). Progress to date Searches of targeted websites and the internet have been completed. Preliminary analysis shows that 49 (25%) countries have national surveys that include at least one sleep health-related question. Breakdown by the WHO defined regions reveal the European Region (45%) with the highest sleep health surveillance and the African Region (6%) with the lowest. An electronic database search is currently being conducted. Intended outcome and impact This scoping review will provide an overview of the current status of global sleep health surveillance including how sleep is measured in population health surveys. The results will raise awareness about the need to monitor sleep at a national level to improve health and social outcomes.

scholarly journals Trend of healthcare-associated infections in a teaching hospital in Tunisia, 2014-2019

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Ghali ◽  
A Ben Cheikh ◽  
S Bhiri ◽  
S Khefacha Aissa ◽  
L Dhidah ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Cross Sectional Study ◽  
University Hospital ◽  
World Health ◽  
Healthcare Associated Infections ◽  
Prevalence Survey ◽  
Cross Sectional ◽  
Gram Negative ◽  
Healthcare Associated

Abstract Background National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. During this period, actions to improve HAI prevention were implemented, including strengthened isolation measures; hand hygiene promotion using the World Health Organization multimodal strategy; and promotion of appropriate antimicrobial use. We aimed to examine trends in HAI in Sahloul Hospital over six years. Methods Annual prevalence surveys of healthcare-associated infections (HAIs) between 2014 and 2019 were conducted in the university hospital in Tunisia. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey). Results Over six years, prevalence of HAI ranged from 11.4% in 2014 to 9.5% in 2019. The prevalence of HAIs did not show a significant change across the six surveys. However, there were significant (P = 0.008) reductions in the prevalence of total HAIs in intensive care units, which had the highest frequencies of HAIs over those six years. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2019, 27 germs were identified, the most frequent were Gram Negative Bacilli (74%), mostly Escherichia coli. Conclusions This HAI prevention strategy was influential in decreasing infections among hospitalized patients in intensive care units. Challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms. Key messages Using prevalence surveys, we were able to have an insight into the most common isolates identified throughout the last six years. Repeated prevalence surveys are an effective tool for monitoring HAI frequency and contributing to the establishment of effective infection control.

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