Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems

This review identifies evidence on supply-side interventions to change the practices of antibiotic prescribers and gatekeepers in low- and middle-income countries (LMICs). A total of 102 studies met the inclusion criteria, of which 70 studies evaluated interventions and 32 provided insight into prescribing contexts. All intervention studies were from human healthcare settings, none were from animal health. Only one context study examined antibiotic use in animal health. The evidence base is uneven, with the strongest evidence on knowledge and stewardship interventions. The review found that multiplex interventions that combine different strategies to influence behaviour tend to have a higher success rate than interventions based on single strategies. Evidence on prescribing contexts highlights interacting influences including health system quality, education, perceptions of patient demand, bureaucratic processes, profit, competition, and cultures of care. Most interventions took place within one health setting. Very few studies targeted interventions across different kinds of providers and settings. Interventions in hospitals were the most commonly evaluated. There is much less evidence on private and informal private providers who play a major role in drug distribution in LMICs. There were no interventions involving drug detailers or the pharmaceutical companies despite their prominent role in the contextual studies.

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

10.21203/rs.3.rs-1082462/v1 ◽

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

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Determinants of trends in reported antibiotic use among sick children under five years of age across low-income and middle-income countries in 2005-17: a systematic analysis of user characteristics based on 132 national surveys from 73 countries

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2021.05.058 ◽

2021 ◽

Author(s):

Gbemisola Allwell-Brown ◽

Laith Hussain-Alkhateeb ◽

Maquins Odhiambo Sewe ◽

Freddy Eric Kitutu ◽

Susanne Strömdahl ◽

...

Keyword(s):

Low Income ◽

Antibiotic Use ◽

User Characteristics ◽

Systematic Analysis ◽

Middle Income ◽

Children Under Five ◽

Under Five ◽

National Surveys ◽

Middle Income Countries ◽

Sick Children

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The burgeoning role of global health diplomacy to alleviate suffering of cancer patients in low- and middle-income countries

International Health ◽

10.1093/inthealth/ihaa004 ◽

2020 ◽

Vol 12 (3) ◽

pp. 231-233

Author(s):

Melissa Adomako ◽

Alaei Kamiar ◽

Abdulla Alshaikh ◽

Lyndsay S Baines ◽

Desiree Benson ◽

...

Keyword(s):

Global Health ◽

Evidence Base ◽

International Affairs ◽

Global Health Diplomacy ◽

Middle Income ◽

Middle Income Countries ◽

Health Diplomacy ◽

Health Practitioners ◽

And Control ◽

Low And Middle Income

Abstract The science of global health diplomacy (GHD) consists of cross-disciplinary, multistakeholder credentials comprised of national security, public health, international affairs, management, law, economics and trade policy. GHD is well placed to bring about better and improved multilateral stakeholder leverage and outcomes in the prevention and control of cancer. It is important to create an evidence base that provides clear and specific guidance for health practitioners in low- and middle-income countries (LMICs) through involvement of all stakeholders. GHD can assist LMICs to negotiate across multilateral stakeholders to integrate prevention, treatment and palliative care of cancer into their commercial and trade policies.

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The Impact of Cash Transfers: A Review of the Evidence from Low- and Middle-income Countries

Journal of Social Policy ◽

10.1017/s0047279418000715 ◽

2018 ◽

Vol 48 (03) ◽

pp. 569-594 ◽

Cited By ~ 18

Author(s):

FRANCESCA BASTAGLI ◽

JESSICA HAGEN-ZANKER ◽

LUKE HARMAN ◽

VALENTINA BARCA ◽

GEORGINA STURGE ◽

...

Keyword(s):

Evidence Base ◽

Cash Transfers ◽

Cash Transfer ◽

Future Research ◽

Unintended Effects ◽

Screening Process ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

AbstractThis article presents the findings of a review of the impact of non-contributory cash transfers on individuals and households in low- and middle-income countries, covering the literature of 15 years, from 2000 to 2015. Based on evidence extracted from 165 studies, retrieved through a systematic search and screening process, this article discusses the impact of cash transfers on 35 indicators covering six outcome areas: monetary poverty; education; health and nutrition; savings, investment and production; work; and empowerment. For most of the studies, cash transfers contributed to progress in the selected indicators in the direction intended by policymakers. Despite variations in the size and strength of the underlying evidence base by outcome and indicator, this finding is consistent across all outcome areas. The article also investigates unintended effects of cash transfer receipt, such as potential reductions in adult work effort and increased fertility, finding limited evidence for such unintended effects. Finally, the article highlights gaps in the evidence base and areas which would benefit from additional future research.

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Video Relay Interpreting and Overcoming Barriers in Health Care for Deaf Users: A Scoping Review (Preprint)

10.2196/preprints.32439 ◽

2021 ◽

Author(s):

Minerva Rivas Velarde ◽

Caroline Jagoe ◽

Jess Cuculick

Keyword(s):

Health Care ◽

Sign Language ◽

Scoping Review ◽

Secondary Analysis ◽

Healthcare Services ◽

Eligibility Criteria ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Settings ◽

Study Selection

UNSTRUCTURED Abstract Objectives To identify existing evidence regarding the use of Video Remote Interpretation (VRI) in healthcare settings. To assess if VRI technology can enable deaf-users to overcome interpretation barriers and improve communication outcomes between them and health care personnel. Design Scoping review. Data sources Seven medical research databases (Medline, Web of Science, Embase, Google Scholar) from 2006 and bibliographies and citations of relevant papers. Searches included articles in English, Spanish and French. Eligibility criteria for study selection Original articles about the use of VRI for Deaf or Hard of Hearing sign language users (DHH) for, or within, healthcare. Results From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. Fifteen articles were selected for inclusion. Four were literature reviews; four were surveys, three qualitative studies; and one mixed-methods study that combined qualitative and quantitative data, one brief communication, one quality improvement report and one secondary analysis. This scoping review identified a knowledge gap regarding the quality of interpretation and training of sign language interpretation for healthcare. It also shows that this area is under researched and evidence is scant. All evidence was from high-income countries which is particularly problematic given that the majority of DHH persons live in low- and middle-income countries. Conclusions Furthering our understanding on the use of VRI technology is pertinent and relevant. Available literature shows that VRI may enable deaf-users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within healthcare services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screen and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.

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2031. Impact of Education and Antibiotic Guidelines on Dispensing Antibiotics with Community Pharmacists in a Low- and Middle-Income Country

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1711 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S682-S682

Author(s):

Smitha Gudipati ◽

Deepak Bajracharya ◽

Lenjana Jimee ◽

Gina Maki ◽

Marcus Zervos ◽

...

Keyword(s):

Community Pharmacists ◽

Antibiotic Use ◽

Educational Assessment ◽

The Body ◽

Control Groups ◽

Post Intervention ◽

Middle Income ◽

Middle Income Countries ◽

And Control ◽

Low And Middle Income

Abstract Background Non-prescription use of antibiotics in low- and middle-income countries has contributed to significant antimicrobial resistance (AMR). Henry Ford Health System has partnered with multinational organizations in Nepal to address the need for increasing awareness of AMR and implementation of effective antimicrobial stewardship. This partnership confirmed the importance of increasing knowledge and awareness regarding AMR and antibiotic use to community pharmacists. The present pilot study assessed if outpatient antibiotic dispensing guidelines given to community pharmacists could result in a reduction of unneeded antibiotic use. Methods Nine community pharmacies from Kathmandu were selected of which two were used as controls. Seven pharmacists were educated on the appropriate use of antibiotics, and outpatient dispensing before and after guidelines at all pharmacies were evaluated. The pharmacists were given guidelines on antibiotic use and duration needed for common bacterial infections encountered. Controls were not given guidelines. At baseline and post-intervention (1 week), pill counts were performed of the top six antibiotics that were dispensed by the pharmacist. Pharmacists were requested to keep a log of how many antibiotics were dispensed for one week. The pharmacists also were requested to fill out a post-intervention educational assessment to evaluate retention. Results Pill count pre-intervention was 15,856 and 1512 and post-intervention was 11,168 and 1,440 in the intervention and control groups respectively (Table 1). A post-intervention educational assessment revealed that both the intervention and control groups believed antibiotics can treat viruses (57% vs. 50%) and that antibiotics do not kill good bacteria that protect the body from infection (57% vs. 50%) (Table 2). Conclusion There was no difference in the dispensing of antibiotics between pre- and post-intervention. The findings of this study show significant room for improvement in continuing education about antibiotic use in outpatient pharmacies. Further studies are needed to target outpatient antibiotic dispensing with education and identifying economic or other incentives in hopes of reducing the burden of AMR in low- and middle-income countries. Disclosures All authors: No reported disclosures.

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Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

Antibiotics ◽

10.3390/antibiotics9080497 ◽

2020 ◽

Vol 9 (8) ◽

pp. 497

Author(s):

Massimo Sartelli ◽

Timothy C. Hardcastle ◽

Fausto Catena ◽

Alain Chichom-Mefire ◽

Federico Coccolini ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Middle Income ◽

Middle Income Countries ◽

And Control ◽

Low And Middle Income

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons’ compliance with best practices even more important.

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Impact of national interventions to promote responsible antibiotic use: a systematic review

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz348 ◽

2019 ◽

Vol 75 (1) ◽

pp. 14-29 ◽

Cited By ~ 7

Author(s):

Jane Mingjie Lim ◽

Shweta Rajkumar Singh ◽

Minh Cam Duong ◽

Helena Legido-Quigley ◽

Li Yang Hsu ◽

...

Keyword(s):

Systematic Review ◽

National Level ◽

Public Health Problem ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Middle Income ◽

Middle Income Countries ◽

Policy Interventions ◽

The Impact

Abstract Background Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. Methods We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. Results We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. Conclusions National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

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