scholarly journals Knowledge, attitude, and practices of health-care providers toward antibiotic prescribing, antibiotic resistance, and multidrug-resistant tuberculosis

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
Deepak Juyal ◽  
Ashna Malhotra ◽  
Vimal Kumar ◽  
Deepak Gautam ◽  
Rajesh Malhotra
Keyword(s):  
Health Care ◽  
Antibiotic Resistance ◽  
Health Care Providers ◽  
Multidrug Resistant ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis

scholarly journals Gridlock from diagnosis to treatment of multidrug resistant tuberculosis (MDR-TB) in Tanzania: patients’ perspectives from a focus group discussion

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stellah G. Mpagama ◽  
Mangi J. Ezekiel ◽  
Peter M. Mbelele ◽  
Anna M. Chongolo ◽  
Gibson S. Kibiki ◽  
...  
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Health System ◽  
Health Care Providers ◽  
Multidrug Resistant ◽  
International Standards ◽  
Care Providers ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background Molecular diagnostics have revolutionized the diagnosis of multidrug resistant tuberculosis (MDR-TB). Yet in Tanzania we found delay in diagnosis with more than 70% of MDR-TB patients having a history of several previous treatment courses for TB signaling prior opportunities for diagnosis. We aimed to explore patients’ viewpoints and experiences with personal and socio-behavioral obstacles from MDR-TB diagnosis to treatment in an attempt to understand these prior findings. Methods The study was conducted in December 2016 with MDR-TB patients admitted at Kibong’oto Infectious Diseases Hospital. A qualitative approach deploying focus group discussions (FGDs) was used to gather information. Groups were sex aggregated to allow free interaction and to gauge gender specific issues in the social and behavioral contexts. The FGDs explored pathways and factors in the service delivery that may have contributed in the delay in accessing MDR-TB diagnostics and/or treatment. Collected data were coded, categorized and thematically interpreted. Results Forty MDR-TB patients participated in six FGDs. Challenges and barriers contributing to the delay in accessing MDR-TB diagnosis to treatment were as follows: 1) Participants had a different understanding of MDR-TB that led to seeking services outside the conventional health system; 2) Socio-economic adversity made health-seeking behavior difficult and often unproductive; 3) In the health system, challenges included inadequacy of MDR-TB diagnostic centers, lack of knowledge on behalf of health care providers to consider MDR-TB and order appropriate diagnostics; 4) The specimen referral system for early diagnosis of MDR-TB was inefficient. Non-adherence of TB patients to first-line anti-TB drugs prior to MDR-TB diagnosis, given the multitude of barriers discussed, was coupled with both intentional and unintentional non-adherence of health care providers to international standards of TB care. Conclusion Patient-centered strategies bridging communities and the health system are urgently required for optimum MDR-TB control in Tanzania.

scholarly journals Contact Investigation of Multidrug-Resistant Tuberculosis Patients: A Mixed-Methods Study from Myanmar

2019 ◽  
Vol 5 (1) ◽  
pp. 3
Author(s):  
Aye Mon Phyo ◽  
Ajay M. V. Kumar ◽  
Kyaw Thu Soe ◽  
Khine Wut Yee Kyaw ◽  
Aung Si Thu ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Care Providers ◽  
Multidrug Resistant ◽  
Mixed Methods Study ◽  
Care Providers ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Contact Investigation ◽  
Mdr Tb

There is no published evidence on contact investigation among multidrug-resistant tuberculosis (MDR-TB) patients from Myanmar. We describe the cascade of contact investigation conducted in 27 townships of Myanmar from January 2018 to June 2019 and its implementation challenges. This was a mixed-methods study involving quantitative (cohort analysis of programme data) and qualitative components (thematic analysis of interviews of 8 contacts and 13 health care providers). There were 556 MDR-TB patients and 1908 contacts, of whom 1134 (59%) reached the health centres for screening (chest radiography and symptoms). Of the latter, 344 (30%) had presumptive TB and of them, 186 (54%) were investigated (sputum microscopy or Xpert MTB/RIF®). A total of 27 TB patients were diagnosed (six bacteriologically-confirmed including five with rifampicin resistance). The key reasons for not reaching township TB centres included lack of knowledge and lack of risk perception owing to wrong beliefs among contacts, financial constraints related to loss of wages and transportation charges, and inconvenient clinic hours. The reasons for not being investigated included inability to produce sputum, health care providers being unaware of or not agreeing to the investigation protocol, fixed clinic days and times, and charges for investigation. The National Tuberculosis Programme needs to note these findings and take necessary action.

scholarly journals Gridlock from Diagnosis to Treatment of Multidrug Resistant Tuberculosis (MDR-TB) in Tanzania: Patients’ Perspectives from the Focus Group Discussion

2018 ◽  
Author(s):  
Stellah G Mpagama ◽  
Ezekiel Mangi ◽  
Peter M Mbelele ◽  
Anna M Chongolo ◽  
Gibson S Kibiki ◽  
...  
Keyword(s):  
Health Care ◽  
Focus Group ◽  
Health System ◽  
Health Care Providers ◽  
Group Discussion ◽  
Multidrug Resistant ◽  
Care Providers ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

AbstractIntroductionMolecular diagnostics have revolutionized the diagnosis of multidrug resistant tuberculosis (MDR-TB). Yet in Tanzania we found delay in diagnosis with more than 70% of MDR-TB patients having history of several previous treatment courses for TB signaling complications of prior missed diagnosis. We aimed to explore patients’ viewpoints and experiences with personal and socio-behavioral obstacles from MDR-TB diagnosis to treatment in an attempt to understand these prior findings.MethodsThe study was conducted in December 2016 with MDR-TB patients admitted at Kibong’oto Infectious Diseases Hospital. We used semi-structured interviews and focus group discussion to examine patients’ views and experiences during MDR-TB diagnosis. Groups were sex aggregated to allow free interaction and to gauge gender specific issues in the social and behavioral contexts. The discussion – explored patients’ delivery factors that were impacting delay from MDR-TB diagnosis to treatment. Iterative data collection and analysis was applied with data, codes and categories being compared and refined.ResultsForty-five MDR-TB patients participated in 6 focus group discussions. Challenges and barriers contributing to the delay from MDR-TB diagnosis to treatment were as follows: 1) The general population had differing understanding of MDR-TB that led to seeking services from traditional healers; 2) Also socio-economic adversity made health-seeking behavior difficult and often unproductive; 3) In the health system, challenges included inadequacy of MDR-TB diagnostic centers, lack of knowledge on behalf of health care providers to consider MDR-TB and order appropriate diagnostics; 4) Insufficiency in the specimen referral system for early diagnosis of MDR-TB. Non-adherence of TB patients to first-line anti-TB drugs prior to MDR-TB diagnosis given the multitude of barriers discussed was coupled with both intentional and unintentional non-adherence of health care providers to international standards of TB care.ConclusionPatient-centered strategies bridging communities and the health system are urgently required for optimum MDR-TB control in Tanzania.

scholarly journals Challenges for Economic Evaluation of Health Care Strategies to Contain Antimicrobial Resistance

Antibiotics ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 166 ◽  
Author(s):  
Emily A. F. Holmes ◽  
Dyfrig A. Hughes
Keyword(s):  
Health Care ◽  
Economic Evaluation ◽  
Antimicrobial Resistance ◽  
Health Care Providers ◽  
Quality Adjusted Life Year ◽  
Economic Evaluations ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Short Term ◽  
Health Care Interventions

The threat of antimicrobial resistance has global health and economic consequences. Medical strategies to reduce unnecessary antibiotic prescribing, to conserve the effectiveness of current antimicrobials in the long term, inevitably result in short-term costs to health care providers. Economic evaluations of health care interventions therefore need to consider the short-term costs of interventions, to gain future benefits. This represents a challenge for health economists, not only in terms of the most appropriate methods for evaluation, but also in attributing the potential budget impact over time and considering health impacts on future populations. This commentary discusses the challenge of accurately capturing the cost-effectiveness of health care interventions aimed at tackling antimicrobial resistance. We reflect on methods to capture and incorporate the costs and health outcomes associated with antimicrobial resistance, the appropriateness of the quality-adjusted-life year (QALY), individual time preferences, and perspectives in economic evaluation.

scholarly journals Health care seeking patterns of rifampicin-resistant tuberculosis patients in Harare, Zimbabwe: A prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254204
Author(s):  
Rebecca Tadokera ◽  
Stella Huo ◽  
Grant Theron ◽  
Collins Timire ◽  
Salome Manyau-Makumbirofa ◽  
...  
Keyword(s):  
Health Care ◽  
Effective Treatment ◽  
Health Care Providers ◽  
Private Health Care ◽  
Care Providers ◽  
System Delay ◽  
Health Seeking ◽  
Total Delay ◽  
Resistant Tuberculosis ◽  
Initial Symptoms

Background Delays in seeking and accessing treatment for rifampicin-resistant tuberculosis (RR-TB) and multi-drug resistant (MDR-TB) are major impediments to TB control in high-burden, resource-limited settings. Method We prospectively determined health-seeking behavioural patterns and associations with treatment outcomes and costs among 68 RR-TB patients attending conveniently selected facilities in a decentralised system in Harare, Zimbabwe. Results From initial symptoms to initiation of effective treatment, patients made a median number of three health care visits (IQR 2–4 visits) at a median cost of 13% (IQR 6–31%) of their total annual household income (mean cost, US$410). Cumulatively, RR-TB patients most frequently first visited private facilities, i.e., private pharmacies (30%) and other private health care providers (24%) combined. Median patient delay was 26 days (IQR 14–42 days); median health system delay was 97 days (IQR 30–215 days) and median total delay from symptom onset to initiation of effective treatment was 132 days (IQR 51–287 days). The majority of patients (88%) attributed initial delay in seeking care to “not feeling sick enough.” Total delay, total cost and number of health care visits were not associated with treatment or clinical outcomes, though our study was not adequately powered for these determinations. Conclusions Despite the public availability of rapid molecular TB tests, patients experienced significant delays and high costs in accessing RR-TB treatment. Active case finding, integration of private health care providers and enhanced service delivery may reduce treatment delay and TB associated costs.

scholarly journals Antibiotic Resistance - Knowledge, Attitude And Practice Based Survey Amongst Dental Health Care Providers In An Institution​

2021 ◽  
Author(s):  
Gaur Shivangi ◽  
◽  
Marimuthu Madhulaxmi
Keyword(s):  
Health Care ◽  
Antibiotic Resistance ◽  
Health Care Providers ◽  
Survey Methods ◽  
Dental Health ◽  
Antibiotic Usage ◽  
Care Providers ◽  
Dental Health Care ◽  
Attitude And Practice ◽  
Knowledge Attitude And Practice

Introduction: Antibiotic resistance is definitely one of the most dreaded outcomes of injudicious use of antibiotics in a developing country like India. The prevalence of Over the counter (OTC) availability of antibiotics has also contributed to this bane and burden of antibiotic resistance in our country. Aim: The aim of this survey based study was to examine the knowledge on antibiotic usage, resistance, attitudes, perceptions and practices among dental health care providers using an online survey. Methods and Methodology: An Eighteen point online close ended questionnaire based survey was conducted amongst 100 randomly selected postgraduate stu- dents in various dental specialities from our institution, whereby their Knowledge, attitude and Practice regard- ing antibiotic resistance and usage was assessed. The questionnaire was designed to include demographic information of the participants along with questions based on frequency of antibiotic usage, resistance and interest of participants to attend educational seminars as a part of continuing education. Results: 76.47% participants agreed that antibiotic resis- tance is a major public health burden in India and glob- ally. Participants who had never attended seminars on antibiotic resistance were 82.35% and 89.41% were willing to attend seminars. Conclusions: Our survey showed few mis-prescriptions of antibiotics in cases of resistance to penicillin groups of drugs and use of broad versus narrow spectrum antibiotics. However, the overall awareness and prescription protocols were appropriate, thereby concluding that post graduates had a good knowledge of antibiotics, their use and risks involved.

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