The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences aff ect everybody in the world. Similarities with climate change are evident. Many eff orts have been made to describe the many diff erent facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to eff ective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed.

Background Tanzania’s primary healthcare system suffers from a scarcity of financial and human resources that impedes its effectiveness to deliver dependable and uniform quality healthcare. Adherence to standard treatment guidelines (STG) can help provide more consistent and correct diagnoses and treatments and limit the irrational use of medicines and the negative health consequences that can occur as a result. The purpose of this study was to investigate prescribers’ adherence of their diagnoses and respective treatments to national STG and to identify potential areas for planning interventions. Methods A cross-sectional study on prescribers’ adherence to diagnosis and treatment, according to national STG, was conducted in 2012 in public primary healthcare facilities (HCF) in the Dodoma region of Tanzania. Information on 2886 patients was collected, prospectively and retrospectively, from 120 HCF across the Dodoma region using a structured questionnaire. Twenty-five broadly defined main illness groups were recorded and the nine most prevalent and relevant conditions were statistically analysed in detail. Results Diagnoses and related treatments were recorded and analysed in 2872 cases. The nine most prevalent conditions were upper respiratory tract infections (25%), malaria (18%), diarrhoea (9.9%), pneumonia (6.1%), skin problems (5.8%), gastrointestinal diagnoses (5%), urinary tract infections (4%), worm infestations (3.6%) and eye problems (2.1%). Only 1.8% of all diagnoses were non-communicable diseases. The proportion of prescribers’ primary diagnoses that completely adhered to national STG was 599 (29.9%), those that partially adhered totalled 775 (38.7%), wrong medication was given in 621 cases (30.9%) and no diagnosis or medication was given in nine cases (0.5%). Sixty-one percent of all patients received an antibiotic regardless of the diagnoses. Complete adherence was highest when worms were diagnosed and lowest for diarrhoea. The proportion of cases that did not adhere to STG was highest with patients with skin problems and lowest for malaria. Conclusion Prescribers’ general adherence to national STG in primary HCF in the public sector in Dodoma region is sub-optimal. The reasons are multifaceted and focused attention, directed at improving prescribing and pharmacotherapy, is required with a view of improving patient care and health outcomes.

No abstract

No abstract

Introduction Antimicrobial resistance is still not given enough attention and the public is insufficiently aware of its existence, leading to behaviour, which propagates the rise of antimicrobial resistance (AMR). One of the objectives of Tanzania's national action plan on antimicrobial resistance is to improve awareness and understanding of antimicrobial use and resistance through effective communication, education and training. This task will need involvement of many stakeholders and sectors. Objectives To assess the knowledge, attitudes and practices toward antimicrobial use and resistance among students in three secondary schools in Dodoma city. Methods For this interventional pre-post comparative study, data were collected before and after training on antimicrobial use and resistance. Secondary school students from Mkonze, Merriwa and Kiwanja cha Ndege secondary school who are members of AMR school clubs participated. Training included classroom teaching and arts and crafts. We used quantitative and qualitative data collection methods by using self-administered paper-based structured coded questionnaires delivered to the students with the supervision of school guardians. Analysis was done through Excel and SPSS. Results Three aspects were investigated: awareness of ways to reduce AMR; knowledge that antibiotics cannot be used to treat flu and factors that contribute to AMR. Before the training knowledge of these was below 37%. Three months after the training knowledge had increased to above 90%. Conclusions Training of secondary school students significantly improved awareness, knowledge and attitude regarding antimicrobial use and antimicrobial resistance. AMR school clubs are an effective vehicle to raise awareness and mitigate the AMR crisis. Focus on students will lead to wider awareness in the community.