ObjectivesAntimicrobial-resistant infections are a major global health issue. Ease of antimicrobial access in developing countries is proposed to be a key driver of the antimicrobial resistance (AMR) epidemic despite a lack of community antimicrobial usage data.MethodsUsing a mixed-methods approach (geospatial mapping, simulated clients, healthcare utilization, longitudinal cohort) we assessed antimicrobial access in the community and quantified antimicrobial usage for childhood diarrhoea in an urban Vietnamese setting.ResultsThe study area had a pharmacy density of 15.7 pharmacies/km2 (a pharmacy for every 1316 people). Using a simulated client method at pharmacies within the area, we found that 8% (3/37) and 22% (8/37) of outlets sold antimicrobials for paediatric watery and mucoid diarrhoea, respectively. However, despite ease of pharmacy access, the majority of caregivers would choose to take their child to a healthcare facility, with 81% (319/396) and 88% (347/396) of responders selecting a specialized hospital as one of their top three preferences when seeking treatment for watery and mucoid diarrhoea, respectively. We calculated that at least 19% (2688/14427) of diarrhoea episodes in those aged 1 to <5 years would receive an antimicrobial annually; however, antimicrobial usage was almost 10 times greater in hospitals than in the community.ConclusionsOur data question the impact of community antimicrobial usage on AMR and highlight the need for better education and guidelines for all professionals with the authority to prescribe antimicrobials.

Abstract. The paper presents a new indicator called normalized energy index (nei) in damage locating vector method (DLV) for detecting multiple damaged positions in beam and truss structures. In the DLV method, a set of load vectors, which is extracted from the change in flexibility matrix between an undamaged structure and a damaged one, is applied as static loads to the undamaged structure which are evaluated via the finite element modeling. Then, the nei values are computed for each element by using the displacements. In order to verify the accuracy and efficiency of a proposed indicator, a cantilevered beam and a 14-bay planar truss are considered.