ObjectivesThe objective of this study was to address the knowledge gap regarding antibiotic use in Medecins Sans Frontiéres (MSF) projects located in Africa by exploring antibiotic prescription and consumption habits and their drivers at different healthcare levels.DesignThis study used an exploratory study design through thematic analysis of semistructured, in-depth interviews, focus group discussions (FGDs) and field observations in order to understand the main drivers influencing current antibiotics prescription habits and consumption habits of patients in different geographical settings.SettingThe study took place in MSF centres and towns across four countries: Guinea-Bissau, Central African Republic (CAR), Democratic Republic of Congo (DRC) and Sudan.Participants384 respondents participated in the study, which includes project staff, prescribers, community members, patients, among other groups.ResultsTreatment protocols were physically present in all countries except DRC, but compliance to protocols varied across contexts. A failing health system and barriers to accessing healthcare were perceived as major drivers of overuse and inconsistent prescription practices. Patient demands influenced prescription decisions, and self-medication was commonly reported in the context of failing health systems. Additionally, there was a strong demand for quick cures and communities preferred injections over pills. Patients tended to stop antibiotic treatment once symptoms abated and had major gaps in understanding antibiotic intake instructions and functions.ConclusionsWhile there were specific findings in each context, the larger trend from these four MSF projects in Africa indicates widespread use of antibiotics based on unclear assumptions, which are often influenced by patient demands. There needs to be a broader focus on the balance between access and excess, especially in such fragile contexts where access to healthcare is a real challenge.

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Background: Successful epidemic preparedness and response require an understanding of social behaviour: social values, priorities and practices fundamentally shape human engagements with measures to prepare for and to prevent epidemics and antimicrobial resistance. Because of its capacity to document and evaluate health-seeking behaviors, local understandings of disease and explanations of transmission, and local reactions to public health interventions, social science, in particular anthropological research is well positioned to facilitate insight into these priorities and practices.Method: The SoNAR-Global project (A Social Science Network for Infectious Threats and Antimicrobial Resistance) undertook a mapping and assessment of existing Community Engagement (CE) models that target infectious threats and/or antimicrobial resistance (AMR) Bangladesh, Uganda and Ukraine, which are integrated in the project through partner universities. We compared our findings with the UNICEF Communication for Development (C4D) Minimum Quality Standards for Community Engagement. Conclusions: On these grounds, we emphasize six critical elements for Community Engagement before and during epidemics. We argue that CE efforts must cooperate and dialogue with people in need and negotiate integrated, localized public health models that improve their lives before and during an epidemic.Results: We identified and recommend currently available social science tools for Community Engagement, which correspond to the six critical elements and can contribute to enhance preparedness and response activities to infectious threats.

Election management bodies (EMBs) can be classified according to different criteria; their composition is one of them. Most EMB typologies pertain to composition and recruitment at the top, and not at the level of sub-ordinate commissions and polling stations. wahlbeboachtung.org has undertaken preliminary research to compare EMB models in Europe on the basis of OSCE/ODIHR reports. This research illustrates that Austria shares a common model – political parties nominating poll workers – predominantly with countries in its eastern neighbourhood, but also indicates the need to conduct further research into EMB compositions and the correlations between various levels, not the least in the context of ongoing electoral reform debates in Europe.