Purpose The implementation of an advanced antimicrobial stewardship program (ASP) at a quaternary care hospital in the United Arab Emirates is described, including a report on the implementation and outcomes of the program. Methods This was a single‐center quasi‐experimental study to assess the impact of the ASP on antimicrobial use measures, ASP interventions performed, and clinical outcomes by comparing the data collected at baseline, from the third quarter (Q3) 1 July 2015 to the fourth quarter (Q4) of 31 December 2017, approximately 2 years following program implementation. Results From 1 July 2015 until 31 December 2017, the program reported a total direct cost savings estimated at $1 339 499, despite a significant increase in patient discharges and total patient‐days. The antimicrobial cost per inpatient‐day decreased by 32% from $47.2 to $32.3. Usage of monitored antimicrobials decreased despite an increase in patient census since hospital opening. Hospital‐onset Clostridioides difficile infection (CDI) rates decreased from 0.46 cases per 1000 patient days in 2015 to 0.12 cases per 1000 patient days in 2017 (P = 0.035, 95% CI 0.08 to 0.91). Hospital‐onset infections due to multidrug‐resistant organisms (MDROs) decreased from 2.39 cases per 1000 patient days in 2015 to 0.38 cases per 1000 patient days in 2017 (P = 0.05, 95% CI 0.09 to 0.28). Overall, the number of ASP interventions amounted to a total of 4123 interventions, with an acceptance rate of 91%. Conclusion The implementation of an advanced ASP at a quaternary care hospital in the United Arab Emirates was associated with a decrease in antimicrobial utilization, antimicrobial expenditure, and a reduction in hospital‐onset CDI and MDRO rates. To our knowledge, this is the first report describing the outcomes of an advanced ASP program at a quaternary care hospital utilizing real‐time surveillance software and CDSS in the Middle East.

The frequency of drought presents huge challenges to the most rural communities in Africa. This article highlights drought characteristics and the many responses to drought stresses employed by Galmudug State, Somalia. Multiple data sources, including socioeconomic questionnaires with 123 households, focus group discussions, and key informant interviews with farmers livestock were used to capture various aspects of droughtoccurance. Results revealed that extreme drought events were increasingly frequent, and have negatively impacted pastoral livestock.in addition to the survey result showed that 100% of the respondents indicated that drought incidence increased for last three decades. In order to adapt to or cope with climatic anomalies, households are using a variety of strategies. In addition to the traditional short-term coping mechanisms, the long-term adaptation strategies used include livestock diversification species, livestock mobility to track forage and water resources diversification of herd composition to benefit from the varied drought tolerance, However, the adaptation strategies are not practiced in full capacity, specifically Lack of meteorological information and lack of intuitional capacityabout the livestock rearing are the constraints in this regard. Finally, the study suggested as a point of departure in developing drought adaption strategy and other pressures.

Activity 5.Selection of target groups and determination of preferred dissemination pathways.

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it is true in all the regions of the country; there is no stable and reliable documented meteorological data for reasonable tracking of the climate change and variability. Thus, this study explores the perception of significant variability in climate and related impact on local livestock holders among smallholders in pastoral systems of Abudwak district, Somalia. We drew on empirical data obtained from pastoral communities surveys conducted in 4 villages, 169 pastoral associations. Using this data, this study analyses smallholders' perception of climate variability and its associated impact on local livelihood, and the effect of several household on perception. Respondents interviewed during the study period, however, believed that there has been significant variability in the rainfall and temperature patterns for the last twenty years and considered climate variability as a salient risk to their future livelihoods and economic development. Likewise, the general perception of the people is that both rainfall and temperature have highly been fluctuating for decades now became unpredictable with less rainfall in shorter duration and warmer temperature over year now than usual. Different levels of perception were expressed in terms of climate variability and the impact on traditional rain-fed. Age, education level, livestock holding, access to climate information and extension services significantly affected perception levels.