Mapping the Antimicrobial Supply Chain in Bangladesh: A Scoping-Review-Based Ecological Assessment Approach

Orubu, Ebiowei Samuel F; Samad, Mohammed A.; Rahman, Md. Tanvir; Zaman, Muhammad H.; Wirtz, Veronika J.

doi:10.9745/ghsp-d-20-00502

Cited by 17 publications

(19 citation statements)

References 32 publications

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“…There is a scarcity of data on the pattern of antibiotic dispensing in pharmacies in Bangladesh according to the WHO AWaRe classification; however, a recent report showed that a high proportion (86%) of Watch group antibiotics were used for the suspected cases of COVID–19 with SARI [ 33 ]. A recently published article on mapping the antimicrobial supply chain in Bangladesh showed that most (54%) of the top ten antibiotics in terms of sales belonged to the Watch group, followed by 39% in the Access group, which is comparable to our study findings [ 31 ]. However, the WHO recommends that Access group should comprise at least 60% of the national antibiotic consumption to support AMR mitigation [ 20 ].…”

Section: Discussionsupporting

confidence: 91%

“…A recent study jointly conducted by the Directorate General of Drug Administration (DGDA), Bangladesh, and the WHO reported in 2021 that the sale of antibiotics increased by 31%, and most antibiotics were sold without a registered physician’s prescription [ 30 ]. A report on mapping the antimicrobial supply chain in Bangladesh showed that in terms of sales, most (54%) of the top ten antibiotics belonged to the Watch and 39% in the Access groups [ 31 ]. A recent study in Bangladesh on suspected cases of COVID-19 with severe acute respiratory infections (SARI) reported multiple antibiotics were prescribed to a number of individuals with a higher proportion of Watch group (86%), followed by the Access and Reserve groups [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

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Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh

et al. 2022

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The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate antibiotic stewardship and optimal use. In Bangladesh, data on antibiotic dispensing in pharmacies according to the AWaRe classification are scarce. We aimed to explore antibiotic dispensing pattern in pharmacies according to the WHO AWaRe classification to aid pharmacy-targeted national antibiotic stewardship program (ASP). From January to July 2021, we interviewed drug-sellers from randomly selected pharmacies and randomly selected customers attending the pharmacies. We collected data on demographics and medicines purchased. We classified the purchased antibiotics into the Access, Watch, and Reserve groups among 128 pharmacies surveyed, 98 (76.6%) were licensed; 61 (47.7%) drug-sellers had pharmacy training. Of 2686 customers interviewed; 580 (21.6%) purchased antibiotics. Among the 580 customers, 523 purchased one, 52 purchased two, and 5 purchased three courses of antibiotics (total 642 courses). Of the antibiotic courses, the Watch group accounted for the majority (344, 53.6%), followed by the Access (234, 36.4%) and Reserve (64, 10.0%) groups. Approximately half of the antibiotics (327/642, 50.9%) were purchased without a registered physician’s prescription. Dispensing of non-prescribed antibiotics was higher in the Access group (139/234, 59.4%), followed by Watch (160/344, 46.5%) and Reserve (28/64, 43.8%) groups. These findings highlight the need to implement strict policies and enforce existing laws, and pharmacy-targeted ASP focusing on proper dispensing practices to mitigate antimicrobial resistance in Bangladesh.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh

et al. 2022

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“…In the absence of effective regulations, there is a risk for large number of antibiotics including medically important antibiotics becoming available for purchase by fish farmers over the counter without a prescription. Our study identified a diverse class of antibiotics used in aquaculture, including tetracyclines, fluoroquinolones, macrolides, and aminoglycosides, which was in accordance with previous reports in Bangladesh [ 25 , 27 , 29 , 35 , 37 ].…”

Section: Discussionsupporting

confidence: 91%

Antibiotics usage practices in aquaculture in Bangladesh and their associated factors

et al. 2022

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“…We believe that pharmacists who are experts in medicine inventory management and forecasting may benefit resource-deprived developing countries ( 56 , 58 ); therefore, consulting and utilizing pharmacist expertise may ease the burdens of procurement. In other developing countries, pharmacists are involved in medicine supply chain management ( 59 ). Consequently, we consider adopting a similar approach for the Fijian livestock sector.…”

Section: Discussionmentioning

confidence: 99%

Fijian Veterinarian and Para-Veterinarians' Behavior, Attitude and Knowledge Toward Antimicrobial Use and Antimicrobial Resistance: A Qualitative Study

et al. 2022

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Antimicrobial resistance (AMR) is a global health issue affecting humans and livestock. Reduction in antimicrobial use (AMU) and appropriate use of antimicrobials in livestock production systems have been encouraged. Lack of access to qualified veterinarians, policies regulating AMU and knowledge of AMU and AMR have been identified as drivers of inappropriate AMU behavior in developing countries. Hence, para-veterinarians take a lead role in providing veterinary services to livestock farmers in developing countries. Our previous work found Fijian farmers lack knowledge and understanding of AMU and AMR. However, the attitude, knowledge, and behavior of Fijian veterinary professionals toward AMU and AMR is currently unknown. Therefore, this qualitative study used face-to-face, semi-structured interviews to explore and understand Fijian veterinarian and para-veterinarians' attitude, knowledge, and behavior toward AMU and AMR. A sample of at least ten participants was targeted and recruited from the Central and Western divisions of Viti Levu, Fiji. The Theory of Planned Behavior (TPB) informed the development of the semi-structured interview guide. The interviews were audio-recorded and analyzed using reflexive thematic analysis and deductively using the TPB framework. Our analysis generated three key themes: 1) Antimicrobials prescribed and used based on availability and cost rather than clinical need, 2) Para-veterinarians awareness and knowledge of AMR influence treatment decisions, and 3) Limited resources impede effective consultation and veterinary service delivery. This study demonstrated para-veterinarians (not veterinarians) lacked knowledge and understanding of AMU and AMR. The availability and cost of antimicrobials rather than clinical justification drove antimicrobial prescribing amongst the para-veterinarians. Veterinarians did not visit farms to provide veterinary services; therefore, para-veterinarians provided the veterinary services to the livestock farmers. Lack of human resources, antimicrobials, and physical resources incapacitated veterinary service delivery, where services to farmers' were delayed or not provided at all. Terms of reference for veterinary service delivery and para-veterinarian training framework targeting prescribing, dispensing, use of antimicrobials and risks associated with inappropriate AMU are recommended as part of antimicrobial stewardship (AMS) programmes. Allocation of physical and human resources to Fijian veterinary services should be considered part of AMS programmes to improve veterinary service delivery to livestock farmers and optimize the AMU at the country level.

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Mapping the Antimicrobial Supply Chain in Bangladesh: A Scoping-Review-Based Ecological Assessment Approach

Cited by 17 publications

References 32 publications

Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh

Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh

Antibiotics usage practices in aquaculture in Bangladesh and their associated factors

Fijian Veterinarian and Para-Veterinarians' Behavior, Attitude and Knowledge Toward Antimicrobial Use and Antimicrobial Resistance: A Qualitative Study

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