Tackling antimicrobial resistance in low-income and middle-income countries

Pokharel, Sunil; Raut, Shristi; Adhikari, Bipin

doi:10.1136/bmjgh-2019-002104

Cited by 259 publications

(246 citation statements)

References 14 publications

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“…These infections have similar initial presentation, a unique clinical course and treatment response. Therefore, making a proper diagnosis is crucial for patient management, outbreak control and antimicrobial stewardship [15].…”

Section: Discussionmentioning

confidence: 99%

“…In the absence of robust epidemiological data and reliable point-of-care diagnostics, a large number of patients in the outbreaks of AUFI in enteric fever endemic settings such as Kathmandu, Nepal are empirically diagnosed and treated as enteric fever [18,19]. It is a common practice to initiate antimicrobials with minimal effort to establish a specific diagnosis [15]. This can lead to prolonged fever clearance time, treatment failures, and antimicrobial resistance.…”

Section: Discussionmentioning

confidence: 99%

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Outbreak of acute undifferentiated febrile illness in Kathmandu, Nepal: clinical and epidemiological investigation

et al. 2020

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Background: Outbreaks of acute undifferentiated febrile illness (AUFI) are common in Nepal, but the exact etiology or risk factors for them often go unrecognized. Diseases like influenza, enteric fever and rickettsial fevers account for majority of such outbreaks. Optimal diagnostic tests to inform treatment decisions are not available at the point-ofcare. A proper epidemiological and clinical characterization of such outbreaks is important for appropriate treatment and control efforts. Methods: An investigation was initiated as a response to increased presentation of patients at Patan Hospital from Chalnakhel locality in Dakchinkali municipality, Kathmandu with AUFI from June 10 to July 1, 2016. Focused group discussion with local inhabitants and the epidemiological curve of febrile patients at local primary health care centre confirmed the outbreak. The household-survey was conducted in the area with questionnaire administered on patients to characterize their illnesses and their medical records were reviewed. A different set of questionnaire was administered on the patients and controls to investigate the association with common risk factors. Water samples were collected and analyzed microbiologically. Results: Eighty one patients from 137 households suffered from febrile illness within 6 weeks window before the investigation. All the 67 sampled patients with acute fever had a generalized illness without a discernible focus of infection. Only 38% of the patients had received a clinical diagnosis while the rest were treated empirically without a diagnosis. Three patients had blood culture confirmed enteric fever. Forty-two (63%) patients had been administered antibiotics, most commonly, ofloxacin, cefixime or azithromycin with a mean fever clearance time of 4 days. There was no definite association between several risk factors and fever. Fecal contamination was noted in tap water samples. Conclusion: Based on the pattern of illness, this outbreak was most likely a mixture of self-limiting viral infections and enteric fever. This study shows that even in the absence of a confirmed diagnosis, a detailed characterization of the illness at presentation and the recovery course can suggest the diagnosis and help in formulating appropriate recommendation for treatment and control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outbreak of acute undifferentiated febrile illness in Kathmandu, Nepal: clinical and epidemiological investigation

et al. 2020

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Section: Antibiotic Use and Antibiotic Resistance In The Pork-valuechainmentioning

confidence: 99%

“…Antimicrobial resistance is a growing threat to human and animal health with a disproportionate burden in low-to-middle-income countries (LMIC) [37]. Often LMIC's have a high burden of infectious diseases, poverty and weak governance and health systems [37]. These prevailing conditions are aggravated by low awareness about antibiotics and its resistance, poor access to health services, easy availability of antibiotics over the counter, pleural health care with delayed, inappropriate and sub-standard treatments [37,38].…”

Section: Antibiotic Use and Antibiotic Resistance In The Pork-valuechainmentioning

confidence: 99%

“…Often LMIC's have a high burden of infectious diseases, poverty and weak governance and health systems [37]. These prevailing conditions are aggravated by low awareness about antibiotics and its resistance, poor access to health services, easy availability of antibiotics over the counter, pleural health care with delayed, inappropriate and sub-standard treatments [37,38]. Inappropriate use of antibiotics in LMIC have been linked to the lack of diagnostics and poor infrastructure; industry incentives and advertising; and the economic benefits for the prescriber [39][40][41][42].…”

Section: Antibiotic Use and Antibiotic Resistance In The Pork-valuechainmentioning

confidence: 99%

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The challenges of investigating antimicrobial resistance in Vietnam - what benefits does a One Health approach offer the animal and human health sectors?

et al. 2020

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Background: The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimised by adopting a One Health approach to AMR surveillance. To advance understanding of the willingness and abilities of the human and animal health sectors to undertake investigations of AMR with a One Health approach, we explored the perceptions and experiences of those tasked with investigating AMR in Vietnam, and the benefits a multi-sectorial approach offers. Methods: This study used qualitative methodology to provide key informants' perspectives from the animal and human health sectors. Two scenarios of food-borne AMR bacteria found within the pork value chain were used as case studies to investigate challenges and opportunities for improving collaboration across different stakeholders and to understand benefits offered by a One Health approach surveillance system. Fifteen semi-structured interviews with 11 participants from the animal and six from the human health sectors at the central level in Hanoi and the provincial level in Thai Nguyen were conducted. Results: Eight themes emerged from the transcripts of the interviews. From the participants perspectives on the benefits of a One Health approach: (1) Communication and multi-sectorial collaboration; (2) Building comprehensive knowledge; (3) Improving likelihood of success. Five themes emerged from participants views of the challenges to investigate AMR: (4) Diagnostic capacity; (5) Availability and access to antibiotics (6) Tracing ability within the Vietnamese food chain; (7) Personal benefits and (8) Managing the system. Conclusion: The findings of this study suggest that there is potential to strengthen multi-sectorial collaboration between the animal and human health sectors by building upon existing informal networks. Based on these results, we recommend an inclusive approach to multi-sectorial communication supported by government network activities to facilitate partnerships and create cross-disciplinary awareness and participation. The themes relating to diagnostic capacity show that both sectors are facing challenges to undertake investigations in AMR. Our results indicate that the need to strengthen the animal health sector is more pronounced.

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Evidence-Based Interventions for Antimicrobial Resistance in Conflict-Afflicted Arab Countries

Reffat¹,

Khoshnood²,

Dembry³

2021

Handbook of Healthcare in the Arab World

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Tackling antimicrobial resistance in low-income and middle-income countries

Cited by 259 publications

References 14 publications

Outbreak of acute undifferentiated febrile illness in Kathmandu, Nepal: clinical and epidemiological investigation

Outbreak of acute undifferentiated febrile illness in Kathmandu, Nepal: clinical and epidemiological investigation

The challenges of investigating antimicrobial resistance in Vietnam - what benefits does a One Health approach offer the animal and human health sectors?

Evidence-Based Interventions for Antimicrobial Resistance in Conflict-Afflicted Arab Countries

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