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Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in lowand middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes.

Introduction: Coronavirus Disease-19 (COVID-19) pandemic is posing a challenge not only with sheer number of people infected but also with the large number of patients with persistent symptoms of COVID-19 infection. A proper understanding of the magnitude and associated factors of persistent COVID-19 symptoms will go a long way in planning treatment and control strategies. Aim: To determine the proportion of patients who have persistent symptoms post acute COVID-19 infection and to determine the factors associated with it, among those who have been discharged from Government Medical College, Thrissur, Kerala, India. Materials and Methods: The current cross-sectional study was conducted among 335 patients who were admitted and discharged with COVID-19 infection in Government Medical College, Thrissur, Kerala, a tertiary care institution in southern India between December 2020 and February 2021. They were contacted through a telephonic interview 28 days from symptom onset through a semi-structured interview schedule. The questions included basic demographic details, symptomatology at admission, persistent symptoms at 28 days after onset and other clinical details including comorbidities. For defining post COVID-19 symptom persistence National Institute for Health and Care (NICE) guidelines were used. Association between persistent symptoms and selected factors was done by Chi-square test. Results: Out of the 335 patients, the persistence of symptoms of COVID-19 infection after 28 days of symptom onset was 221 (66%) (CI 60.7-79.8). Persistence of two or more COVID-19 symptoms after 28 days of onset was seen in 120 (35.8%). The most common persistent symptoms among the patients were fatigue in 109 (32.5%) of people followed by dyspnoea in 77 (23%), cough in 45 (13.4%) and myalgia in 37 (11%) patients. Highest persistence was seen in Category C patients where symptoms were persisting in 75%. Persistence was also higher in those with Diabetes Mellitus (DM), those who received oxygen support and those who were in Intensive Care Unit (ICU) or on ventilator and the association was statistically significant (p-value <0.05). Conclusion: The study shows that two-third of patients still continues to have persistent symptoms even after 28 days of symptom onset. Health systems should be prepared to face the consequences of morbidities caused by post COVID-19 syndrome.

Objective: To estimate the prevalence and associated factors of self-medication among slum dwellers, and to explore the perception of community pharmacists' on self-medication practices in Udupi taluk of Karnataka state in India.Methods: A quantitative survey among 300 randomly selected slum dwellers and in-depth interviews with community pharmacists and pharmacy practice experts were conducted during January-April 2016. Descriptive and analytical methods were used to estimate the prevalence and to identify associated factors. Thematic analysis was carried out on qualitative data. Results:The prevalence of self-medication practice was 47%. Factors such as gender, recent experience of an illness, and stocking medicines at home were significantly associated with self-medication practice. Self-medication practices were high for common ailments and for the illnesses they perceived as 'mild' (66%). Community pharmacists (87%) were the main source of information on medication. The majority (76%) of participants were ignorant about the expiry date of the medicines. The qualitative data highlighted pharmacist's' role to promote consultation with a physician, and educating patients on completion of treatment course and possible drug reactions. Conclusion:Self-medication practices found to be common among slum-dwellers due to reasons such as lesser awareness, easy availability of overthe-counter medications, and limitations related to universal access to health. There is a need to improve the awareness of dangers of selfmedication to the general public and strengthen the mechanism to monitor dispensing of medicines without prescriptions.

Background: The global impact of COVID pandemic has been unprecedented and had expedited the urgent need of mass vaccination especially in a densely populated country like India. Sustained efforts in strategies for increase the vaccination campaigns are essential at the community level to address the acceptance of vaccines. The perception of public understanding on COVID vaccinations would help healthcare professionals advise the public on vaccination and guide policy decisions. The aim of the study was to discover knowledge gaps related to various aspects of COVID vaccination among the general population and enhance awareness that improves the vaccination practice.Methods: A semi structured questionnaire was administered exploring the knowledge and awareness of public was conducted in a tertiary care centre located in southern part of India. The study participants were contacted during the time of vaccination. The key domains we collected from our survey included general perception on vaccines, knowledge on vaccine practice, vaccination practices on special population, vaccine specific knowledge and vaccine related socio-cultural factors on vaccinations.Results: Valid and complete responses were obtained from 4471 participants, among this majority were female participants (61.04%) with the median age of 36 years. Majority of the participants had a belief that vaccines are effective 3415 (81.8%) for preventing COVID-19.Conclusions: Vaccination campaigns must consider strong public participation and contextually relevant communication tactics for the better acceptability. Furthermore, we need a targeted capacity building initiative with more emphasis towards vulnerable populations to be implemented on vaccination.

BACKGROUND Elderly people are often neglected in the society particularly with regards to the healthcare service delivery in Indian context. Most of them live with certain forms of morbidities. The consequences of these illnesses in terms of severity affect their willingness to seek help from health care services. Therefore, understanding the morbidities and their health seeking behaviour is a prerequisite for providing essential need-based healthcare services to this marginalised population. A cross sectional study was conducted to understand the pattern of comorbidities and factors of health seeking behaviours of the elderly in a rural area of Thrissur district, Kerala. METHODS A total of 243 elderly participants who were above 60 years was selected from a rural area of Thrissur district to participate the study. SPSS Ver. 16.0 was used to carry out analysis of the data. Descriptive statistics were used to express the pattern of chronic morbidity, and assess the health seeking behaviour and associated factors in the above population. RESULTS Our findings revealed that majority of the study population (82.7 %) was suffering from at least one chronic health problem; among them, 44 % had hypertension, 35.8 % had diabetes mellitus and 23.5 % had musculoskeletal diseases. 60.5 % were not doing any kind of exercise. Health seeking behavior was highest for diabetes and hypertension (100 % and 97.1 %). It was lowest for urinary disorders (72.72 %) followed by visual problems and respiratory problems (82.75 % and 83.3 %). Most common reasons for not seeking health care were that they consider the illness to be insignificant or they believe it to be a part of ageing process (37.5 %). CONCLUSIONS Prevalence of chronic morbidity is high among the elderly. Health seeking behavior is better in Kerala compared to other states. KEYWORDS Chronic Morbidity, Healthcare Seeking Behaviour, Morbidity, Elderly, Kerala

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