Antimicrobial resistance (AMR) is a global health problem threatening safe, effective healthcare delivery in all countries and settings. The ability of microorganisms to become resistant to the effects of antimicrobials is an inevitable evolutionary process. The misuse and overuse of antimicrobial agents have increased the importance of a global focus on antimicrobial stewardship (AMS). This review provides insight into the current AMS landscape and identifies contemporary actors and initiatives related to AMS projects in eight African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia), which form a network of countries participating in the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme. We focus on common themes across the eight countries, including the current status of AMR, infection prevention and control, AMR implementation strategies, AMS, antimicrobial surveillance, antimicrobial use, antimicrobial consumption surveillance, a one health approach, digital health, pre-service and in-service AMR and AMS training, access to and supply of medicines, and the impact of COVID-19. Recommendations suitable for adaptation are presented, including the development of a national AMS strategy and incorporation of AMS in pharmacists’ and other healthcare professionals’ curricula for pre-service and in-service training.
Meeting the needs of an ageing population, particularly in the global South, is increasingly an issue for WASH service provision. An ageing-related issue for women, warranting specific attention from the WASH sector, is the perimenopause, but this is often not discussed publicly. Drawing on data from the UK and Ghana, this paper provides recommendations for meeting the additional WASH needs of women as they experience the perimenopause (the transition period to menopause). Finding these ‘hidden’ needs involved a UK-based phenomenological review and mixed feminist methods in two low-income urban communities in Accra and Kumasi, Ghana. The hidden WASH needs of perimenopausal women included understanding the perimenopause, menstrual hygiene management, urine incontinence management, bathing, and laundry. Community awareness, engagement and empowerment, and ensuring good perimenopausal health can begin to address these needs. Infrastructural measures for perimenopausal women include a continuous water supply, user-friendly bathing and laundry infrastructure, and gender-sensitive, accessible toilets with discrete sanitary disposal bins. High-absorbency sanitary products are important for managing heavy menstruation. A better understanding of the needs of perimenopausal women and training on how to meet these would benefit the WASH sector in ensuring that perimenopausal women are not left behind in efforts to meet the Sustainable Development Goals.
In recent years, health partnerships have shared infection prevention and control (IPC) innovations between United Kingdom (UK) hospitals and Low-Middle-Income Countries (LMICs). However, none had focused on antimicrobial stewardship (AMS), a core component of tackling antimicrobial resistance (AMR). This paper documents an effective approach to developing a programme to increase antimicrobial stewardship (AMS) capacity in four African countries: Ghana, Tanzania, Uganda, and Zambia as part of the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme. A systematic approach was applied to assess gaps in AMS interventions and inform development of the CwPAMS programme through desk-based assessments, including of National Action Plans on AMR, online focus group meetings, and expert advisory group reviews. Twelve partnerships were selected for the CwPAMS programme. AMS support tools were developed based on recommendations from the scoping, including an AMS checklist tool, a healthcare worker knowledge and attitudes questionnaire, and an antimicrobial prescribing app to support clinical decision making. Training workshops on AMS were developed and delivered to volunteers in Africa and the UK using a train the trainer model. The tools and workshops facilitated capacity building for AMS through the generation and strengthening of knowledge, skills, commitment, structures, systems, and leadership among stakeholders in the UK and Africa. The overall score assigned to the programme following evaluation using the Organisation for Economic Cooperation and Development Assistance Committee (OECD-DAC) Evaluation Criteria was 82% (very good).
Introduction. The use of medicines is a ubiquitous practice for the management of healthcare conditions. In the delivery of healthcare, medicines may remain unused and may expire within the various stakeholders in the pharmaceutical value chain. If these unused and expired medicines are not disposed of properly, they may result in the concentration of pharmaceuticals in environmental media contaminating food sources for humans and animals. Implementation of ecopharmacovigilance strategies will reduce the quantities of pharmaceuticals in the environmental media, reduce the potential for inadvertent consumption by humans and animals, and reduce potential pharmacological effects on the environment, humans, and animals. The drug disposal flow diagram (DDFD) provides an effective way of assessing the most cost-effective strategies to reduce environmental contamination. Method. A combined method of desk study and questionnaires, both structured and unstructured was used. The desk study reviewed the institutional arrangements for the regulation of disposal of pharmaceutical waste in Krowor. The questionnaires were used to gather information from community members, community pharmacies, and pharmaceutical manufacturers in Krowor. Results. The drug disposal flow diagram shows that up to 96% of pharmaceuticals are handled and disposed of in ways that are harmful to the environment with only 4% being handled in ways that are environmentally friendly. Forty-nine percent (49%) of generated pharmaceutical waste ends up in the local and surrounding areas, 21% contaminates the drainage system and 25% is discharged into receiving waters. Discussion. The DDFD for Krowor shows that engagement with community members and institutional healthcare service providers and strategies that result in separation of pharmaceutical waste from general household waste will reduce the quantities of pharmaceuticals that end up in the environmental media. Conclusion. The DDFD will support the effective implementation of ecopharmacovigilance (EPV) strategies.
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