An opportunity for global antimicrobial stewardship research: Refugee populations

Abstract

Antimicrobial resistance is a well-known global health threat that has higher prevalence in the refugee population. Although guidance has been provided by the World Health Organization and Centers for Disease Control and Prevention on implementing antimicrobial stewardship in lower- and middle-income countries, as well as by the United Nations Refugee Agency on other infection prevention and control efforts, no specific guidance exists for implementation of stewardship in this population. We highlight challenges specific to this population, review recent studies of interest within this space, and propose a research agenda to help move stewardship forward in the refugee population. We advocate for the importance of this issue, particularly given recent current events of geopolitical volatility that render this population more vulnerable, in the setting of its already well-known numerous health challenges.

Assessment of antibiotic storage practices, knowledge, and awareness related to antibiotic uses and antibiotic resistance among household members in post-conflict areas of Pakistan: Bi-central study

“…Violent conflict and displacement heighten the difficulties of limiting the emergence and spread of AMR. LMICs affected by conflict must not only deal with resource constraints but also discover ways to care for and treat injured people carrying more resistant infections ( 60 ). According to the literature and expert opinions, better lab diagnoses, the establishment of surveillance systems, and infection prevention and control should be prioritized along with AMR control strategies in the conflict-affected LMICs ( 61 ).…”

Understanding refugee and immigrant health literacy and beliefs toward antimicrobial resistance

“…While other related research has been conducted in various encampment areas abroad, 3 our study is unique in its assessment of this population resettled in the US. Most strikingly, history of refugeeism/asylum-seeking/immigration from an LMIC most strongly correlated with lower health literacy, independent of other demographic variables.…”

“…Antimicrobial resistance (AMR) is a global health threat with higher prevalence in migrant and refugee populations, 1,2 yet public health agencies have provided little guidance on stewardship interventions to counter this threat. 3 Past research has focused on encampment areas or other countries abroad with little attention in the United States (US). Furthermore, poor health literacy regarding antibiotic use has been shown to be associated with inappropriate antibiotic use, 4,5 which contributes to AMR and is hence a key research need we have highlighted previously in refugee populations.…”

“…Furthermore, poor health literacy regarding antibiotic use has been shown to be associated with inappropriate antibiotic use, 4,5 which contributes to AMR and is hence a key research need we have highlighted previously in refugee populations. 3 Therefore, we aimed to assess health literacy in appropriate antibiotic use and AMR in patients with history of refugeeism, asylum-seeking, or immigration from low and middle-income countries (LMICs) in the US. We hypothesized that this target population had gaps in health literacy compared with native-born Americans and those from high-income countries (HICs).…”