Antibiotic resistance in conflict settings: lessons learned in the Middle East

Kanapathipillai, Rupa; Malou, Nada; Hopman, Joost; Bowman, Conor; Yousef, Nagwan; Michel, J.; Hussein, Nagham; Hérard, Patrick; Ousley, Janet; Mills, Clair; Seguin, Caroline; Saim, Malika

doi:10.1093/jacamr/dlz002

Cited by 11 publications

(14 citation statements)

References 6 publications

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“…MSF has already designed some context-adapted ABR responses in countries across the Middle East and similar approaches need to be developed for MSF projects in Africa. 21 …”

Section: Discussionmentioning

confidence: 99%

“…In the African context, studies have reported several inadequacies in the availability and implementation of antibiotic stewardship programmes. [16][17][18][19][20][21][22][23] Fadare et al reported that even tertiary hospitals in Nigeria, one of the African countries where ABR plans have progressed most, lacked institutional capacity in that only 35% had a formal organisational structure and facility-based treatment recommendations based on local antimicrobial resistance patterns were only available in 24% of the facilities. 16 A systematic review of ABR in Africa found that data on antimicrobial resistance was not available for 42.6% of African countries and the level of resistance to commonly prescribed antibiotics is significant.…”

Section: Incomplete Intake Of Antibiotic Treatment and Explanatory Famentioning

confidence: 99%

“…MSF has already designed some context-adapted ABR responses in Open access countries across the Middle East and similar approaches need to be developed for MSF projects in Africa. 21 First, MSF must invest in understanding the contextspecific ABR profiles (ie, with regular studies at sentinel sites) and adapt treatment protocols accordingly. Protocols must be made available in local languages for each specific context.…”

Section: Incomplete Intake Of Antibiotic Treatment and Explanatory Famentioning

confidence: 99%

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Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo

Eibs¹,

Koščálová²,

Nair³

et al. 2020

BMJ Open

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ObjectivesThe objective of this study was to address the knowledge gap regarding antibiotic use in Medecins Sans Frontiéres (MSF) projects located in Africa by exploring antibiotic prescription and consumption habits and their drivers at different healthcare levels.DesignThis study used an exploratory study design through thematic analysis of semistructured, in-depth interviews, focus group discussions (FGDs) and field observations in order to understand the main drivers influencing current antibiotics prescription habits and consumption habits of patients in different geographical settings.SettingThe study took place in MSF centres and towns across four countries: Guinea-Bissau, Central African Republic (CAR), Democratic Republic of Congo (DRC) and Sudan.Participants384 respondents participated in the study, which includes project staff, prescribers, community members, patients, among other groups.ResultsTreatment protocols were physically present in all countries except DRC, but compliance to protocols varied across contexts. A failing health system and barriers to accessing healthcare were perceived as major drivers of overuse and inconsistent prescription practices. Patient demands influenced prescription decisions, and self-medication was commonly reported in the context of failing health systems. Additionally, there was a strong demand for quick cures and communities preferred injections over pills. Patients tended to stop antibiotic treatment once symptoms abated and had major gaps in understanding antibiotic intake instructions and functions.ConclusionsWhile there were specific findings in each context, the larger trend from these four MSF projects in Africa indicates widespread use of antibiotics based on unclear assumptions, which are often influenced by patient demands. There needs to be a broader focus on the balance between access and excess, especially in such fragile contexts where access to healthcare is a real challenge.

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“…MSF has already designed some context-adapted ABR responses in countries across the Middle East and similar approaches need to be developed for MSF projects in Africa. 21 …”

Section: Discussionmentioning

confidence: 99%

Section: Incomplete Intake Of Antibiotic Treatment and Explanatory Famentioning

confidence: 99%

Section: Incomplete Intake Of Antibiotic Treatment and Explanatory Famentioning

confidence: 99%

See 1 more Smart Citation

Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo

Eibs¹,

Koščálová²,

Nair³

et al. 2020

BMJ Open

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“…Médecins Sans Frontières’ current infection prevention and control policy focuses, standardizes, and simplifies high-impact infection prevention and control interventions (ie, hand hygiene, cleaning and disinfection, and transmission-based precautions) so that all HCWs are able to understand and prioritize these interventions. 15,16 For hand hygiene, this includes infrastructure adjustments (eg, more space between beds, availability of clean water and alcohol-based hand sanitizer [ABHS]), training and education for all HCWs, establishing evaluation and feedback mechanisms for adherence, and posters and staff meeting reminders about the importance of the 5 Moments for Hand Hygiene . As part of improving the evaluation and feedback for hand hygiene adherence, we developed and piloted the use of open-source software on mobile devices and interactive analytical dashboards for the collection and visualization of hand hygiene adherence data in 2 MSF-supported hospitals in northwest Nigeria after hand hygiene strengthening activities.…”

Section: Introductionmentioning

confidence: 99%

Inclusion of Real-Time Hand Hygiene Observation and Feedback in a Multimodal Hand Hygiene Improvement Strategy in Low-Resource Settings

Lenglet

Deursen

Viana³

et al. 2019

JAMA Netw Open

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“…In recognition of the high levels of AMR among certain impacted populations in its health facilities in conflict-affected countries in this region, the MSF routinely use AST including rapid diagnostics and has developed a propriety field device to facilitate AST. 5,66 However, the challenges in both the development and deployment of these devices, and of AST in certain contexts, must be acknowledged. 67…”

Section: Discussionmentioning

confidence: 99%

Assessing antimicrobial resistance, utilization and stewardship in Yemen: An exploratory mixed-methods study

Orubu

Najwa²,

Ching

et al. 2021

Preprint

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Antimicrobial resistance (AMR), largely driven by irrational use of antimicrobials, is a global, multi-faceted problem calling for a complete understanding of all contributory factors for effective containment. In conflict settings, war-wounds and malnutrition can combine with existing social determinants to increase demand for antibiotics, compounding irrational use. In this study, we focus on Yemen, a low-income country with active conflict for the last five years, and analyze the current status of awareness and stewardship efforts regarding AMR. We performed a survey of prescribers/physicians and pharmacists to describe perceptions of AMR prevalence, antibiotic use practices and stewardship in Yemen, supported by a non-systematic scoping literature review and a key informant interview. Participants (96%, n=57) reported a perceived high AMR prevalence rate. Prescribers (74%, 20/27) reported pressure to prescribe broad-spectrum antibiotics. In the majority of cases (81%, 22/27), Antimicrobial Sensitivity Tests (AST) were not performed to inform antibiotic choice. The main barrier to AST was cost. Most pharmacists (67%, 18/27) sold antibiotics without prescriptions. Amoxicillin (including amoxicillin-clavulanate) was the most-commonly prescribed (63%, 17/27) or dispensed (82%, 22/27) antibiotic. AST was rated the least important solution to AMR in Yemen. While there was awareness of a high AMR rate, stewardship is poor in Yemen. We note that barriers to the use of AST could be addressed through the deployment of low-cost AST kits. Compulsory continuing education emphasizing the use of AST to guide prescribing and patients’ awareness programs could help avoid irrational use.

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Antibiotic resistance in conflict settings: lessons learned in the Middle East

Cited by 11 publications

References 6 publications

Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo

Qualitative study of antibiotic prescription patterns and associated drivers in Sudan, Guinea-Bissau, Central African Republic and Democratic Republic of Congo

Inclusion of Real-Time Hand Hygiene Observation and Feedback in a Multimodal Hand Hygiene Improvement Strategy in Low-Resource Settings

Assessing antimicrobial resistance, utilization and stewardship in Yemen: An exploratory mixed-methods study

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