Measuring antibiotic consumption in low-income countries: a systematic review and integrative approach

Padget, Michael; Guillemot, Didier; Delarocque-Astagneau, Elisabeth

doi:10.1016/j.ijantimicag.2016.04.024

Cited by 30 publications

(33 citation statements)

References 40 publications

(62 reference statements)

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“…It is difficult to fully estimate the prevalence of URTIs especially in LMICs where extensive self-purchasing of antibiotics occurs 42,43,49,123,212 . Overall, the incidence and prevalence of URTIs varies considerably across and within countries and across age groups, although children from newborn to four years are at the highest risk of developing a URTI 69,188,[213][214][215][216][217][218] .…”

Section: Epidemiology Of Urtismentioning

confidence: 99%

“…High AMR rates are a particular issue in LMICs, exacerbated by poor hygiene, malnutrition and overcrowded living conditions, lack of adequate infrastructures and pressure by patients and carers on physicians to prescribe antibiotics and on pharmacists to dispense them without a prescription 13,14,19,21,[42][43][44][45][46][47][48][49][50][51][52][53][54][55] . Unfortunately, antibiotics can achieve good health outcomes even in patients with viral infections, which runs counter to changing public perceptions of their efficacy [56][57][58][59] .…”

Section: Introductionmentioning

confidence: 99%

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Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

126

170

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Section: Epidemiology Of Urtismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Godman

Haque

McKimm

et al. 2019

Current Medical Research and Opinion

126

170

View full text Add to dashboard Cite

show abstract

“…The study design was informed by critical elements drawn from frameworks on intervention development (17) (26) (27). Speci cally, the intervention was developed using a sequential mixed methods study design (28). This consisted of:…”

Section: Methodsmentioning

confidence: 99%

A process for developing a sustainable and scalable approach to community engagement: Community Dialogue Approach for addressing the drivers of antibiotic resistance in Bangladesh

King

Hicks

Rassi³

et al. 2020

Preprint

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Background Community engagement approaches that have impacted on health outcomes are often time intensive, small-scale and require high levels of financial and human resources. They can be difficult to sustain and scale-up in low resource settings. Given the reach of health services into communities in low income countries, the health system provides a valuable and potentially sustainable entry point that would allow for scale-up of community engagement interventions. This study explores the process of developing an embedded approach to community engagement taking the global challenge of antibiotic resistance as an example.Methods The intervention was developed using a sequential mixed methods study design. This consisted of: exploring the evidence base through an umbrella review, and identifying key international standards on the appropriate use of antibiotics; undertaking detailed formative research through a) a qualitative study to explore the most appropriate mechanisms through which to embed the intervention within the existing health system and community infrastructure, and to understand patterns of knowledge, attitudes and practice regarding antibiotics and antibiotic resistance; and b) a household survey – which drew on the qualitative findings - to quantify knowledge, and reported attitudes and practice regarding antibiotics and antibiotic resistance within the target population; and c) drawing on appropriate theories regarding change mechanisms and experience of implementing community engagement interventions to co-produce the intervention processes and materials with key stakeholders at policy, health system and community level.Results A community engagement intervention was co-produced and was explicitly designed to link into existing health system and community structures and be appropriate for the cultural context, and therefore have the potential to be implemented at scale. We anticipate that taking this approach increases local ownership, as well as the likelihood that the intervention will be sustainable and scalable.Conclusions This study demonstrates the value of ensuring that a range of stakeholders co-produce the intervention, and ensuring that the intervention is designed to be appropriate for the health system, community and cultural context.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Most of our knowledge on antibiotic use in LMICs stems from hospital-based studies or prescription/sales records 7–9. Little is known about antibiotic use in primary care settings in LMICs, and few studies have explored reasons for inappropriate antibiotic prescription by primary care clinicians 7. Reasons for antibiotic overuse by clinicians in LMICs can fall under either ‘knowledge gaps’, such as lack of awareness or unfamiliarity with current clinical practice guidelines or ‘know-do gaps’, where provider practices diverge from what they know they should do 10.…”

Section: Introductionmentioning

confidence: 99%

Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

et al. 2019

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BackgroundAntibiotic use in primary care can drive antimicrobial resistance (AMR) in the community. However, our understanding of antibiotic prescribing in low- and middle-income countries (LMICs) stems mostly from hospital-based studies or prescription/sales records, with little information available on routine primary care practices. We used an innovative, paper-to-digital documentation approach to deliver routine data and understand antibiotic use for common infections in low-resource primary healthcare clinics (PHCs).MethodsRubber stamps were introduced in nine private sector PHCs serving Nairobi’s informal settlements to ‘print-on-demand’ clinical documentation templates into paper charts. The intervention included one mobile phone per PHC to take and share images of filled templates, guideline compilation booklets and monthly continuing medical education (CME) sessions. Templates for upper respiratory tract (URTI), urinary tract (UTI), sexually transmitted (STI) and gastrointestinal infection (GI) management were used in eight PHCs. Information in templates from 889 patient encounters was digitised from smartphone images, analysed, and fed back to clinicians during monthly CME sessions. UTI charts (n=130 and 96, respectively) were audited preintervention and postintervention for quality of clinical documentation and management.ResultsAntibiotics were prescribed in 94.3%±1.6% of all patient encounters (97.3% in URTI, 94.2% in UTI, 91.6% in STI and 91.3% in GI), with 1.4±0.4 antibiotics prescribed per encounter. Clinicians considered antibiotic use appropriate in only 58.6% of URTI and 47.2% of GI cases. While feedback did not affect the number of antibiotics prescribed for UTIs, the use of nitrofurantoin, an appropriate, narrow-spectrum antibiotic, increased (9.2% to 29.9%; p<0.0001) and use of broad spectrum quinolones decreased (30.0% to 16.1%; p<0.05).ConclusionAntibiotic use for common infections is high in private sector PHCs in Kenya, with both knowledge and ‘know-do’ gaps contributing to inappropriate prescription. Paper-based templates in combination with smartphone technologies can sustainably deliver routine primary care case management data to support the battle against AMR.

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Measuring antibiotic consumption in low-income countries: a systematic review and integrative approach

Cited by 30 publications

References 40 publications

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

A process for developing a sustainable and scalable approach to community engagement: Community Dialogue Approach for addressing the drivers of antibiotic resistance in Bangladesh

Using rubber stamps and mobile phones to help understand and change antibiotic prescribing behaviour in private sector primary healthcare clinics in Kenya

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