Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

Wellcome Open Research

article

Heiman F.L. Wertheim¹  Nguyen Thi Kim Chuc⁴  Sureeporn Punpuing⁵  Wasif Ali Khan⁵  Margaret Gyapong⁵  Kwaku Poku Asante⁵  Khatia Munguambe⁵  F. Xavier Gómez-Olivé⁵  Proochista Ariana¹  Johannes John-Langba^1,13  Betuel Sigauque⁵  Tran Khanh Toan⁴  Stephen Tollman⁵  Amelieke J.H. Cremers³  Nga T.T. Do²  Behzad Nadjm¹  H. Rogier van Doorn¹  John Kinsman^1,14  Osman Sankoh⁵ 

[1] Nuffield Department of Clinical Medicine, University of Oxford;Oxford University Clinical Research Unit;Department of Medical Microbiology and Radboud Centre for Infectious Disease, Radboud University Nijmegen Medical Centre;Hanoi Medical University;INDEPTH Network;Kanchanaburi HDSS, Institute for Population and Social Research, Mahidol University;International Centre for Diarrhoeal Disease Research;Dodowa INDEPTH Site;University of Health and Allied Sciences;Kintampo INDEPTH Site;Manhica Health Research Site;MRC/Wits Rural Public Health and Health Transitions Research Unit ,(Agincourt), University of the Witwatersrand;University of Kwazulu-Natal;Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University;School of Public Health, Faculty of Health Sciences, University of the Witwatersrand;Department of Mathematics and Statistics, Njala University

关键词: antibiotic;    provision;    access;    use;    low and middle income;    community;   

DOI  :  10.12688/wellcomeopenres.11985.1

学科分类：内科医学

来源: Wellcome

【 摘 要 】

In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.

【 授权许可】

CC BY