Global trends in antimicrobial resistance in animals in low- and middle-income countries

Science ◽  
2019 ◽  
Vol 365 (6459) ◽  
pp. eaaw1944 ◽  
Author(s):  
Thomas P. Van Boeckel ◽  
João Pires ◽  
Reshma Silvester ◽  
Cheng Zhao ◽  
Julia Song ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Large Scale ◽  
Protein Production ◽  
Animal Health ◽  
Scale Up ◽  
Global Scale ◽  
Animal Protein ◽  
Middle Income ◽  
Global Trends ◽  
Middle Income Countries

The global scale-up in demand for animal protein is the most notable dietary trend of our time. Antimicrobial consumption in animals is threefold that of humans and has enabled large-scale animal protein production. The consequences for the development of antimicrobial resistance in animals have received comparatively less attention than in humans. We analyzed 901 point prevalence surveys of pathogens in developing countries to map resistance in animals. China and India represented the largest hotspots of resistance, with new hotspots emerging in Brazil and Kenya. From 2000 to 2018, the proportion of antimicrobials showing resistance above 50% increased from 0.15 to 0.41 in chickens and from 0.13 to 0.34 in pigs. Escalating resistance in animals is anticipated to have important consequences for animal health and, eventually, for human health.

scholarly journals Ethical issues in the use of SMS messaging in HIV care and treatment in low- and middle-income countries: case examples from Mozambique

2017 ◽  
Vol 25 (4) ◽  
pp. 423-427 ◽  
Author(s):  
Ezequiel B Ossemane ◽  
Troy D Moon ◽  
Martin C Were ◽  
Elizabeth Heitman
Keyword(s):  
Large Scale ◽  
Ethical Issues ◽  
Scale Up ◽  
Hiv Care ◽  
Ethical Framework ◽  
Middle Income ◽  
Middle Income Countries ◽  
Retention In Hiv Care ◽  
Care And Treatment ◽  
Low And Middle Income

Abstract The introduction of mobile communication technologies in health care in low- and middle-income countries offers an opportunity for increased efficiencies in provision of care, improved utilization of scarce resources, reductions in workload, and increased reach of services to a larger target population. Short message service (SMS) technologies offer promise, with several large-scale SMS-based implementations already under way. Still largely lacking in the research literature are evaluations of specific ethical issues that arise when SMS programs are implemented and studied in resource-limited settings. In this paper, we examine the ethical issues raised by the deployment of SMS messaging to support patient retention in HIV care and treatment and in the research conducted to evaluate that deployment. We use case studies that are based in Mozambique and ground our discussion in the ethical framework for international research proposed by Emanuel et al., highlighting ethical considerations needed to guide the design and implementation of future SMS-based interventions. Such guidance is increasingly needed in countries such as Mozambique, where the local capacity for ethical study design and oversight is still limited and the scale-up and study of mHealth initiatives are still driven predominantly by international collaborators. These issues can be complex and will need ongoing attention on a case-by-case basis to ensure that appropriate protections are in place, while simultaneously maximizing the potential benefit of new mHealth technologies.

scholarly journals Global trends in antimicrobial resistance in animals in low- and middle-income countries

2020 ◽  
Vol 101 ◽  
pp. 19
Author(s):  
T. van Boeckel ◽  
J. Pires ◽  
R. Silvester ◽  
C. Zhao ◽  
J. Song ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Middle Income ◽  
Global Trends ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals How is implementation research applied to advance health in low-income and middle-income countries?

2019 ◽  
Vol 4 (2) ◽  
pp. e001257 ◽  
Author(s):  
Olakunle Alonge ◽  
Daniela Cristina Rodriguez ◽  
Neal Brandes ◽  
Elvin Geng ◽  
Ludovic Reveiz ◽  
...  
Keyword(s):  
Low Income ◽  
Implementation Research ◽  
Large Scale ◽  
Scale Up ◽  
Middle Income ◽  
Policy Makers ◽  
Is Implementation ◽  
Middle Income Countries ◽  
Ir Studies ◽  
Learning And Change

This paper examines the characteristics of implementation research (IR) efforts in low-income and middle-income countries (LMICs) by describing how key IR principles and concepts have been used in published health research in LMICs between 1998 and 2016, with focus on how to better apply these principles and concepts to support large-scale impact of health interventions in LMICs. There is a stark discrepancy between principles of IR and what has been published. Most IR studies have been conducted under conditions where the researchers have considerable influence over implementation and with extra resources, rather than in ‘real world’ conditions. IR researchers tend to focus on research questions that test a proof of concept, such as whether a new intervention is feasible or can improve implementation. They also tend to use traditional fixed research designs, yet the usual conditions for managing programmes demand continuous learning and change. More IR in LMICs should be conducted under usual management conditions, employ pragmatic research paradigm and address critical implementation issues such as scale-up and sustainability of evidence-informed interventions. This paper describes some positive examples that address these concerns and identifies how better reporting of IR studies in LMICs would include more complete descriptions of strategies, contexts, concepts, methods and outcomes of IR activities. This will help practitioners, policy-makers and other researchers to better learn how to implement large-scale change in their own settings.

Infectious diseases and prions

2021 ◽  
pp. 163-186
Author(s):  
Davidson H. Hamer ◽  
Amira Khan ◽  
Zulfiqar A. Bhutta
Keyword(s):  
Antimicrobial Resistance ◽  
Infectious Diseases ◽  
Respiratory Infections ◽  
Scale Up ◽  
Emerging Infections ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disease Mortality ◽  
Causes Of Mortality ◽  
Parasitic Pathogens

Infectious diseases continue to contribute considerably to the global burden of morbidity, disability, and mortality, especially in low- and middle-income countries. Lower respiratory infections, diarrhoea, and tuberculosis remain among the top ten causes of mortality for all ages and sexes. Moreover, the emergence of many new viral, bacterial, fungal, and parasitic pathogens as well as rising antimicrobial resistance are current challenges. Despite a decline in infectious disease mortality, the growing dangers of antimicrobial resistance and emerging infections pose a critical threat to the health of millions. It is imperative, now more than ever, to scale up interventions for prevention and control of infectious diseases while promoting judicious use of antimicrobials.

scholarly journals Towards a bottom-up understanding of antimicrobial use and resistance on the farm: A knowledge, attitudes, and practices survey across livestock systems in five African countries

2019 ◽  
Author(s):  
Mark A Caudell ◽  
Alejandro Dorado-Garcia ◽  
Suzanne Eckford ◽  
Denis Byarugaba ◽  
Kofi Afakye ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Animal Health ◽  
Antimicrobial Use ◽  
Bottom Up ◽  
Middle Income ◽  
Attitudes And Practices ◽  
Middle Income Countries ◽  
Livestock Systems ◽  
Knowledge Attitudes And Practices ◽  
Low And Middle Income

AbstractThe nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and laissez faire access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N=110) and Kenya (N=76), pastoralists keeping cattle, sheep, and goats in Tanzania (N=195), and broiler farmers in Zambia (N=198), and Zimbabwe (N=298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralists households. Multivariate models showed that variation is related to several factors, including education, disease dynamics on the farm, and sources of animal health information. Study results emphasize that interventions to limit antimicrobial resistance must be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat AMR globally.

scholarly journals A road-map for addressing antimicrobial resistance in low- and middle-income countries: lessons learnt from the public private participation and co-designed antimicrobial stewardship programme in the State of Kerala, India

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Sanjeev Singh ◽  
Esmita Charani ◽  
Sarada Devi ◽  
Anuj Sharma ◽  
Fabia Edathadathil ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
The State ◽  
Action Plans ◽  
Public And Private ◽  
Middle Income ◽  
Middle Income Countries ◽  
Public Health Threat

Abstract Background The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat. Strategies Through a committed and collaborative effort from all healthcare related disciplines and its professional societies from both public and private sector, the Kerala Public Private Partnership (PPP) has been able to deliver a state-wide strategy to tackle AMR A multilevel strategic leadership model and a multilevel implementation approach that included developing state-wide antibiotic clinical guidelines, a revision of post-graduate and undergraduate medical curriculum, and a training program covering all general practitioners within the state the PPP proved to be a successful model for ensuring state-wide implementation of an AMR action plan. Collaborative work of multi-professional groups ensured co-design and development of disease based clinical treatment guidelines and state-wide infection prevention policy. Knowledge exchange though international and national platforms in the form of workshops for sharing of best practices is critical to success. Capacity building at both public and private institutions included addressing practical and local solutions to the barriers e.g. good antibiotic prescription practices from primary to tertiary care facility and infection prevention at all levels. Conclusion Through 7 years of stakeholder engagement, lobbying with government, and driving change through co-development and implementation, the PPP successfully delivered an antimicrobial stewardship plan across the state. The roadmap for the implementation of the Kerala PPP strategic AMR plan can provide learning for other states and countries aiming to implement action plans for AMR.

A REVIEW ON GLOBAL TRENDS IN HEART FAILURE AND EVOLUTION OF ANGIOTENSIN–NEPRILYSIN INHIBITOR

2020 ◽  
pp. 32-37
Author(s):  
VEERENDRA UPPARA ◽  
SAISEKHAR KODIVANDLA ◽  
ASHIK ALI SHAIK
Keyword(s):  
Heart Failure ◽  
Public Health Problem ◽  
Global Public Health ◽  
Middle Income ◽  
Global Trends ◽  
Middle Income Countries ◽  
Health Loss ◽  
Neprilysin Inhibitor ◽  
Health Related ◽  
Global Public Health Problem

Heart failure (HF) is a major global public health problem irrespective of its causes. It generates an enormous clinical, societal, and economic, health loss burden with an increase in its prevalence reaching an epidemic proportion. The morbidity and mortality associated with heart failure are increasing the health-related burdens worldwide, especially in low- and middle-income countries. This review highlights the trends in HF burden, the clinical spectrum of HF, and the importance of neurohormonal pathways and the evolution of angiotensin receptor neprilysin inhibition in HF with updated clinical practice guidelines.

scholarly journals Farming with Alternative Pollinators benefits pollinators, natural enemies, and yields, and offers transformative change to agriculture

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Stefanie Christmann ◽  
Youssef Bencharki ◽  
Soukaina Anougmar ◽  
Pierre Rasmont ◽  
Moulay Chrif Smaili ◽  
...  
Keyword(s):  
Large Scale ◽  
Transformative Change ◽  
Net Income ◽  
Land Sharing ◽  
Pollinator Decline ◽  
Middle Income ◽  
Land Sparing ◽  
Middle Income Countries ◽  
Small Grant ◽  
Wildflower Strips

AbstractLow- and middle-income countries cannot afford reward-based land sparing for wildflower strips to combat pollinator decline. Two small-grant projects assessed, if an opportunity-cost saving land-sharing approach, Farming with Alternative Pollinators, can provide a method-inherent incentive to motivate farmers to protect pollinators without external rewards. The first large-scale Farming-with-Alternative-Pollinators project used seven main field crops in 233 farmer fields of four agro-ecosystems (adequate rainfall, semi-arid, mountainous and oasis) in Morocco. Here we show results: higher diversity and abundance of wild pollinators and lower pest abundance in enhanced fields than in monocultural control fields; the average net-income increase per surface is 121%. The higher income is a performance-related incentive to enhance habitats. The income increase for farmers is significant and the increase in food production is substantial. Higher productivity per surface can reduce pressure on (semi)-natural landscapes which are increasingly used for agriculture. Land-use change additionally endangers biodiversity and pollinators, whereas this new pollinator-protection approach has potential for transformative change in agriculture.

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