Social Dimensions of Antibiotic Resistance in Asia - a One Health Perspective

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 22924

Special Issue Editors


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Guest Editor
Centre for International Health and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
Interests: antibiotic resistance; vaccine-preventable diseases; maternal, newborn, child and adolescent health; complex interventions; behaviour change; public health

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Guest Editor
Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
Interests: the acceptability of novel influenza vaccine technologies; implementation of novel antibiotic resistance surveillance for humans and livestock; decentralizing diabetes and hypertension care in Eswatini; implementing a critical registry in South and South East Asia

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Guest Editor
1. Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
2. Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
Interests: bioethics; community engagement; public engagement; antimicrobial resistance; AMR

Special Issue Information

Dear Colleagues,

Antibiotic resistance is a global public health concern, and a particular threat in Asia, where the burden of infectious disease remains high, and antibiotic access and use has increased dramatically. The largest volume of antibiotics is used in agriculture, with little monitoring or regulation. In the human domain, antibiotics are often provided without health providers following diagnostic guidelines; they are also sold widely over-the-counter, and taken in inappropriate doses. These practices are entwined with the social, cultural and economic context in which they are found. They also have clear implications for the development and spread of antibiotic resistance. Understanding the social dimensions of these practices is crucial to designing effective interventions to mitigate the threat of antibiotic resistance.

With a view to learning lessons for interventions, this Special Issue will explore the social dimensions of antibiotic resistance in Asia, taking a One Health perspective, looking at antibiotic use in different sectors as well as across whole systems.

Dr. Sonia Lewycka
Dr. Christopher Pell
Prof. Dr. Phaik Yeong Cheah
Guest Editors

Manuscript Submission Information

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Keywords

  • antibiotic use
  • antibiotic resistance
  • One Health
  • prescribing
  • agriculture
  • Asia
  • social
  • cultural
  • economic
  • drivers
  • behaviour
  • interventions

Published Papers (7 papers)

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Research

20 pages, 1118 KiB  
Article
Assessment of the Implementation of Pakistan’s National Action Plan on Antimicrobial Resistance in the Agriculture and Food Sectors
by Yu Qiu, Jorge Pinto Ferreira, Riasat Wasee Ullah, Peter Flanagan, Muhammad Usman Zaheer, Muhammad Farooq Tahir, Javaria Alam, Armando E. Hoet, Junxia Song and Muhammad Akram
Antibiotics 2024, 13(3), 206; https://doi.org/10.3390/antibiotics13030206 - 22 Feb 2024
Viewed by 1518
Abstract
The agriculture and food (agrifood) sectors play key roles in the emergence, spread, and containment of antimicrobial resistance (AMR). Pakistan’s first National Action Plan (NAP) on AMR was developed to guide One Health interventions to combat AMR through 2017–2022. To improve subsequent iterations, [...] Read more.
The agriculture and food (agrifood) sectors play key roles in the emergence, spread, and containment of antimicrobial resistance (AMR). Pakistan’s first National Action Plan (NAP) on AMR was developed to guide One Health interventions to combat AMR through 2017–2022. To improve subsequent iterations, we assessed the implementation of Pakistan’s NAP in the agrifood sectors (NAPag) in October 2022, using the Progressive Management Pathway on AMR tool developed by the Food and Agriculture Organization of the United Nations (FAO). The assessment tool addressed four crucial focus areas of the NAPag: governance, awareness, evidence, and practices. Each focus area contains multiple topics, which involve four sequential stages of activities to progressively achieve systematic management of AMR risk in the agrifood sectors. High-level representatives of the NAPag stakeholders provided information for the assessment through pre-event documentary review and workshop discussions. The assessment results showed that Pakistan’s NAPag had an overall moderate coverage (59%) of the anticipated activities. Gaps were particularly notable in strengthening governance, good practices, and interventions in non-livestock sectors. Furthermore, only 12% of the evaluated activities were fully executed and documented, consistently remaining at the planning and piloting stages in the livestock sector across all the examined topics. Insufficient attention to non-livestock sectors, inadequate regulation and enforcement capacity, and resource constraints have hindered scalable and sustainable interventions under the current plan. This assessment provides valuable insights to strengthen the inclusiveness and contribution of the agrifood sectors in the next NAP iteration. In the short-to-medium term, strategic prioritization is necessary to optimize the use of limited resources and target the most critical gaps, such as improving awareness among key stakeholders and fortifying regulations for prudent antimicrobial use. In the long term, integration of AMR into the country’s broader health, development, and agricultural transformation agendas will be needed to generate sustainable benefits. Full article
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16 pages, 1607 KiB  
Article
Awareness of Antibiotics and Antibiotic Resistance in a Rural District of Ha Nam Province, Vietnam: A Cross-Sectional Survey
by Godwin Ulaya, Tu Cam Thi Nguyen, Bich Ngoc Thi Vu, Duc Anh Dang, Hien Anh Thi Nguyen, Hoang Huy Tran, Huong Kieu Thi Tran, Matthew Reeve, Quynh Dieu Pham, Tung Son Trinh, H. Rogier van Doorn and Sonia Lewycka
Antibiotics 2022, 11(12), 1751; https://doi.org/10.3390/antibiotics11121751 - 04 Dec 2022
Cited by 1 | Viewed by 4294
Abstract
Low awareness of antibiotics and antibiotic resistance may lead to inappropriate antibiotic use and contribute to the problem of antibiotic resistance. This study explored levels and determinants of antibiotic awareness in a rural community in northern Vietnam, through a cross-sectional survey of 324 [...] Read more.
Low awareness of antibiotics and antibiotic resistance may lead to inappropriate antibiotic use and contribute to the problem of antibiotic resistance. This study explored levels and determinants of antibiotic awareness in a rural community in northern Vietnam, through a cross-sectional survey of 324 households in one commune of Ha Nam Province. Awareness and knowledge of antibiotics and antibiotic resistance and determinants were evaluated using structured questionnaires. Most respondents (232/323 (71.8%)) had heard of antibiotics, but fewer could name any antibiotic (68/323 (21.1%)) or had heard of antibiotic resistance (57/322 (17.7%)). In adjusted regression models, antibiotic awareness was lower among those who lived further from health facilities (Odds Ratio (OR): 0.08; 95% Confidence Interval (CI): 0.04–0.19) but higher among those who used interpersonal sources for health information (OR: 4.06; 95% CI: 1.32–12.46). Antibiotic resistance awareness was lower among those who used private providers or pharmacies as their usual health facility (OR: 0.14; 95% CI: 0.05–0.44) but higher among those with medical insurance (OR: 3.70; 95% CI: 1.06–12.96) and those with high media use frequency (OR: 9.54; 95% CI: 2.39–38.07). Awareness of Antimicrobial Resistance (AMR) was also higher among those who sought health information from official sources (OR: 3.88; 95% CI: 1.01–14.86) or had overall high levels of health information seeking (OR: 12.85; 95% CI: 1.63–101.1). In conclusion, communication interventions need to target frequently used media platforms, such as television, as well as key health information providers, such as health workers, as channels for increasing knowledge and changing community antibiotic use behaviour. Full article
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14 pages, 696 KiB  
Article
A Dual Perspective of Psycho-Social Barriers and Challenges Experienced by Drug-Resistant TB Patients and Their Caregivers through the Course of Diagnosis and Treatment: Findings from a Qualitative Study in Bengaluru and Hyderabad Districts of South India
by Karikalan Nagarajan, Karthikeyan Kumarsamy, Rehana Begum, Vikas Panibatla, Rameshchandra Reddy, Rajesham Adepu, Joseph Francis Munjattu, Senthil Sellapan, Stephen Arangba, Amrita Goswami, Reuben Swamickan and Malaisamy Muniyandi
Antibiotics 2022, 11(11), 1586; https://doi.org/10.3390/antibiotics11111586 - 10 Nov 2022
Cited by 2 | Viewed by 2054
Abstract
Qualitative insights regarding psycho-social barriers and challenges experienced by drug-resistant tuberculosis (DR-TB) patients and their caregivers are understudied in India. We conducted a qualitative study using semi-structured qualitative interviews among treatment-completed DR-TB patients (n = 20) and caregivers (n = 20) [...] Read more.
Qualitative insights regarding psycho-social barriers and challenges experienced by drug-resistant tuberculosis (DR-TB) patients and their caregivers are understudied in India. We conducted a qualitative study using semi-structured qualitative interviews among treatment-completed DR-TB patients (n = 20) and caregivers (n = 20) in Bengaluru and Hyderabad districts, which represented two different socio-cultural settings in South India. Criterion sampling was used for recruiting the eligible participants who completed treatment with adherence. “Emotional issues and social barriers” were identified to represent a major challenge for patients and caregivers, which occurred acutely after disease diagnosis, characterized by fear and emotional distress due to their perceived loss of life prospects, severity of symptoms, discomfort, and disease denial. Medication intolerance, chronic symptoms, lack of visible signs of treatment progress, loss of weight, and physical concerns caused subsequent fear and distress during the treatment phases for patients along with experiences of stigma. External triggers generated “decisive moments” of hopelessness and life-ending thoughts for patients at the diagnosis and early treatment phase. Medication related challenges included the perceived burden and power of pills which caused emotional distress for patients and intolerance towards caregivers. Pill burden was found as consequential as the side effects of injections. Challenges related to lack of support were another major theme, in which caregivers lacked resources for treatment support and nutrition. Throughout treatment, caregivers and patients expressed concern about a lack of supportive care from family members, sympathy, and intangible social support. Challenges during hospital admission in terms of lack of privacy, quality of services, individual attention, and empathy from health care workers were reported by patients and caregivers. Despite better adherence, DR-TB patients and caregivers experienced considerable emotional and social consequences. Differentiating DR-TB patients and caregivers’ issues at different stages of diagnosis and treatment could help improve patient-centered outcomes in India and other high-burden nations. Full article
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17 pages, 288 KiB  
Article
Exploring Barriers to One Health Antimicrobial Stewardship in Sri Lanka: A Qualitative Study among Healthcare Professionals
by Yasodhara Deepachandi Gunasekara, Tierney Kinnison, Sanda Arunika Kottawatta, Ruwani Sagarika Kalupahana and Ayona Silva-Fletcher
Antibiotics 2022, 11(7), 968; https://doi.org/10.3390/antibiotics11070968 - 19 Jul 2022
Cited by 4 | Viewed by 2126
Abstract
Antimicrobial resistance (AMR) is a global health threat, but little is known about the perceptions regarding antimicrobials and AMR among healthcare professionals in Sri Lanka. This research aimed to take a One Health approach to explore the knowledge, attitudes and perceptions of antibiotic [...] Read more.
Antimicrobial resistance (AMR) is a global health threat, but little is known about the perceptions regarding antimicrobials and AMR among healthcare professionals in Sri Lanka. This research aimed to take a One Health approach to explore the knowledge, attitudes and perceptions of antibiotic stewardship and AMR among healthcare professionals in Sri Lanka. A qualitative study, using telephone interviews, allowing for an in-depth exploration of attitudes, beliefs and perspectives was conducted. Healthcare professionals from both the medical and veterinary sectors were included (n = 29). Interviews were conducted by an independent interviewer and were audio-recorded and transcribed. Conventional qualitative content analysis was undertaken. Four main categories were identified: (1) understanding of AMR and observing AMR, (2) barriers to antimicrobial stewardship, (3) personal factors in, and as a result of, inappropriate antibiotic usage and (4) how to tackle AMR. Healthcare professionals showed poor awareness regarding the spread of AMR and identified inappropriate prescribing behaviours by their inter- and intra-professional colleagues. Patient demands and the influence of pharmaceutical companies were factors contributing to poor prescribing behaviour. Suggestions for the future are stricter regulation of AMR control policy, effective government involvement, and awareness campaigns for healthcare professionals and the public. Full article
15 pages, 609 KiB  
Article
Health Information Orientation Profiles and Their Association with Knowledge of Antibiotic Use in a Population with Good Internet Access: A Cross-Sectional Study
by Huiling Guo, Huai Yang Lim and Angela Chow
Antibiotics 2022, 11(6), 769; https://doi.org/10.3390/antibiotics11060769 - 04 Jun 2022
Cited by 1 | Viewed by 1837
Abstract
Background: Poor knowledge of antibiotic use drives poor antibiotic practices, but little is known about the influence of health information orientation (HIO) on knowledge of antibiotic use in the general public. Methods: We conducted a nationally-representative population-wide cross-sectional study (November 2020–January 2021), on [...] Read more.
Background: Poor knowledge of antibiotic use drives poor antibiotic practices, but little is known about the influence of health information orientation (HIO) on knowledge of antibiotic use in the general public. Methods: We conducted a nationally-representative population-wide cross-sectional study (November 2020–January 2021), on a proportionately stratified random sample of 2004 Singapore residents aged ≥21 years. Multivariable logistic regression analysis was performed to assess the association between HIO and knowledge of antibiotic use. Results: Forty percent of respondents had low-levels of HIO (LL-HIO); they tended to be younger, not currently married, and did not have family/friends working in the healthcare sector. Respondents with LL-HIO (aOR 1.82, 95% CI 1.32–2.51, p < 0.001) were 82% more likely to have poor knowledge of antibiotic use. In particular, older adults aged ≥50 years with LL-HIO (aOR 1.81, 95% CI [1.32–2.51], p < 0.001) were much more likely to have poor knowledge than their HL-HIO counterparts. They were also less likely to use the Internet to seek health information and had poor eHealth efficacy. Conclusion: LL-HIO is independently associated with poor knowledge of antibiotic use. Educational strategies on antibiotic use should disseminate a consistent message through both online and offline platforms, involving traditional and non-traditional healthcare and non-healthcare influencers. Full article
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12 pages, 1632 KiB  
Article
Impact of COVID-19 on Antimicrobial Consumption and Spread of Multidrug-Resistance in Bacterial Infections
by Kibum Jeon, Seri Jeong, Nuri Lee, Min-Jeong Park, Wonkeun Song, Han-Sung Kim, Hyun Soo Kim and Jae-Seok Kim
Antibiotics 2022, 11(4), 535; https://doi.org/10.3390/antibiotics11040535 - 18 Apr 2022
Cited by 43 | Viewed by 4179
Abstract
The spread of COVID-19 pandemic may have affected antibiotic consumption patterns and the prevalence of colonized or infected by multidrug-resistant (MDR) bacteria. We investigated the differences in the consumption of antibiotics easily prone to resistance and the prevalence of MDR bacteria during the [...] Read more.
The spread of COVID-19 pandemic may have affected antibiotic consumption patterns and the prevalence of colonized or infected by multidrug-resistant (MDR) bacteria. We investigated the differences in the consumption of antibiotics easily prone to resistance and the prevalence of MDR bacteria during the COVID-19 pandemic (March 2020 to September 2021) compared to in the pre-pandemic period (March 2018 to September 2019). Data on usage of antibiotics and infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were obtained from hospitalized patients in four university hospitals. The consumption of penicillin with β-lactamase inhibitors (3.4% in ward, 5.8% in intensive care unit (ICU)), and carbapenems (25.9% in ward, 12.1% in ICU) increased during the pandemic period. The prevalence of MRSA (4.7%), VRE (49.0%), CRE (22.4%), and CRPA (20.1%) isolated in clinical samples from the ward and VRE (26.7%) and CRE (36.4%) isolated in clinical samples from the ICU were significantly increased, respectively. Meanwhile, only the prevalence of CRE (38.7%) isolated in surveillance samples from the ward increased. The COVID-19 pandemic is associated with increased consumption of antibiotics and has influenced the prevalence of infections caused by MDR isolates. Full article
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13 pages, 1002 KiB  
Article
Understanding Antibiotic Usage on Small-Scale Dairy Farms in the Indian States of Assam and Haryana Using a Mixed-Methods Approach—Outcomes and Challenges
by Naresh Kumar, Garima Sharma, Eithne Leahy, Bibek R. Shome, Samiran Bandyopadhyay, Ram Pratim Deka, Rajeswari Shome, Tushar Kumar Dey and Johanna Frida Lindahl
Antibiotics 2021, 10(9), 1124; https://doi.org/10.3390/antibiotics10091124 - 18 Sep 2021
Cited by 13 | Viewed by 4459
Abstract
The use and misuse of antibiotics in both humans and animals contributes to the global emergence of antimicrobial resistant (AMR) bacteria, a threat to public health and infection control. Currently, India is the world’s leading milk producer but antibiotic usage within the dairy [...] Read more.
The use and misuse of antibiotics in both humans and animals contributes to the global emergence of antimicrobial resistant (AMR) bacteria, a threat to public health and infection control. Currently, India is the world’s leading milk producer but antibiotic usage within the dairy sector is poorly regulated. Little data exists reflecting how antibiotics are used on dairy farms, especially on small-scale dairy farms in India. To address this lack of data, a study was carried out on 491 small-scale dairy farms in two Indian states, Assam and Haryana, using a mixed method approach where farmers were interviewed, farms inspected for the presence of antibiotics and milk samples taken to determine antibiotic usage. Usage of antibiotics on farms appeared low only 10% (95% CI 8–13%) of farmers surveyed confirmed using antibiotics in their dairy herds during the last 12 months. Of the farms surveyed, only 8% (6–11%) had milk samples positive for antibiotic residues, namely from the novobiocin, macrolides, and sulphonamide classes of antibiotics. Of the farmers surveyed, only 2% (0.8–3%) had heard of the term “withdrawal period” and 53% (40–65%) failed to describe the term “antibiotic”. While this study clearly highlights a lack of understanding of antibiotics among small-scale dairy farmers, a potential factor in the emergence of AMR bacteria, it also shows that antibiotic usage on these farms is low and that the possible role these farmers play in AMR emergence may be overestimated. Full article
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