Pharmacists are recommended as one of the key contributors to antimicrobial stewardship (AMS) programmes, however, the extent of their participation varies in different countries. We report the ...evidence of pharmacists’ roles in AMS and its outcomes over 20 years in High-, Middle- and Low-income countries.
A systematic review of the literature was conducted using the main databases for research publications. Studies describing pharmacist-driven or led AMS and its outcomes published in the English language between January 1999 and June 2020 from high-, low-, and -middle-income countries were included. Review of papers (title-abstract and full text) occurred independently by three reviewers and any disagreements were reviewed and discussed with a fourth reviewer.
A total of 118 studies were included in the final analysis of which 78% (92/118) were published from high-income countries (HICs) with 74% (68/92) from the United States of America. The review found a progressive rise in pharmacist- led or driven AMS from all income settings. Across the variety of AMS interventions reported, audit and feedback was the most frequent intervention by pharmacists resulting in improved appropriateness of antimicrobial therapy and reduced consumption of antimicrobials. Whilst the involvement of infectious diseases trained pharmacists were reported, predominantly in HICs, various studies from across the globe highlighted the support provided by the wider AMS team to pharmacist's contributions to the program.
Pharmacists’ involvement in AMS has been shown to positively impact antimicrobial prescribing. The increasing evidence of pharmacist-led or driven AMS is predominantly reported in the HICs and gradually evolving in middle- and low-income countries. There needs to be a concerted effort in facilitating pharmacists' roles in AMS across all countries, irrespective of income setting.
•Capacity building for research and implementation is key to operationalzing concerted and sustained strategies for addressing antimicrobial resistance.•Reciprocal and long-term partnerships between ...high-income and low- and middle-income countries can successfully develop robust, agile, and flexible antimicrobial stewardship research and implementation teams.•Capacity building in AMR, when supported by adequate funding to ensure investment in the workforce and infrastructure, can result in sustainable and resilient AMS programmes.
Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes.
There are no widely adopted ethical standards for the use of imagery in global health publications. We reviewed imagery used by global health actors in grey literature related to antimicrobial ...resistance (AMR) and vaccination and analysed whether the imagery used was relevant, ethical, and equitable.
Reports produced by key global health actors on AMR and vaccination were retrieved through searches on 1) Google using key MESH terms; and 2) the website of each actor. Reports containing at least one image of person/s, published between 2015 and 2022 were included. Guidelines from Photographers Without Borders, European Non-governmental confederation for relief and development (CONCORD) Code of Conduct on Images and Messages, and the National Press Photographers Association were used to develop an analysis framework. Consensus was reached iteratively on the (qualitative and quantitative) indicators used in the final framework.
In 118 reports from 14 global health actors, there were 1115 images, of which 859 included people (370 healthcare professionals (HCPs), 402 adult non-HCPs, and 393 children). Of HCP images, 301/370 (81%) included non- whites, 273/370 (74%) included women, and 247/370 (67%) included non-white women. Of the non-HCP images, 346/402 (86%) included non-whites, 321/402 (80%) included women, and 278/402 (69%) included non-white women. Of images including children, 359/393 (91%) included non-whites. Qualitative analysis identified issues of relevance, integrity, consent, and representation from high income versus low-and middle-income countries (LMIC). Inequities in staging, digital manipulation, and breaches of confidentiality were noted in images depicting LMICs.
Biased representation of LMICs drives misleading and irrelevant disease associations and power imbalances. This work highlights how imagery in global health contributes to representations that are inequitable and unethical.
Through the process of inquiry, we have created an ethical framework for appropriate imagery use in global health grey literature to help key actors avoid these biases.
To optimise surgical outcomes and minimise the risk of infections, effective communication and teamwork are essential in the operating theatre (OT). In this pilot study, we mapped the OT team ...dynamics and roles in infection and safety-related practices.
Between November 2021 and February 2022, data were gathered from adult surgical teams at a tertiary hospital in India. Data included direct ethnographic observations of OT activities and interactions, sociograms of targeted infection and safety-related communication, measurement of OT traffic, and focus group discussions with teams. Qualitative data were coded and analysed using a grounded theory approach. Quantitative data were analysed using descriptive statistics.
Data gathered from 51 hours of direct observations across ten surgical pathways include 16 sociograms and 15 traffic-flow maps. Team hierarchies and dynamics are directly influenced by the senior surgeon. The OT staff adhere to implicitly understood roles, creating a missed opportunity for infection-related interventions. Instances of non-verbal communication are common, especially for routine activities. While the surgical and anaesthetic residents and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating and activating tasks among role players across hierarchies. Despite this role, the plan of events is not always communicated to them ahead of the procedure resulting in multiple door openings to source equipment and disposables. Traffic flow, counted by the number of door openings reach up to 14-15 per five minutes, with implications for infection management. Communication around the WHO checklist was limited.
While interventions exist to optimise care in the OT, implementation challenges remain. Assigning explicit roles and responsibilities for actioning, including the WHO checklist completion, to specific team members is critical. On reflexive feedback to teams, the visual methods utilised provided an effective means for team reflection and an awareness of practices that may compromise infection management and patient safety.
Pentecostals' dominant liturgical principle has traditionally taken the pattern of unlimited expression of emotion and charismata, often formless and emphasising the subjective. The manifestations of ...the Spirit's direct activity often interpreted as the reason for Pentecostals' antiliturgical position, have in the past few years passed through a paradigm shift. The introduction of concrete rituals encompassing various significations, in a manner reminiscent of African traditions and culture by some churches, shows uncritical engagement with biblical theology of worship. Furthermore, the encouragement of individual appropriation of God's promise in rites performance is a deviation from African traditional emphasis on community function. The researcher employed a participant observation methodology and engagement with pertinent literary works of pastors of the churches investigated. The article shows that the struggle of Pentecostals to be relevant is responsible for its juxtaposition of African traditions and culture with the Spirit in the performance of liturgical rites. The article concludes that in Nigeria Pentecostals' practice of worship encourages the individual to appropriate the biblical promises of God at the expense of the community of Christ whose work in building character and guiding our lives is done through other Christians in the community.
This article is a critical analysis of the present crisis in the Assemblies of God, Nigeria (AGN). A background history of the church is given to show how growth had taken place and how decline had ...set in. Doing this involves analysing the factors responsible for the present crisis that has brought the church to its knees. The article finds that the AGN’s membership and leadership are dominated by the Igbo ethnic group whose worldviews are known to be highly competitive, individualistic and ‘pantomimic’. The AGN’s constitution and bye-laws do not include a clause that prevents pastors from the same ethnic group from holding the two top-most positions of the General Superintendent and the Assistant General Superintendent at the same time. Therefore the article submits that the AGN should amend its constitution to deal with these pertinent issues. The significance of the article is that it calls the attention of other Pentecostal denominations in Nigeria and the rest of Africa to the crisis-ridden AGN, whose eschatological and Pentecostal persuasion is at orita the crossroads and urges them to learn from it.
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