Measuring antibiotic availability and use in 20 low- and middle-income countries

Objective To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization’s AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities

COATING OF GUAVA (PSIDIUM GUAJAVA L.) FRUITS WITH BOTANICAL EDIBLE OILS FOR SHELF LIFE AND FRUIT FLIES

Guava (Psidium guajava L.) fruit is a popular nutritious dessert in Sudan. It is famous for its medicinal values as a prompt cure for digestive disorders and respiratory ailness this besides being a rich source of C vitamin. This fruit is highly amenable to fruit fly attack and it is a harbor of eggs of five different species [Ceratitis capitata Wied.; Ceratitis quinaria Bez.; Ceratitis cosyra Wlk.; Bactrocera invadens De Trusta and White and Bactrocera zonata (Saunders)] in Sudan. This is stimulating to a chain of endless research to combat these notorious pests which account for huge losses in this crop that reach up to 80% or even more. This research aimed at evaluating the effect of oil coating on fruit fly infestation and the quality indexes in guava fruit using five different botanical edible oils. The results showed that groundnut (Arachis hypogaea L.) (GNO), sesame (Sesamum indicum L.) (SO), baobab (Adansonia digitata L.) (BO), olive (Olea europaea L.) (OO) and neem (Azadirachta indica A. Juss) (NO) oils effected a corrected disinfestation of 80, 72, 56, 52 and 28% in test fruits brought from Kadaro orchards North Khartoum, respectively. The corresponding average readings of maggots in infested fruits were 4, 17, 11, 5, 7 and [10 (for the first 4) and 26 for NO] in the control. Two essential quality indexes were checked in test fruits which included fruit color (FC) and firmness (FF). The corrected test readings reflected 64, 80, 44, 52,-4 and [8 (for the first 4) and 20 for NO] in the control sustained FC for GNO, SO, BO, OO, NO and the control, respectively. However, the corresponding readings for FF were 3 (medium) for all oils and 4 (soft) for the controls. These results reflect a potent and the best efficacy of peanut and sesame oils, of the five test oils, in controlling fruit flies in guava and extending its shelf life

Health workforce metrics pre- and post-2015: A stimulus to public policy and planning

© 2017 The Author(s). Background: Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015. Methods: Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies. Results: There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed. Conclusions: There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning

Nucleus-targeted Dmp1 transgene fails to rescue dental defects in Dmp1 null mice

Dentin matrix protein 1 (DMP1) is essential to odontogenesis. Its mutations in human subjects lead to dental problems such as dental deformities, hypomineralization and periodontal impairment. Primarily, DMP1 is considered as an extracellular matrix protein that promotes hydroxyapatite formation and activates intracellular signaling pathway via interacting with αvβ3 integrin. Recent in vitro studies suggested that DMP1 might also act as a transcription factor. In this study, we examined whether full-length DMP1 could function as a transcription factor in the nucleus and regulate odontogenesis in vivo. We first demonstrated that a patient with the DMP1 M1V mutation, which presumably causes a loss of the secretory DMP1 but does not affect the nuclear translocation of DMP1, shows a typical rachitic tooth defect. Furthermore, we generated transgenic mice expressing (NLS)DMP1, in which the endoplasmic reticulum (ER) entry signal sequence of DMP1 was replaced by a nuclear localization signal (NLS) sequence, under the control of a 3.6 kb rat type I collagen promoter plus a 1.6 kb intron 1. We then crossbred the (NLS)DMP1 transgenic mice with Dmp1 null mice to express the (NLS)DMP1 in Dmp1-deficient genetic background. Although immunohistochemistry demonstrated that (NLS)DMP1 was localized in the nuclei of the preodontoblasts and odontoblasts, the histological, morphological and biochemical analyses showed that it failed to rescue the dental and periodontal defects as well as the delayed tooth eruption in Dmp1 null mice. These data suggest that the full-length DMP1 plays no apparent role in the nucleus during odontogenesis

Additions to the distribution of Sudanese scorpions

Six species of scorpion (Arachnida: Scorpiones) are documented from eighteen localities in seven different states within the Republic of the Sudan. Combining this new data with historical records in the Sudan Natural History Museum and the published literature enables the first provisional distribution maps for Sudanese scorpions. New state records could be added for three medically significant species: Androctonus amoreuxi (Audouin, 1826) from Khartoum, North Kordofan and North Darfur, Leiurus quinquestriatus (Ehrenberg, 1829) from Kassala, River Nile, White Nile and North Darfur, and Parabuthus abyssinicus (Pocock, 1901) from Kassala. Among the less venomous species, we offer new state records for Buthacus leptochelys (Ehrenberg, 1829) in White Nile State, for Compsobuthus werneri (Birula, 1908) in North Kordofan, White Nile and Kassala States and for Orthochirus olivaceus (Karsch, 1881) in River Nile, Northern and Kassala States. Further information about the taxonomy, distribution and toxicity of Sudanese scorpions is presented

Mandatory pharmacist-led education session for patients seeking medical cannabis

Objective: The primary objectives of this pre-post session study, was to evaluate the impact of a pharmacist-led education session on the perceived benefits and safety of cannabis among patients with chronic pain, as well as determine the influence of pharmacist education on the selection of safer cannabis products and dosage forms for medical use among patients. Methods: A retrospective analysis of completed pre-post session questionnaires was conducted among chronic pain patients attending a mandatory education session led by a pharmacist, prior to being authorized cannabis in clinic. All questionnaire data was analyzed using SPSS v. 25. Demographic and sample characteristics were reviewed using univariate analyses. Chi-Square tests were employed to determine if the group-based education significantly affected knowledge, perception of efficacy and safety of cannabis. Results: Of the 260 session participants, 203 completed pre-post session questionnaires. After the session, a majority of current cannabis users (33.8%) and cannabis naïve/past users (56.9%) reported they would use a low THC product in the future, and a majority of current users (54.5%) would use a high CBD product in the future. After education, participants were more likely to report cannabis as having the potential for addiction (chi-square =42.6, p <0.0001) and harm (chi-square =34.0, p <0.0001). Conclusions: Pharmacist counselling and education has the potential to influence patient selection and use of cannabis, from more harmful to safer products, as well as moderate the potential perceived benefits of use

Development of Ethnic Identity in Young Adults from Immigrant Families: “I Want to Hold Onto My Roots, But I Also Want to Experience New Routes”

This article explores ethnic identity development among young adults from immigrant families from diverse countries of origin. Based on in-depth interviews with young women and men, the authors examined the formation of ethnic identity through childhood, adolescence, and into young adulthood. Analysis of the participants’ narratives revealed that, compared with fluent bilinguals, limited bilinguals reported weaker connections to their heritage culture. Most participants progressed through the model of ethnic identity formation, which was influenced by their family socialization and community context, and reported integrated or bicultural ethnic identities. Practitioners may use the experiences shared by our participants to inform their work with second-generation immigrant youth in varying stages of ethnic identity development

Understanding antibiotic availability and use in low and middle income countries: Insights from health facility surveys

Objective To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization’s AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (maostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities