Interventions to Improve Antibiotic Prescribing in Upper Middle Income Countries: A Systematic Review of the Literature 1990 2009

Background: Inappropriate antibiotic use is a global public health problem with serious consequences, including antimicrobial resistance. In response, countries have to take comprehensive action with interventions that improve antibiotic use at various levels. Several reviews have evaluated interventions on antibiotic prescribing practices in different healthcare settings. Objective: To identify interventions targeting antibiotic prescribing by medical doctors in primary health care in upper middle-income countries and to assess intervention effectiveness. Methods: We undertook systematic literature review of studies for the period 1990 – 2009. Studies had to report quantitative data on antibiotic prescribing by primary care doctors using medicines use indicators. Intervention effects were based on data from intervention studies with valid study designs. Results: Eight studies describing ten interventions met all the inclusion criteria. We found that single educational interventions targeting all diseases had low or no impact on percentages of patients prescribed antibiotics. Greater impact on antibiotic prescribing was achieved by multifaceted interventions focusing on specific diseases. Conclusion: The limited evidence on interventions from upper middle-income countries has produced results similar to other reviews. More concerted commitment is needed to monitor antibiotic prescribing regularly and to conduct well designed evaluations of interventions

Antibiotic Use in South East Asia and Policies to Promote Appropriate Use: Reports from Country Situational Analyses

Inappropriate use of antibiotics is rampant in South East Asia1-6 and is a major contributor to antimicrobial resistance.7-9 However, data on antibiotic use are scant, few effective interventions to improve appropriate antibiotic use have been implemented,10 11 and implementation of policies for appropriate use of antibiotics is also poor.12 13 An analysis of secondary data on antibiotic use from 56 low and middle income countries found that countries reporting implementation of more policies also had more appropriate antibiotic use.14 15 Effective policies included having a government health department to promote rational use of medicines, a national strategy to contain antimicrobial resistance, a national drug information centre, drug and therapeutic committees in more than half of all general hospitals and provinces, and undergraduate education on standard treatment guidelines.15 An updated essential medicines list and national formularies were also associated with lower antibiotic use

Prescribing for acute childhood infections in developing and transitional countries, 1990–2009

Background: Evidence of global progress in treating acute paediatric infections is lacking. Objectives: To assess progress over two decades in prescribing for childhood infections and interventions to improve treatment by reviewing empirical evidence in developing and transitional countries. Methods: Data were systematically extracted on the use of medicines for diarrhoea, respiratory infections and malaria from published and unpublished studies (1990–2009) in children under 5 years of age. Medians of each indicator were calculated across studies by study year, geographic region, sector, country income level and prescriber type. To estimate intervention effects from studies meeting methodologically accepted design criteria [randomised controlled trials (RCTs), pre-post with control, and time series studies], the medians of the median effect sizes (median MES) were calculated across outcome measures. Results: Data were extracted from 344 studies conducted in 78 countries with 394 distinct study groups in public (64%), private (22%) and other facilities to estimate trends over time. Of 226 intervention studies, only the 44 (19%) with an adequate study design were used to estimate intervention effects. Over time, use of anti-diarrhoeals for acute diarrhoea decreased significantly (P<0·01). However, treatment of malaria and acute respiratory infection remained largely sub-optimal. Multi-component interventions resulted in larger improvements than single-component ones. The median MES indicated a 28% improvement with community case-management, an 18% improvement with provider education combined with consumer education, but only 9% improvement with provider education alone. Conclusions: While diarrhoea treatment has improved over the last 20 years, treatment of other childhood illnesses remains sub-optimal. Multi-component interventions demonstrated some success in improving management of acute childhood illness

Promoting Quality Use of Medicines in South-East Asia: Reports from Country Situational Analyses

Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. The aim was to determine whether public-sector QUM is better in SEAR countries implementing essential medicines (EM) policies than in those not implementing them

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Proceedings of the 13th annual conference of INEBRIA

CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.The original publication is available at https://ascpjournal.biomedcentral.comENGLISH SUMMARY : Meeting abstracts.https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0062-9Publisher's versio

WHO Essential Medicines Policies and Use in Developing and Transitional Countries: An Analysis of Reported Policy Implementation and Medicines Use Surveys

<div><p>Background</p><p>Suboptimal medicine use is a global public health problem. For 35 years the World Health Organization (WHO) has promoted essential medicines policies to improve quality use of medicines (QUM), but evidence of their effectiveness is lacking, and uptake by countries remains low. Our objective was to determine whether WHO essential medicines policies are associated with better QUM.</p><p>Methods and Findings</p><p>We compared results from independently conducted medicines use surveys in countries that did versus did not report implementation of WHO essential medicines policies. We extracted survey data on ten validated QUM indicators and 36 self-reported policy implementation variables from WHO databases for 2002–2008. We calculated the average difference (as percent) for the QUM indicators between countries reporting versus not reporting implementation of specific policies. Policies associated with positive effects were included in a regression of a composite QUM score on total numbers of implemented policies. Data were available for 56 countries. Twenty-seven policies were associated with better use of at least two percentage points. Eighteen policies were associated with significantly better use (unadjusted <i>p</i><0.05), of which four were associated with positive differences of 10% or more: undergraduate training of doctors in standard treatment guidelines, undergraduate training of nurses in standard treatment guidelines, the ministry of health having a unit promoting rational use of medicines, and provision of essential medicines free at point of care to all patients. In regression analyses national wealth was positively associated with the composite QUM score and the number of policies reported as being implemented in that country. There was a positive correlation between the number of policies (out of the 27 policies with an effect size of 2% or more) that countries reported implementing and the composite QUM score (<i>r</i> = 0.39, 95% CI 0.14 to 0.59, <i>p = </i>0.003). This correlation weakened but remained significant after inclusion of national wealth in multiple linear regression analyses. Multiple policies were more strongly associated with the QUM score in the 28 countries with gross national income per capita below the median value (US$2,333) (<i>r = </i>0.43, 95% CI 0.06 to 0.69, <i>p = </i>0.023) than in the 28 countries with values above the median (<i>r = </i>0.22, 95% CI −0.15 to 0.56, <i>p = </i>0.261). The main limitations of the study are the reliance on self-report of policy implementation and measures of medicine use from small surveys. While the data can be used to explore the association of essential medicines policies with medicine use, they cannot be used to compare or benchmark individual country performance.</p><p>Conclusions</p><p>WHO essential medicines policies are associated with improved QUM, particularly in low-income countries.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div

Have we improved use of medicines in developing and transitional countries and do we know how to? Two decades of evidence

Objective: To assess progress in improving use of medicines in developing and transitional countries by reviewing empirical evidence, 1990–2009, concerning patterns of primary care medicine use and intervention effects. methods We extracted data on medicines use, study setting, methodology and interventions from published and unpublished studies on primary care medicine use. We calculated the medians of six medicines use indicators by study year, country income level, geographic region, facility ownership and prescriber type. To estimate intervention impacts, we calculated greatest positive (GES) and median effect sizes (MES) from studies meeting accepted design criteria. results Our review comprises 900 studies conducted in 104 countries, reporting data on 1033 study groups from public (62%), and private (mostly for profit) facilities (26%), and households. The proportion of treatment according to standard treatment guidelines was 40% in public and <30% in private-for-profit sector facilities. Most indicators showed suboptimal use and little progress over time: Average number of medicines prescribed per patient increased from 2.1 to 2.8 and the percentage of patients receiving antibiotics from 45% to 54%. Of 405 (39%) studies reporting on interventions, 110 (27%) used adequate study design and were further analysed. Multicomponent interventions had larger effects than single component ones. Median GES was 40% for provider and consumer education with supervision, 17% for provider education alone and 8% for distribution of printed education materials alone. Median MES showed more modest improvements. conclusions Inappropriate medicine use remains a serious global problem

Differences in quality use of medicines between countries that did versus did not report implementation of specific medicine policies.

<p>The figure presents the weighted mean (and 95% confidence interval) of differences (in percent) across ten selected QUM measures. ^∧Joint regulation by government and industry as opposed to government regulation only. CME, continuing medical education; DTC, drug and therapeutics committee; EML, essential medicines list; NMP, national medicines policy; STG, standard treatment guidelines.</p

Correlation between number of implemented policies and percentage of cases of acute diarrhoeal illness treated with oral rehydration solution.

<p>DR Congo, Democratic Republic of the Congo; Laos, Lao People's Democratic Republic; ORS, oral rehydration solution.</p