Pharma-cartography: Navigating the complexities of antibiotic supply to rural livestock in West Bengal, India, through value chain and power dynamic analysis.
Pharma-cartography: Navigating the complexities of antibiotic supply to rural livestock in West Bengal, India, through value chain and power dynamic analysis.
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制药学：通过价值链和动力动态分析，向印度西孟加拉邦的农村牲畜供应抗生素供应的复杂性。
DOI：
10.1371/journal.pone.0281188
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Alarcon, Pablo
中科院分区：
文献类型：
--
作者：
Hennessey, Mathew;Ebata, Ayako;Samanta, Indranil;Mateus, Ana;Jean-Christophe, Arnold;Day, Dominic;Gautham, Meenakshi;Alarcon, Pablo
抗生素耐药性威胁着全世界的医疗保健和畜牧业生产，预计会产生负面的社会经济影响。抗生素管理对于生活在农村社区的人们来说非常重要，其中许多人依赖农业作为食物和收入来源，并依赖抗生素来控制牲畜的传染病。因此，有必要明确抗生素价值链的结构，以了解社区环境中抗生素生产和分销的复杂性，因为这将有助于制定有效的政策和干预措施。我们使用价值链方法来研究在抗生素分销过程中如何建立关系，行为和影响。访谈进行了关键的线人（n = 17），价值链的利益相关者（n = 22），牲畜饲养家庭（n = 36）在加尔各答，和两个农村网站在西孟加拉，印度。进行价值链绘图和权力动态评估，使用清单内容分析，以调查抗生素分布和确定抗生素管理的切入点。抗生素从制造商到零售商的流动被描述和绘制，并提出了两个地方一级的地图，显示分配给最终消费者。这些地图表明，抗生素的分发是通过许多正式和非正式途径进行的，其中许多途径规避了抗生素使用立法。部分原因是公共部门管理价值链活动的机构权力有限。存在“兽医服务空白”，导致牲畜饲养者更加依赖私人和非正规供应商，这些供应商往往缺乏开抗生素处方和分发抗生素的法律的授权。许多抗生素处方者的非法性阻碍了他们获得正规培训，他们依赖于模仿更有经验的处方者的行为，而这些处方者也缺乏管理指南。我们认为，有限的机构权力，以执行现有的抗生素立法和指导抗生素的使用和牲畜医疗服务的重大差距，试图遏制非正式处方不可持续。替代方案可能包括解决公共部门在医疗保健服务和抗生素供应方面的赤字，并向所有抗生素处方者提供资源，如当地相关的抗生素指南。此外，可以修改非正式处方的合法性，这可能会允许成立协会或团体，以激励良好的抗生素实践。
Antibiotic resistance threatens provision of healthcare and livestock production worldwide with predicted negative socioeconomic impact. Antibiotic stewardship can be considered of importance to people living in rural communities, many of which depend on agriculture as a source of food and income and rely on antibiotics to control infectious diseases in livestock. Consequently, there is a need for clarity of the structure of antibiotic value chains to understand the complexity of antibiotic production and distribution in community settings as this will facilitate the development of effective policies and interventions. We used a value chain approach to investigate how relationships, behaviours, and influences are established during antibiotic distribution. Interviews were conducted with key informants (n = 17), value chain stakeholders (n = 22), and livestock keeping households (n = 36) in Kolkata, and two rural sites in West Bengal, India. Value chain mapping and an assessment of power dynamics, using manifest content analysis, were conducted to investigate antibiotic distribution and identify entry points for antibiotic stewardship. The flow of antibiotics from manufacturer to stockists is described and mapped and two local level maps showing distribution to final consumers presented. The maps illustrate that antibiotic distribution occurred through numerous formal and informal routes, many of which circumvent antibiotic use legislation. This was partly due to limited institutional power of the public sector to govern value chain activities. A ‘veterinary service lacuna’ existed resulting in livestock keepers having higher reliance on private and informal providers, who often lacked legal mandates to prescribe and dispense antibiotics. The illegitimacy of many antibiotic prescribers blocked access to formal training who instead relied on mimicking the behaviour of more experienced prescribers–who also lacked access to stewardship guidelines. We argue that limited institutional power to enforce existing antibiotic legislation and guide antibiotic usage and major gaps in livestock healthcare services make attempts to curb informal prescribing unsustainable. Alternative options could include addressing public sector deficits, with respect to both healthcare services and antibiotic provision, and by providing resources such as locally relevant antibiotic guidelines to all antibiotic prescribers. In addition, legitimacy of informal prescribers could be revised, which may allow formation of associations or groups to incentivise good antibiotic practices.
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DOI：
10.1016/j.socscimed.2021.113813
发表时间：
2021-04
期刊：
Social science & medicine (1982)
影响因子：
--
作者：
Gautham M;Spicer N;Chatterjee S;Goodman C
通讯作者：
Goodman C
影响因子：
5.5
作者：
Chauhan AS;George MS;Chatterjee P;Lindahl J;Grace D;Kakkar M
通讯作者：
Kakkar M
DOI：
10.3390/antibiotics10121433
发表时间：
2021-11-23
期刊：
Antibiotics (Basel, Switzerland)
影响因子：
--
作者：
Arnold JC;Day D;Hennessey M;Alarcon P;Gautham M;Samanta I;Mateus A
通讯作者：
Mateus A
影响因子：
3.2
作者：
Gemeda, Biruk Alemu;Amenu, Kebede;Wieland, Barbara
通讯作者：
Wieland, Barbara
影响因子：
1
作者：
Cobbold, Rowland N.;Simmons, Heather L.;Sherman, David M.
通讯作者：
Sherman, David M.