Community dialogues for preventing and controlling antibiotic resistance in Bangladesh

背景我们计划在孟加拉国开发和测试预防和控制抗生素耐药性的“社区对话”方法。在抗生素可以在没有处方的情况下购买，而且卫生工作者过度开出抗生素和公众过度使用的情况下，抗生素耐药性的出现和传播尤其成问题。世界卫生组织建议，普通公众可以通过预防感染、仅在卫生专业人员开出处方时使用抗生素、完成完整的处方、从不使用剩余的抗生素和从不共享抗生素来帮助抗击抗生素耐药性。卫生和家庭福利部在孟加拉国建立了振兴社区卫生保健倡议。他们这样做是为了改善医疗保健的可及性、利用率和公平性。这项倡议旨在使农村地区的社区诊所能够向集水区约6000人提供基本服务。到目前为止，全国已建立了约13,300家社区诊所。该研究小组的成员已经与卫生部合作，制定和评估一项干预措施，以提高科米拉区社区诊所提供的基本服务的质量。这套方案的一个关键部分是培训社区卫生保健提供者正确开出抗生素处方，这是非常成功的。提高提供者正确开出抗生素的能力是影响抗生素使用方式的一系列行为问题中的一个重要组成部分。我们打算在现有伙伴关系的基础上，开发一种干预措施，改善在孟加拉国社区内预防和控制抗生素耐药性的知识和行为，在孟加拉国，抗生素不仅可以从社区诊所获得，也可以从药店获得。该项目有五个目标：开展研究，为开展社区对话的内容和程序提供信息；使社区对话方法适应环境；在五个社区诊所的集水区试行这一方法；评估试行干预措施的可行性，包括其覆盖的人数、按预期提供的程度以及是否为一系列利益攸关方所接受；与主要利益攸关方接触，如政策制定者、地区卫生官员、社区诊所工作人员和社区，以确保干预措施是适当的。应用和益处我们将确保社区对话“嵌入”在社区诊所社区支持小组的基础设施中。这意味着它们将通过现有机制交付，因此可在孟加拉国推广。这一干预措施有可能a.促进世卫组织建议的一系列紧急行动，以防止进入抗生素后时代，在这个时代，普通感染和轻伤会导致死亡；b.在孟加拉国建立卫生系统能力，以提供以社区为基础的干预措施；c.增强孟加拉国社区的凝聚力和社会资本，从而使它们能够进一步促进国家的经济和社会福利。此外，它有可能被调整以在支持类似基础设施的其他国家卫生系统中实施，并被调整以处理ARM的其他领域，包括导致对治疗由寄生虫(例如疟疾)和病毒(例如艾滋病毒)引起的感染的药物产生抗药性的行为。

ContextWe plan to develop and test the "community dialogue" approach for preventing and controlling antibiotic resistance in Bangladesh. The emergence and spread of antibiotic resistance is especially problematic in settings where antibiotics can be bought without a prescription and where they are over-prescribed by health workers and over-used by the public. The World Health Organisation recommends that the general public can help combat antibiotic resistance by preventing infections, using antibiotics only when prescribed by a health professional, completing the full prescription, never using leftover antibiotics and never sharing antibiotics.The Ministry of Health and Family Welfare has established the Revitalization of Community Health Care Initiative in Bangladesh. They have done so in order to improve access, utilisation and equity of healthcare. This initiative aims to enable community clinics in rural areas to deliver an essential service package to the approximately 6000 people in their catchments areas. So far, around 13,300 community clinics have been built across the country. Members of this research team have already collaborated with MOHFW on developing and evaluating an intervention to improve the quality of essential services provided within the community clinics in Comilla district. A key part of this package was training community health care providers to prescribe antibiotics correctly and this was very successful. Improving provider capacity to prescribe antibiotics correctly is one important component within a range of behavioural issues that impact on the ways in which antibiotics are used. We intend to build on our existing partnership and develop an intervention that improves knowledge and behaviour in relation preventing and controlling antibiotic resistance within communities in Bangladesh, where antibiotics are available not only from community clinics but also from drug stores. ObjectivesThe project has five objectives: to conduct research to inform the content of and processes for delivering community dialogues; to adapt the community dialogues approach to the setting; to pilot-test the approach in the catchment areas of five community clinics; to evaluate the feasibility of the pilot intervention in terms of the number of people it reaches, the extent to which it is delivered as intended, and whether or not is it acceptable to a range of stakeholders; and to engage with key stakeholders, such as policy makers, district health officials, community clinic staff and communities to ensure that the intervention is appropriate. Applications and benefitsWe will ensure that the community dialogues are "embedded" within the infrastructure of the community support groups of the community clinics. This means that they will be delivered through existing mechanisms and will, therefore, be replicable across Bangladesh. This intervention has the potential to a. contribute to a body of urgent action recommended by WHO to prevent a post-antibiotic era, in which common infections and minor injuries will kill; b. build health system capacity in Bangladesh to deliver community-based interventions; and c. empower communities in Bangladesh to build cohesion and social capital, thus enabling them to contribute further to the economic and social welfare of the country. Furthermore, it has the potential to be adapted for implementation in other national health systems that support similar infrastructures, and to be adapted to address other areas of ARM, including behaviours that contribute to resistance to drugs to treat infections caused by parasites (e.g. malaria) and viruses (e.g. HIV).