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Supporting the National Action Plan for Antimicrobial Resistance (SNAP-AMR) in Tanzania

支持坦桑尼亚抗微生物药物耐药性国家行动计划 (SNAP-AMR)

基本信息

批准号：
MR/S004815/1
负责人：
Shona Hilton
金额：
$ 406.52万
依托单位：
University of Glasgow
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2018
资助国家：
英国
起止时间：
2018 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FS004815%2F1
关键词：
Supporting National Action Plan Antimicrobial

项目摘要

Antimicrobial resistance (AMR), the ability of bacteria to resist the effect of drugs, is a threat to human and animal health in resource rich nations like the UK and low and middle income countries like the United Republic of Tanzania. In Tanzania, as in many low and middle income countries, the AMR problem is compounded by the fact that people and livestock often live close together and widespread use of antimicrobials in both. In response to a global call to action from the World Health Organisation, Tanzania has created an ambitious National Action Plan to combat AMR, including improving awareness and understanding of the AMR problem among policy makers, professionals and the public and enhancing surveillance, research, infection prevention and antimicrobial stewardship in people and livestock. Successful implementation of the NAP is challenged by lack of human and financial resources, making prioritisation of activities and interventions an essential component of an effective and efficient campaign to control AMR.Our research will provide new evidence to support this prioritisation and targeting, taking an approach that recognises that individuals are part of a larger system and that behaviour of professionals and the public may depend on policy, regulations or knowledge, but also on cultural background, social norms and access to medical, veterinary or diagnostic infrastructure and drugs. Our team of UK and Tanzania-based researchers and policy experts will take an interdisciplinary approach, working with a wide range of biological and social scientists as well as health professionals and community members, to provide novel insights into cultural, socio-economic and biological drivers of antimicrobial use (AMU) in hospitals and the community and in contextually appropriate methods of communication around those issues.The origin of AMR problems can be described as hospital-, community- or livestock-associated so we will work with doctors and nurses, householders and patients, and veterinarians and livestock keepers as well as (in)formal drug providers and other stakeholders to investigate knowledges, beliefs, attitudes and practices around health and AMU/AMR. We will compare health care settings (health centres, district, regional and referral hospitals) and livestock keeping communities (Chagga, Masaai and Sukuma) to reflect a range of professional and cultural contexts. Using focus group discussions, questionnaires and interviews, we will examine factors that influence prescribing and use of antimicrobials and through choice experiments we will examine how changes in e.g. knowledges, social norms or access might change such behaviour. To complement the socio-economic investigations, we will use DNA-sequencing of hospital -, community - or livestock-associate bacteria in combination with mathematical modelling approaches to establish the relative contribution of different sources and transmission routes to the clinical and economic burden of AMR. The combination of insight into the drivers and relative importance of behaviours that may contribute to the AMR problem provides a unique opportunity to identify and prioritise levers of behavioural change to reduce AMU and limit the risk and impact of AMR.Finally but importantly, we will work with policy makers, professionals and the public to design context-specific messages and methods to communicate AMR awareness and infection prevention and control messages in hospitals and community settings, and evaluate the impact of those communication campaigns using a combination of the social and biological sciences methods described above. The combined outcomes of our research will help priority setting in AMR control by identifying the settings where change is practicable and cost-effective. It will inform implementation of the National Action Plan in Tanzania and serve as a generalisable transdisciplinary model of AMR control in low and middle income country settings.

抗菌素耐药性（AMR），即细菌抵抗药物作用的能力，对英国等资源丰富的国家和坦桑尼亚联合共和国等中低收入国家的人类和动物健康构成威胁。在坦桑尼亚，与许多低收入和中等收入国家一样，由于人和牲畜通常生活在一起，并且在两者中广泛使用抗菌剂，AMR问题变得更加复杂。为了响应世界卫生组织的全球行动呼吁，坦桑尼亚制定了一项雄心勃勃的国家行动计划，以应对AMR，包括提高决策者，专业人员和公众对AMR问题的认识和理解，并加强对人和牲畜的监测，研究，感染预防和抗菌剂管理。由于缺乏人力和财力资源，国家行动计划的成功实施面临挑战，这使得活动和干预措施的优先次序成为有效和高效控制AMR运动的重要组成部分。我们的研究将提供新的证据来支持这种优先次序和目标，采取一种认识到个人是更大系统的一部分，专业人员和公众的行为可能取决于政策的方法，这不仅取决于法规或知识，而且取决于文化背景、社会规范以及获得医疗、兽医或诊断基础设施和药物的机会。我们的英国和坦桑尼亚的研究人员和政策专家团队将采取跨学科的方法，与广泛的生物和社会科学家以及卫生专业人员和社区成员合作，为文化，抗菌药物使用的社会经济和生物驱动因素（AMU）在医院和社区，以及围绕这些问题的适当沟通方法。AMR问题的起源可以描述为医院，因此，我们将与医生和护士、住户和患者、兽医和牲畜饲养员以及（非）正式药物提供者和其他利益相关者合作，调查有关健康和AMU/AMR的知识、信念、态度和做法。我们将比较卫生保健机构（卫生中心，区，区域和转诊医院）和牲畜饲养社区（Chagga，Masaai和Sukuma），以反映一系列的专业和文化背景。使用焦点小组讨论，问卷调查和访谈，我们将研究影响处方和使用抗菌药物的因素，并通过选择实验，我们将研究知识，社会规范或访问的变化如何改变这种行为。为了补充社会经济调查，我们将使用医院，社区或牲畜相关细菌的DNA测序结合数学建模方法，以确定不同来源和传播途径对AMR临床和经济负担的相对贡献。结合对可能导致AMR问题的驱动因素和行为相对重要性的洞察，提供了一个独特的机会来识别和优先考虑行为改变的杠杆，以减少AMU并限制AMR的风险和影响。最后但重要的是，我们将与政策制定者合作，专业人士和公众的设计背景-在医院和社区环境中传达AMR意识和感染预防和控制信息的具体信息和方法，并使用上述社会科学和生物科学相结合的方法，评估这些宣传活动的影响。我们研究的综合结果将有助于确定AMR控制的优先事项，确定改变的可行性和成本效益。它将为坦桑尼亚国家行动计划的实施提供信息，并作为低收入和中等收入国家AMR控制的可推广的跨学科模型。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Existence of Multiple ESBL Genes among Phenotypically Confirmed ESBL Producing Klebsiella pneumoniae and Escherichia coli Concurrently Isolated from Clinical, Colonization and Contamination Samples from Neonatal Units at Bugando Medical Center, Mwanza, Tanzania.

DOI：
10.3390/antibiotics10050476
发表时间：
2021-04-21
期刊：
Antibiotics (Basel, Switzerland)
影响因子：
0
作者：
Silago V;Kovacs D;Samson H;Seni J;Matthews L;Oravcová K;Lupindu AM;Hoza AS;Mshana SE
通讯作者：
Mshana SE

Developing practical clinical tools for predicting neonatal mortality at a neonatal intensive care unit in Tanzania.