Community dialogues for preventing and controlling antibiotic resistance in Bangladesh

我们计划在孟加拉国制定和试验预防和控制抗生素耐药性的“社区对话”方法。抗生素耐药性的出现和传播在无需处方即可购买抗生素以及卫生工作者过度开处方和公众过度使用抗生素的环境中尤其成问题。世界卫生组织（World Health Organisation）建议，公众可以通过以下方式帮助对抗抗生素耐药性：预防感染、仅在卫生专业人员的处方下使用抗生素、完成完整的处方、永远不要使用剩余的抗生素、永远不要共用抗生素。卫生和家庭福利部在孟加拉国制定了《振兴社区保健倡议》。它们这样做是为了改善保健服务的获取、利用和公平性。这一举措旨在使农村地区的社区诊所能够向其集水区的大约6000人提供一揽子基本服务。到目前为止，全国已经建立了大约13300个社区诊所。该研究小组的成员已经与卫生部合作，制定和评估了一项干预措施，以改善科米拉地区社区诊所提供的基本服务的质量。一揽子计划的一个关键部分是培训社区卫生保健提供者正确开抗生素处方，这是非常成功的。提高提供者正确开具抗生素处方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，制定一项干预措施，改善孟加拉国社区预防和控制抗生素耐药性方面的知识和行为，那里不仅可以从社区诊所获得抗生素，还可以从药店获得抗生素。该项目有五个目标：开展研究，为开展社区对话的内容和过程提供信息；使社区对话方法适应环境；在五个社区诊所的集水区进行试验；评估试验干预措施的可行性，包括涉及的人数、按预期交付的程度，以及一系列持份者是否可接受；并与决策者、地区卫生官员、社区诊所工作人员和社区等关键利益攸关方接触，以确保干预措施是适当的。应用和效益我们将确保社区对话“嵌入”在社区诊所的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提供，因此可以在孟加拉国各地复制。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，以防止出现常见感染和轻微伤害致死的后抗生素时代；b.建设孟加拉国卫生系统能力，以提供基于社区的干预措施；c.使孟加拉国社区能够建立凝聚力和社会资本，从而使他们能够进一步为国家的经济和社会福利作出贡献。此外，有可能对其进行调整，以便在支持类似基础设施的其他国家卫生系统中实施，并进行调整，以处理ARM的其他领域，包括有助于对治疗寄生虫（例如疟疾）和病毒（例如艾滋病毒）引起的感染的药物产生耐药性的行为。

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).