Containing antimicrobial resistance in rural Cambodia: a one-health multi-disciplinary intervention to improve village healthcare and farming practice

抗生素耐药性被世界卫生组织称为本世纪最大的威胁。如果不立即采取适当措施减轻抗生素耐药性，估计在不久的将来，将有数百万人死于因无法治疗耐药感染而产生的并发症，其中大部分负担将落在世界上贫穷、不发达地区的身上。抗生素耐药性的主要驱动因素是抗生素的使用和环境中的抗生素残留。两者都会产生抗药性细菌。由于认识不足、基础设施、经济、政治意愿、社会文化层面以及众多其他因素，较贫穷国家忽视了对两者的适当监测和缓解。抵抗没有地理或政治边界；它迅速蔓延到世界各地。因此，不仅来自不发达国家的贫困人口受到影响，这些国家也成为耐药性产生和传播的“热点”。柬埔寨是大湄公河次区域最贫穷的国家，并继续从旷日持久的内战中恢复过来，内战摧毁了柬埔寨的机构和基础设施，导致大部分受过教育的人员流失。在国际伙伴的支持下，柬埔寨正在迅速发展；柬埔寨是在降低婴儿和儿童死亡率方面实现千年发展目标的国家之一。拟议的抗生素耐药性研究和干预省份是正规卫生和农业系统中最偏远、服务最少的省份之一，提供护理的人员只接受过最低限度的病人和动物护理培训。当一个人或动物生病时，包括抗生素在内的药品通常是从当地药店或市场摊位购买的，并由这些人自己给药。人类经常给动物注射抗生素，反之亦然。由于缺乏训练有素的卫生人员，柬埔寨发展了一支村级卫生工作者干部队伍，他们只接受过最少的培训，几乎没有监督来治疗村民或他们生病的动物。在处理抗生素时很少注意，这肯定会导致柬埔寨环境中大量的残留物。拟议的项目将调查和绘制目标地区抗生素使用、抗生素耐药性和抗生素残留的当前状况，并将审查这些偏远地区这些问题的驱动因素，涉及包括人类和动物保健提供者和政策制定者在内的各种利益攸关方。我们将让皇家农业和兽医大学新成立的实验室和人员以及我们的合作伙伴、卫生部和渔业和农业部参与进来。我们还将寻求评估社区对话干预在提高对抗生素的使用、处理和处置的知识和了解方面的有效性，以实现适当的抗生素耐药性管理。

Antibiotic resistance has been termed the greatest menace of the current century by the World Health Organization. If appropriate measures to mitigate antibiotic resistance are not taken immediately, it is estimated that millions of people will die, in the near future due to complications arising out of inability to treat resistant infections and most of this burden will fall on the poor, underdeveloped part of the world. The main drivers of antibiotic resistance are antibiotic use and antibiotic residues in the environment. Both generate resistant bacteria. Appropriate monitoring and mitigation of both is neglected in poorer countries due to inadequacy of awareness, infrastructure, economics, political will, socio-cultural dimensions and a myriad of other factors. Resistance knows no geographical or political boundaries; it spreads quickly all over the world. So, not only the poorer human beings from underdeveloped countries suffer, these countries also become 'hot spots' of resistance generation and spread. Cambodia is the poorest country in the Greater Mekong Sub-Region and continues to recover from a prolonged civil war which saw its institutions and infrastructure destroyed, which resulted in the loss of most of its educated personnel. With support of international partners, Cambodia is rapidly developing; Cambodia was one of the countries, which achieved the millennium development goals in reducing infant and child mortality. The proposed provinces for the antibiotic resistance study and intervention are among the most remote and underserved both within the formal health and agricultural systems and rely for care on personnel who have minimal training for both care of patients and animals. When a person or animal becomes ill, medicines including antibiotics, often of dubious quality are bought from local pharmacies or market stalls and administered by the persons themselves. Human antibiotics are often given to animals and vice versa. Due to the deficit of trained health personnel, Cambodia has developed a cadre of village level healthcare workers, who have minimal training and little supervision to treat villagers or their sick animals. Little care is taken in disposing of antibiotics, which must be resulting in huge amount of residues in Cambodian environment. The proposed project will investigate and map the current status of antibiotic use, antibiotic resistance and antibiotic residues in the target area and would examine the drivers for these in these remote areas, involving various stakeholders including human and animal healthcare providers and policy makers. We would involve the newly instituted laboratory and personnel in the Royal University of Agriculture and Veterinary Medicine as well as our partners, the Ministry of Health and the Ministry of Fisheries and Agriculture. We would also seek to evaluate the efficacy of a community dialogue intervention in improving the knowledge and understanding of use, handling and disposal of antibiotics to achieve appropriate antibiotic resistance management.