Engaging communities to address antimicrobial resistance: Identifying contextualised and sustainable community-led solutions in low resource settings

该研究将为解决抗生素耐药性（AMR）问题做出重要贡献。抗生素耐药性是对全球健康、粮食可持续性和安全以及社会经济发展的重大挑战。如果我们不解决抗菌素耐药性问题，未来我们预防和治疗常见传染病的能力将会下降，在没有有效抗生素的情况下，大手术、癌症化疗和器官移植将变得更加危险。国际上食品生产中使用的抗菌素的数量至少与人类使用的数量相同，在某些地方甚至更高。一些用于人类的最后手段抗生素正在动物身上广泛使用，目前还没有替代品。全球都在努力解决抗生素耐药性问题。全球指南强调的一个领域是提高公众对这一问题的认识的重要性。然而，重要的是不仅要提高认识，还要积极与个人和社区接触，使他们能够确定、制定和实施社区主导的可持续解决方案。据我们所知，世界上任何地方都没有对社区参与解决抗菌素耐药性的方法进行过评估。为了解决这一差距，我们建立了一个世界领先的研究小组，该小组在孟加拉国、尼泊尔和英国的六个研究组织和项目伙伴之间建立了伙伴关系。这个小组的成员已经开发了两种利用社区参与来解决抗菌素耐药性的方法。社区对话方法（CDA）以前曾在若干国家用于解决其他卫生问题，我们将其用于解决孟加拉国人类滥用抗生素的问题。参与式影片（PV）是一种方法，支持社区成员就他们关心的问题制作短片，这些短片用于向政策制定者展示人们如何与问题互动。我们采用这种方法来探索尼泊尔滥用抗生素的情况。在本研究中，我们计划将这两种方法结合起来：PV将帮助我们确定通过CDA解决的关键主题，它将有助于提高社区参与国家和国际政策议程的形象。在这项研究的开始，我们将使用光伏（和其他方法）来帮助我们开发在孟加拉国和尼泊尔提供CDA所需的材料。我们将确保这些材料解决影响农村社区抗菌素耐药性的不同问题，包括人类使用抗菌素的方式、动物使用抗菌素的方式以及它们进入土壤和水的方式。我们将在孟加拉国的Comilla地区实施CDA，看看它是否改变了人们对抗菌素耐药性的知识、态度和报告的行为。我们还想弄清楚在全国范围内实施这项计划需要多少费用，并看看它是否公平，也就是说，它是否能惠及不同的人口群体，并被这些群体所使用，比如男性和女性，以及社会上最贫穷的人。我们还将把我们的方法引入尼泊尔的山区，这样我们就可以了解在不同类型的环境中实施这种方法的难易程度。最后，我们将利用PV方法的成果，特别是社区成员制作的影片，帮助我们提高对尼泊尔、孟加拉、英国等地社区参与重要性的认识。这项研究将通过与个人和社区合作，使他们能够识别、开发和实施解决方案，对我们如何解决抗生素耐药性的理解做出重大贡献。它还将帮助我们了解如何在不同的环境中大规模地实施我们的社区参与方法。最终，我们的目标是确保这项研究影响国际上的政策制定者，将社区参与方法作为解决抗生素耐药性的关键策略之一。

This study will make a significant contribution to addressing antimicrobial resistance (AMR). AMR is a major challenge to global health, food sustainability and security, and socio-economic development. If we do not address AMR, in the future we will be less able to prevent and treat common infectious diseases, and major surgery, cancer chemotherapy and organ transplants will become much more dangerous in the absence of effective antibiotics. The quantity of antimicrobials used in food production internationally is at least the same as that in humans, and in some places is higher. Some last-resort antibiotics for humans are being used extensively in animals, and there are currently no replacements. There is a huge global effort to address AMR. One area that is emphasised in global guidance is the importance of raising public awareness on the issue. However, it is important to go beyond raising awareness and actively engage with individuals and communities, by enabling them to identify, develop and implement community-led sustainable solutions. To the best of our knowledge, community engagement approaches to address AMR have not been evaluated anywhere in the world. In order to address this gap, we have established a world-leading research group, which builds partnerships between six research organisations and project partners in Bangladesh, Nepal and the United Kingdom.Members of this team have already developed two approaches to using community engagement to address AMR. The Community Dialogue Approach (CDA) has previously been used in several countries to address other health issues and we adapted it to address the misuse of antibiotics by humans in Bangladesh. Participatory Video (PV) is an approach whereby community members are supported to make short films about issues that concern them and these films are used to demonstrate to policy makers how people interact with the issue. We adapted this approach to explore the misuse of antibiotics in Nepal. In this study, we plan to combine these two approaches: The PV will help us to identify critical themes to address through the CDA, and it will help to raise the profile of community engagement on national and international policy agendas. At the start of this study, we will use PV (and other methods) to help us develop materials that are needed to deliver the CDA in Bangladesh and in Nepal. We will ensure that these materials address different issues that impact on AMR in rural communities - these include the ways that humans use antimicrobials, the way they are used for animals, and the way they enter into soil and water. We will implement the CDA across the district of Comilla in Bangladesh to see whether it changes people's knowledge, attitudes and reported behaviour in relation to AMR. We also want to find out how much it would cost to implement it on a national scale and to see whether it is equitable i.e. that it reaches and is used by different population groups, such as males and females, and the poorest in society. We will also introduce our approach into a hill region in Nepal so that we can find out how easy or difficult it is to deliver it in different types of settings. Finally, we will use the outputs from the PV methods - especially films that have been made by community members - to help us to increase awareness of the importance of community engagement in Nepal, Bangladesh, the UK and beyond.This study will make a major contribution to our understanding of how to address AMR by working with individuals and communities to enable them to identify, develop and implement solutions. It will also help us to understand how our approach to community engagement can be implemented on a large scale and in different settings. Ultimately, we aim to ensure that this study influences policy makers internationally to include community engagement approaches as one of the key strategies for addressing AMR.