Tackling antimicrobial resistance across dentistry in Sub-Saharan Africa.

挑战是什么？解决抗菌素耐药性（AMR）问题对全球健康和可持续发展至关重要。加纳和乌干达等中低收入国家受到的影响尤其严重。英国政府承诺在改善健康方面发挥主导作用，以实现一个更安全、更繁荣的世界，包括通过改善对AMR的应对措施。在全球范围内，牙科专业人员负责人类医疗保健中十分之一的抗生素处方。在撒哈拉以南非洲（SSA），牙科团队是抗生素的最高处方者之一，一些研究发现十分之九的处方超出了指导范围。SSA的牙科团队在保持抗生素的作用方面发挥着至关重要的作用。我们研究的目的和目标是什么？我们的目标是开发和测试牙科团队在解决SSA AMR中发挥作用的方法。我们的第一个目标是了解是什么影响了加纳和乌干达不必要的牙科抗生素使用。我们的第二个目标是与牙科团队和患者以及政策制定者，医疗服务管理人员和公众合作，制定一种基于证据的方法，以减少牙科专业人员的抗生素处方。我们的最终目标是为非洲主导的临床试验做准备，以测试我们提出的方法是否有效。首先，为了了解牙科专业人员不必要的抗生素处方的原因，我们将询问一系列人，并观察加纳和乌干达医院和社区医疗机构的牙科就诊情况。观察的牙科团队和患者将被邀请接受采访，分享他们的经验和见解，了解是什么影响了访问期间的决策。为了更广泛地了解管理牙齿感染的观点，政策制定者，医疗服务管理人员和公众将被邀请参加访谈和/或焦点小组。接下来，我们将与利益相关者合作，利用第一阶段收集的信息，制定以证据为基础的方法，以减少不必要的抗生素处方。虽然我们还不确定这些干预措施将是什么，但我们认为它们可能与牙科诊所的卫生和消毒程序，处方指南和牙科团队的教育有关。最后，我们将在加纳和乌干达的城市和更多的农村地区进行八个深入的案例研究，以检查干预是否为牙科团队和患者所接受，并通过测试一些使试验可行所需的细节来为临床试验做准备。该研究结果将成为资助申请的基础，以进行一项临床试验，评估干预措施对安全减少SSA牙科专业人员抗生素处方的影响，同时仍然解决患者的牙齿问题。这项研究的好处包括扩大科学知识的因素影响抗生素处方的牙科专业人员在中低收入国家。开发干预措施以减少抗生素处方只是第一步;还需要进一步的测试。最终，通过减少牙科抗生素处方，这项研究将通过解决AMR问题对全球健康和可持续发展产生积极影响。公开为了确保研究及其结果的可见性，我们的研究团队成员和合作者将通过各种渠道与我们的利益相关者和观众互动，包括他们的专家专业网络，社交及其他媒体，学术出版物/会议，以及更多新颖的方式，利用当地传统艺术、故事、插图和视觉辅助。来自英国，加纳和乌干达的非专业成员将帮助为公众创建一个简单的英语摘要（并翻译为当地语言），并将确保信息促进更广泛的理解和认识牙科团队的重要作用，以保持抗生素的工作。

What's the challenge? Tackling antimicrobial resistance (AMR) is crucial for global health and sustainable development. Low- and middle-income countries (LMICs), like Ghana and Uganda, are particularly affected. UK Government has pledged to play a leading role in improving health to deliver a safer and more prosperous world, including through an improved response to AMR. Globally, dental professionals are responsible for one-in-ten antibiotic prescriptions across human healthcare. In Sub-Saharan Africa (SSA), dental teams are among the highest prescribers of antibiotics, with some studies finding nine out of ten prescriptions outside of guidance. Dental teams in SSA have an essential role to play in keeping antibiotics working.What are the aims and objectives of our research? We aim to develop and test ways for dental teams to play their part in tackling AMR in SSA. Our first objective is to understand what influences unnecessary dental antibiotic use in Ghana and Uganda. Our second objective is to work with dental teams and patients as well as policy makers, healthcare service managers and the general public to develop an evidence-based way to reduce antibiotic prescribing by dental professionals. Our final objective is to prepare for an African-led clinical trial to test whether our proposed approach works.How are we approaching it? First, to understand what drives unnecessary antibiotic prescribing by dental professionals, we will ask a range of people and observe dental visits in hospitals and community healthcare settings in Ghana and Uganda. The observed dental teams and patients will be invited to interview to share their experience and insights about what influenced decision making during the visit. To gain wider perspectives on managing dental infections, policy makers, healthcare service managers and members of the public will be invited to take part in interviews and/or focus groups. Next, we will work with our stakeholders to develop evidence-based ways to reduce unnecessary antibiotic prescribing using information gathered in the first stage. Whilst we are not yet sure what these interventions will be, we think they might relate to hygiene and sterilisation procedures in dental clinics, prescribing guidelines, and education for dental teams. Finally, we will undertake eight in-depth case studies in urban and more rural areas of Ghana and Uganda to check whether the intervention is acceptable to dental teams and patients, and to prepare for a clinical trial by testing some of the details needed to make a trial practical.What will be the applications and benefits?The study results will form the basis of a grant application to conduct a clinical trial that evaluates the impact of the interventions on safely reducing antibiotic prescribing by dental professionals across SSA whilst still addressing patients' dental issues. The benefits of this research include expanding scientific knowledge about the factors influencing antibiotic prescribing by dental professionals in LMICs. Developing interventions to reduce antibiotic prescribing is just the first step; further testing will be needed. Ultimately, by reducing antibiotic prescribing in dentistry, this research will have a positive impact on global health and sustainable development by addressing AMR.PublicityTo ensure visibility of the study and its findings, our research team members and collaborators will engage our stakeholders and audience through various channels, including their expert professional networks, social and other media, academic publications/conferences, and more novel ways using local traditional arts, story, illustrations and visual aids. Lay members from the UK, Ghana and Uganda will help create a plain English summary (and translation to local languages) for the public, and will ensure messaging promotes broader understanding and awareness of the important role of dental teams to keep antibiotics working.