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Private sector retail pharmacies, or drug shops, play an important role in access to essential medicines and services in low-and-middle-income countries. Recognising that they have the potential to contribute to health system strengthening efforts, many recent initiatives to engage with drug shops have been launched. These include initiatives that focus on changes in policy, regulation and training. JAK inhibitors in development However, the specific factors that influence their success remain poorly understood. Seven country case studies supported under the Alliance's programme of work 'Strengthening health systems the role of drug shops' help to explore this issue.
Country case studies from the above programme of research from Bangladesh, Indonesia, Myanmar, Nigeria, Tanzania and Zambia were used as the main sources of data for this paper. A modified version of Bigdeli et al.'s Access to Medicines framework was applied within a partially grounded approach to analyze each country case study and compare themes between countries.
Manork approach, these country case studies demonstrate common factors that influence how drug shops can strengthen health systems. These learnings can help inform the design and implementation of successful strategies to engage drug shops towards sustainable systems change.
The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence.
We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group drban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.
Awareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.
Parkinson's disease (PD) is a prevalent neurodegenerative disorder, displaying not only well-known motor deficits but also gastrointestinal dysfunctions. Consistently, it has been increasingly evident that gut microbiota affects the communication between the gut and the brain in PD pathogenesis, known as the microbiota-gut-brain axis. As an approach to re-establishing a normal microbiota community, fecal microbiota transplantation (FMT) has exerted beneficial effects on PD in recent studies. Here, in this study, we established a chronic rotenone-induced PD mouse model to evaluate the protective effects of FMT treatment on PD and to explore the underlying mechanisms, which also proves the involvement of gut microbiota dysbiosis in PD pathogenesis via the microbiota-gut-brain axis.
We demonstrated that gut microbiota dysbiosis induced by rotenone administration caused gastrointestinal function impairment and poor behavioral performances in the PD mice. Moreover, 16S RNA sequencing identified the increase ofnduced PD mouse model, in which suppression of the inflammation mediated by the LPS-TLR4 signaling pathway both in the gut and the brain possibly plays a significant role. Further, we prove that rotenone-induced microbiota dysbiosis is involved in the genesis of PD via the microbiota-gut-brain axis. Video abstract.
Our current study demonstrates that FMT treatment can correct the gut microbiota dysbiosis and ameliorate the rotenone-induced PD mouse model, in which suppression of the inflammation mediated by the LPS-TLR4 signaling pathway both in the gut and the brain possibly plays a significant role. Further, we prove that rotenone-induced microbiota dysbiosis is involved in the genesis of PD via the microbiota-gut-brain axis. Video abstract.
Patent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage.
A cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18-20years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered bs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8.
PPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.
PPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.
The COVID-19 pandemic has deeply impacted healthcare and education systems, including resident education. The impact of the pandemic on the different types of pedagogical activities, and the displacement of pedagogical activities to online modalities have not yet been quantified. We sought to evaluate the impact of the COVID-19 pandemic on formal pedagogic components of otorhinolaryngology-head and neck surgery (ORL-HNS) residency, the switch to distance learning and program director's perceptions of the future of teaching and learning.
A nationwide online survey was conducted on Canadian ORL-HNS program directors. The use of standard didactic activities in-person and online, before and during the pandemic was rated with Likert scales. Perceptions of the pandemic were described with open-ended questions.
A total of 11 of the 13 program directors contacted responded. The analysis were conducted using nonparametric statistics. There was a significant drop in overall didactic activities during the pandemicpport distance teaching and learning.
Metabolic syndrome (MetS) starts from early life and is one of the important underlying factors for non-communicable diseases (NCDs) in adulthood. Controversial evidence exists on the role of vitamin D deficiency in increasing the risk of pediatric MetS.
This study aimed to assess the relationship between vitamin D level with MetS and its components in children and adolescents.
This nationwide cross-sectional study was performed as part of a surveillance program in Iran. Participants were 2596 students, aged 7 to 18 years, living in 30 provinces. In addition to filling questionnaires, a physical examination was conducted, and blood samples were collected. The serum concentration of 25-hydroxy vitamin D (25(OH)D) was measured using the direct competitive immunoassay chemiluminescence method.
2596 students with a mean age of 12.2 y (55.1% boys) were recruited. Prevalence of vitamin D deficiency and insufficiency in participants was 10.6% (n = 276), and 60.5% (n = 1570), respectively. The prevalence of MetS was higher in the vitamin D deficient group. Students with deficient vitamin D levels had higher odds of MetS (OR 4.25, 95%CI 2.26-7.98), abdominal obesity (OR 2.24, 95%CI 1.61-3.12), low HDL-C (OR 1.65, 95%CI 1.18-2.30) and high fasting blood sugar (OR 2.56, 95%CI 1.43-4.57) in comparison to those with sufficient level of vitamin D.
Vitamin D deficiency was associated with increased odds of MetS and its components in the Iranian pediatric population. These findings underscore the importance of prevention and control of vitamin D deficiency in preventative programs against NCDs.
Vitamin D deficiency was associated with increased odds of MetS and its components in the Iranian pediatric population. These findings underscore the importance of prevention and control of vitamin D deficiency in preventative programs against NCDs.
Clinical metagenomics (CMg) has the potential to be translated from a research tool into routine service to improve antimicrobial treatment and infection control decisions. The SARS-CoV-2 pandemic provides added impetus to realise these benefits, given the increased risk of secondary infection and nosocomial transmission of multi-drug-resistant (MDR) pathogens linked with the expansion of critical care capacity.
CMg using nanopore sequencing was evaluated in a proof-of-concept study on 43 respiratory samples from 34 intubated patients across seven intensive care units (ICUs) over a 9-week period during the first COVID-19 pandemic wave.
An 8-h CMg workflow was 92% sensitive (95% CI, 75-99%) and 82% specific (95% CI, 57-96%) for bacterial identification based on culture-positive and culture-negative samples, respectively. CMg sequencing reported the presence or absence of β-lactam-resistant genes carried by Enterobacterales that would modify the initial guideline-recommended antibiotics in every case. CMgion of this technology in a service setting could fundamentally change the multi-disciplinary team approach to managing ICU infections. The potential to improve the initial targeted treatment and rapidly detect unsuspected outbreaks of MDR-pathogens justifies further expedited clinical assessment of CMg.
Indonesia is the second country with the highest number of malaria cases in Southeast Asia. Private health providers including community pharmacies often become the first point of care for the population seeking malaria treatment; however, public-private partnerships for malaria control are not widely implemented. This paper explores the acceptability of a public-private partnership program on the provision of subsidized artemisinin-based combination therapies (ACTs) in community pharmacies from the perspectives of private health providers, patients, and program implementers.
The study was conducted in Manokwari District in West Papua Province, one of the highest endemic districts in Indonesia. Qualitative methods using interviews and focus group discussions (FGDs) were employed to explore the following dimensions of acceptability affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness, and self-efficacy. Study participants were program implementers, private health providers, and pharmacy clients.
