Perceived neighbourhood food access is associated with consumption of animal-flesh food, fruits and vegetables among mothers and young children in peri-urban Cambodia.

OBJECTIVE: To examine whether mothers' perceived neighbourhood food access is associated with their own and their young children's consumption of animal-flesh food, fruits and vegetables in peri-urban areas of Cambodia. DESIGN: A cross-sectional survey measured food consumption frequency and perceived neighbourhood food access, the latter including six dimensions of food availability, affordability, convenience, quality, safety and desirability. Multivariate logistic regression was used to assess the association between perceived food access and food consumption. SETTING: Peri-urban districts of Phnom Penh and Siem Reap, Cambodia. PARTICIPANTS: 198 mothers of children between 6 and 24 months old. RESULTS: Over 25 % of the mothers and 40 % of the children had low consumption (< once a day) of either animal-flesh food or fruits and vegetables. Compared with perceived high food access, perceived low food access was associated with an adjusted 5·6-fold and 4·3-fold greater odds of low animal-flesh food consumption among mothers (95 % CI 2·54, 12·46) and children (95 % CI 2·20, 8·60), respectively. Similarly, relative to perceived high food access, perceived low food access was associated with 7·6-times and 5·1-times higher adjusted odds of low fruits and vegetables consumption among mothers (95 % CI 3·22, 18·02) and children (95 % CI 2·69, 9·83), respectively. CONCLUSIONS: Mothers' perceived neighbourhood food access was an important predictor of their own and their young children's nutrient-rich food consumption in peri-urban Cambodia. Future work is needed to confirm our findings in other urban settings and examine the role of neighbourhood food environment in the consumption of both nutrient-rich and nutrient-poor food.

Impact of national interventions to promote responsible antibiotic use: a systematic review.

BACKGROUND: Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. METHODS: We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. RESULTS: We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. CONCLUSIONS: National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

Vitamin B-12 Deficiency in Children Is Associated with Grade Repetition and School Absenteeism, Independent of Folate, Iron, Zinc, or Vitamin A Status Biomarkers.

BACKGROUND: Micronutrients are essential to neurocognitive development; yet their role in educational outcomes is unclear. OBJECTIVE: We examined the associations of micronutrient status biomarkers with the risk of grade repetition and rates of school absenteeism in a cohort of school children. METHODS: We recruited 3156 children aged 5-12 y from public schools in Bogota, Colombia. Circulating ferritin, hemoglobin, zinc, vitamin A, and vitamin B-12; erythrocyte folate; and mean corpuscular volume (MCV) were measured in blood samples obtained at the beginning of the year. Absenteeism was recorded weekly during the school year, and grade repetition was determined the next year. Risk ratios for grade repetition and rate ratios for absenteeism were estimated by categories of micronutrient status indicators with use of Poisson regression, adjusting for potential confounders. RESULTS: The risk of grade repetition was 4.9%, and the absenteeism rate was 3.8 d per child-year of observation. Vitamin B-12 deficiency (<148 pmol/L) was associated with an adjusted 2.36-fold greater risk of grade repetition (95% CI: 1.03, 5.41; P = 0.04) compared with plasma concentrations ≥148 pmol/L. Other micronutrients were not related to grade repetition. Vitamin B-12 deficiency was also associated with school absenteeism rates. Compared with children with plasma vitamin B-12 concentrations ≥148 pmol/L, vitamin B-12-deficient children had a 1.89-times higher adjusted rate (95% CI: 1.53, 2.34; P < 0.0001). Anemia was related to a 72% higher rate (95% CI: 48%, 99%; P < 0.0001), whereas every 5-fL difference in MCV was associated with a 7% lower adjusted rate (95% CI: 4%, 10%; P < 0.0001). CONCLUSIONS: Vitamin B-12 deficiency was associated with risk of grade repetition and school absenteeism rates in school children from Bogota, Colombia. The effects of correcting vitamin B-12 deficiency on educational outcomes and neurocognitive development of school children need to be determined in intervention studies.

An online Symptom Care and Management System to monitor and support patients receiving chemotherapy: a pilot study.

This pilot study aimed to explore the benefits of an online Symptom Care and Management System (SCMS) in the home monitoring and symptom management of patients receiving chemotherapy. A single-group experimental design was employed, and four patients aged 39-59 years undergoing their first chemotherapy treatment were recruited from one cancer centre in Singapore from November 2010 to February 2011. A mixed method was used to collect patient's data. All patients used the SCMS to record and send daily symptom reports to the cancer centre and receive symptom management advice from the nurse via teleconferencing. Patients' perceptions on the use of the system were evaluated. All participants believed that the system improved the management of their symptom and felt reassured they were being monitored at home. The results presented in this pilot study suggest that the SCMS has the potential to enhance the remote monitoring, feasible and acceptable way for a specific group of cancer patients to manage their symptom at home.

Public knowledge, attitudes and practices related to antibiotic use and resistance in Singapore: a cross-sectional population survey.

OBJECTIVES: The WHO's Global Action Plan on Antimicrobial Resistance (AMR) includes increasing overall public awareness of appropriate antibiotic use and resistance as a key priority area. We aimed to measure public knowledge, attitudes and practices of antibiotics and antibiotic resistance in Singapore, as well as their healthcare-seeking behaviours relating to respiratory illnesses, providing baseline data against which to measure the progress of future interventions. DESIGN: A cross-sectional study. SETTING: The general population in Singapore. PARTICIPANTS: Between May and June 2019, we conducted a survey via an online panel in Singapore with 706 respondents. RESULTS: Our findings indicated common misconceptions surrounding antibiotic effectiveness and mechanisms of antibiotic resistance-most participants thought that resistance occurs when our bodies become resistant to antibiotics (62.5%) or when antibiotics become less powerful (48.5%). In multivariable analyses, better knowledge scores were associated with more favourable antibiotic attitudes (ß=0.29; 95% CI 0.20 to 0.37). In addition, more favourable attitude scores were associated with lower odds of both expecting (OR: 0.84, 95% CI 0.72 to 0.99) and being prescribed antibiotics by a primary care doctor (OR: 0.76, 95% CI 0.63 to 0.90). CONCLUSIONS: This study presents important information about population perceptions towards antibiotics and antibiotic resistance in Singapore. Results from this study emphasise the importance of effective public communication strategies to promote responsible antibiotic use locally and should be used to inform future implementation of programmes and activities as laid out in Singapore's National Strategic Action Plan on AMR.

Determinants influencing antibiotic use in Singapore's small-scale aquaculture sectors: A qualitative study.

Singapore's Antimicrobial Resistance (AMR) national strategic action plan includes inappropriate use of antimicrobials in food-producing animals as a specific priority. Although the use of antibiotics and other drugs are monitored by regulatory bodies, food fish farmers are allowed to buy and administer antimicrobials without a veterinary prescription. We conducted a qualitative study of Singaporean food fish farmers to understand patterns and determinants of antibiotic use, their knowledge of antibiotic resistance, as well as perceptions of on-farm infection prevention and control measures. During the interview, participants were asked about their farming processes, farm infrastructure, antibiotic use and any disease prevention measures. Thematic analysis of participants' interviews showed that antibiotic for growth promotion and infection prevention was uncommon among local food fish farmers. The following three main themes influenced participants' decisions to use antibiotics in their practice: 1) individual factors, 2) local regulatory factors as well as 3) market-related factors. Individual factors included their personal experience and knowledge both with antibiotics as well as with alternate options. In terms of local regulatory factors, we found that regular oversight was a strong deterrent in antibiotic use. Last, at the market level, the relatively high price of antibiotics in Singapore coupled with stiff competition was a strong disincentive for participants to use antibiotics in their farming practice. These factors were also influential in their relationships with local regulatory bodies as well as their counterparts. Although industries differ significantly across countries, lessons learnt from Singapore's food fish farming demonstrate the importance of an environment where multi-dimensional factors come together to discourage the irrational use of antibiotics in food animal production. In addition, our results allow greater insight into food fish farmers' perspectives on infection control and form a basis from which further research work can be undertaken.