Antibiotic practices among household members and their domestic animals within rural communities in Cumilla district, Bangladesh: a cross-sectional survey.

BACKGROUND: Antibiotic resistance is a global threat to human health, and inappropriate use of antibiotics in humans and animals is widely considered to be a key driver of antibiotic resistant infections. Antibiotic use in humans and animals is growing rapidly in low- and, particularly, middle-income countries. However, there is little detailed understanding about practices related to the use of antibiotics in humans and animals within community settings in such countries. Here we aimed to understand the antibiotic practices of rural households across Cumilla district, Bangladesh, in relation to household members and their domestic animals. METHODS: In 2018 we conducted a cross-sectional survey using representative cluster sampling methods. We collected self-reported information from 682 female and 620 male household heads, with women also asked about their children's antibiotic practices. RESULTS: Only 48% (95% CI: 40, 56%) of women and men had heard of antibiotics, and among those women and men who were aware of antibiotics and the children of those women 70% (95% CI: 64, 76%) reported having previously taken antibiotics, while among these individuals who reported previously taking antibiotics 21% (95% CI: 18, 25%) said they had done so most recently within the last month. Risky/inappropriate antibiotic practices in humans and animals were often reported. For example, among women and men who were aware of antibiotics and the children of those women 52% (95% CI: 40, 63%) reported previously taking antibiotics for a "cough/cold", despite antibiotics being typically inappropriate for use against viral upper respiratory tract infections. Among poultry-owning respondents who were aware of antibiotics 11% (95% CI: 8, 15%) reported previously giving healthy poultry antibiotics, mainly for growth/prophylaxis, while among cattle-owning respondents who were aware of antibiotics and reported previously giving their cattle feed 20% (95% CI: 9, 37%) said the feed had contained antibiotics at least sometimes. CONCLUSIONS: Our results highlight the need for context-adapted interventions at both the community level and the health systems level to reduce inappropriate antibiotic use among humans and domestic animals in rural Bangladesh. Successfully reducing inappropriate use of antibiotics among humans and animals is a required and critical step in tackling antimicrobial resistance.

Many Faces of Openness in Adoption: Perspectives of Adopted Adolescents and Their Parents.

Parents and adolescents (mean age, 15.7 years) from 177 adoptive families participating in the second wave of the Minnesota/Texas Adoption Research Project were interviewed about their post-adoption contact arrangements. The sample included families with no contact, stopped contact, contact without meetings, and contact with face-to-face meetings between the adolescent and birth mother. Openness arrangements were dynamic, and different openness arrangements were associated with different experiences and feelings. Adoptive families with contact reported having higher levels of satisfaction about their openness arrangements, experiencing more positive feelings about the birth mother, and possessing more factual and personal knowledge about the birth mother than did families without contact. Adolescents and adoptive mothers in the contact with meetings group reported the greatest satisfaction with their openness arrangements; those with no contact or stopped contact reported the least satisfaction with their arrangements. Participants having no contact were more likely to want the intensity of contact to increase in the future rather than stay the same. Many participants already having contact wanted it to increase in the future. Fewer than 1 percent of all participants wanted to see the intensity of contact decrease.