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1.
Am J Trop Med Hyg ; 102(6): 1172-1174, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32358952

RESUMEN

The first case of novel coronavirus disease (COVID-19) in the Dominican Republic coincided with a period of political crisis. Distrust in governmental institutions shaped the critical phase of early response. Having a weak public health infrastructure and a lack of public trust, the Ministry of Health (MoH) began the fight against COVID-19 with a losing streak. Within 45 days of the first reported case, the political crisis and turmoil caused by "fake news" are limiting the capacity and success of the MoH response to the pandemic.


Asunto(s)
Antivirales/uso terapéutico , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Medios de Comunicación Sociales/ética , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/provisión & distribución , Azitromicina/provisión & distribución , Azitromicina/uso terapéutico , Betacoronavirus/efectos de los fármacos , Desórdenes Civiles , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/economía , Disentimientos y Disputas , República Dominicana/epidemiología , Reposicionamiento de Medicamentos , Humanos , Hidroxicloroquina/provisión & distribución , Hidroxicloroquina/uso terapéutico , Ivermectina/provisión & distribución , Ivermectina/uso terapéutico , Pandemias/economía , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/economía , Política , Salud Pública/economía , Salud Pública/tendencias , Confianza/psicología
3.
Am J Trop Med Hyg ; 100(5): 1105-1109, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30915951

RESUMEN

Mass drug administration (MDA) for trachoma control using azithromycin has generated concern for the development of resistant organisms. However, the contribution from azithromycin available in local pharmacies has not been studied. In Kilosa district, Tanzania, MDA stopped over 4 years ago, and this study sought to determine the availability of azithromycin in local pharmacies and correlate it with azithromycin resistance in children born after MDA. A cross-sectional survey was conducted in 644 randomly selected hamlets in Kilosa district, in which the presence of a pharmacy and the availability of azithromycin and erythromycin were determined. In 30 randomly selected hamlets, a random sample of 60 children less than 5 years were tested for azithromycin-resistant Streptococcus pneumoniae (Spn) and Escherichia coli (Ec), from nasopharyngeal and rectal swabs, based on disk diffusion criteria. Only 26.6% of hamlets had a pharmacy. Azithromycin and erythromycin were available in 30.8% and 89.1% of pharmacies closest to the hamlets, respectively. In the 30 communities tested for resistance, the overall prevalence of azithromycin-resistant Spn isolates was 14%. Six of seven (87%) hamlets where azithromycin was available had resistant Spn, compared with 14 of 23 (61%) hamlets without availability. Similarly, six of seven (87%) hamlets where azithromycin was available had resistant Ec isolates compared with 21 of 23 (70%) hamlets without availability. However, the differences were not statistically significant (P = 0.46 and 0.49, respectively). The availability of azithromycin in pharmacies in the district was limited, and a strong correlation with azithromycin-resistant Spn or Ec was not observed.


Asunto(s)
Antibacterianos/provisión & distribución , Azitromicina/provisión & distribución , Farmacorresistencia Bacteriana , Farmacias , Streptococcus pneumoniae/efectos de los fármacos , Antibacterianos/farmacología , Azitromicina/farmacología , Portador Sano/epidemiología , Portador Sano/microbiología , Preescolar , Ensayos Clínicos como Asunto , Estudios Transversales , Humanos , Lactante , Recién Nacido , Nasofaringe/microbiología , Tanzanía/epidemiología , Tracoma/tratamiento farmacológico , Tracoma/epidemiología
4.
Trans R Soc Trop Med Hyg ; 112(12): 538-545, 2018 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-30265355

RESUMEN

Background: The World Health Organization (WHO) recommends conducting trachoma surveillance surveys in districts where the elimination targets have been met and following a minimum 2-year period after cessation of mass drug administration (MDA) in order to determine the sustainability of low trachoma levels. Methods: In 2015, population-based surveillance surveys were conducted in five districts of Amhara, Ethiopia. All five districts had a prior trachomatous inflammation-follicular (TF) prevalence among children 1-9 y of age of <5% determined by an impact survey and had not received MDA for ≥2 y. Surveys included examinations for trachoma clinical signs and conjunctival swabbing to determine Chlamydia trachomatis infection prevalence. Results: Approximately 1000 children 1-9 y of age were examined for TF and 200 children 1-5 y of age were swabbed per district. All five surveillance districts had a TF prevalence of <5% and infection was only detected in one district. The prevalence of trachomatous trichiasis in adults ≥15 y of age was ≥1% in all districts. Conclusions: In a trachoma hyperendemic region, a TF prevalence <5% was successfully maintained in five districts for ≥2 years after stopping MDA. MDA is still not warranted for these districts, however, the S, F and E components of the SAFE strategy should continue.


Asunto(s)
Antibacterianos/provisión & distribución , Azitromicina/provisión & distribución , Administración Masiva de Medicamentos/estadística & datos numéricos , Tracoma/epidemiología , Privación de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Niño , Preescolar , Etiopía/epidemiología , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , Masculino , Vigilancia de la Población , Prevalencia , Tracoma/tratamiento farmacológico , Organización Mundial de la Salud , Adulto Joven
5.
Patient Educ Couns ; 101(6): 1075-1081, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29329726

RESUMEN

OBJECTIVE: Prevention of Trachoma, the leading cause of infectious blindness, requires community treatment assistants (CTAs) to perform mass drug administration (MDA) of azithromycin. Previous research has shown that female CTAs have higher MDA coverage, but no studies have focused on the content of conversation. We hypothesize that female CTAs had more patient-centered communication and higher MDA coverage. METHODS: In 2011, CTAs from 23 distribution sites undergoing MDA as part of the Partnership for Rapid Elimination of Trachoma were selected. CTA - villager interactions were audio recorded. Audio was analyzed using an adaptation of the Roter Interaction Analysis System. The outcome of interest was the proportion of adults receiving MDA in 2011 who returned in 2012. RESULTS: 58 CTAs and 3122 interactions were included. Sites with female CTAs had significantly higher patient-centeredness ratio (0.548 vs 0.400) when compared to sites with male CTAs. Sites with more patient-centered interactions had higher proportion of patients return (p = 0.009). CONCLUSION: Female CTAs had higher proportion of patient-centered communication. Patient centered communication was associated with higher rates of return for MDA. PRACTICE IMPLICATIONS: Greater patient-centered connection with health care providers affects participation in public health efforts, even when those providers are lay health workers.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Comunicación , Administración Masiva de Medicamentos , Atención Dirigida al Paciente/métodos , Tracoma/tratamiento farmacológico , Adulto , Azitromicina/provisión & distribución , Agentes Comunitarios de Salud , Femenino , Humanos , Masculino , Estudios Prospectivos , Tanzanía
6.
Int J Clin Pract ; 71(2)2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28090718

RESUMEN

BACKGROUND: Despite Namibia's robust medicine use systems and policies, antibiotic use indicators remain suboptimal. Recent medicine use surveys rank cotrimoxazole, amoxicillin and azithromycin (CAA) among the most used medicines. However, there is rising resistance to CAA (55.9%-96.7%). Unfortunately, to date, there have been limited studies evaluating policies to improve antibiotic use in Namibia. AIM: To evaluate public sector pharmaceutical policies and guidelines influencing the therapeutic use of CAA antibiotics in Namibia. METHODS: Evaluate Namibia's pharmaceutical policies and guidelines for CAA use through quantitative text analysis. The main outcome variables were the existence of antibiotic policies, therapeutic indications per antibiotic and the type/level of healthcare facility allowed to use the antibiotic. RESULTS: Policies for antibiotic use were limited, with only the draft Namibia Medicines Policy having a statement on antibiotic use. Several essential antibiotics had no therapeutic indications mentioned in the guidelines. Twenty-nine antibiotics were listed for 69 therapeutic indications; CAA (49.3%) antibiotics and ATC J01C/J01D (48%) having the highest indications per antibiotic. For CAA antibiotics, this suggested use was mainly for acute respiratory infections (n=22, 37.2%). Published policies (58.6%-17/29) recommended antibiotics for use at the primary healthcare (PHC) level, with CAA antibiotics recommended mostly for respiratory tract infections and genitourinary infections. CONCLUSIONS: Policy and guidelines for antibiotic use in Namibia are not comprehensive and are skewed towards PHCs. Existing policies promote the wide use of CAA antibiotics, which may inadvertently result in their inappropriate use enhancing resistance rates. This calls for the development of more comprehensive antibiotic guidelines and essential medicine lists in tandem with local antimicrobial resistance patterns. In addition, educational initiatives among all key stakeholder groups.


Asunto(s)
Antibacterianos/provisión & distribución , Benchmarking , Servicios Comunitarios de Farmacia/normas , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Amoxicilina/provisión & distribución , Azitromicina/provisión & distribución , Quimioterapia Combinada , Humanos , Namibia , Sector Público , Combinación Trimetoprim y Sulfametoxazol/provisión & distribución
7.
PLoS Negl Trop Dis ; 8(3): e2732, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24625539

RESUMEN

BACKGROUND: To eliminate blinding trachoma, the World Health Organization emphasizes implementing the SAFE strategy, which includes annual mass drug administration (MDA) with azithromycin to the whole population of endemic districts. Prevalence surveys to assess impact at the district level are recommended after at least 3 years of intervention. The decision to stop MDA is based on a prevalence of trachomatous inflammation follicular (TF) among children aged 1-9 years below 5% at the sub-district level, as determined by an additional round of surveys limited within districts where TF prevalence is below 10%. We conducted impact surveys powered to estimate prevalence simultaneously at the sub-district and district in two zones of Amhara, Ethiopia to determine whether MDA could be stopped. METHODOLOGY: Seventy-two separate population-based, sub-district surveys were conducted in 25 districts. In each survey all residents from 10 randomly selected clusters were screened for clinical signs of trachoma. Data were weighted according to selection probabilities and adjusted for correlation due to clustering. PRINCIPAL FINDINGS: Overall, 89,735 residents were registered from 21,327 households of whom 72,452 people (80.7%) were examined. The prevalence of TF in children aged 1-9 years was below 5% in six sub-districts and two districts. Sub-district level prevalence of TF in children aged 1-9 years ranged from 0.9-76.9% and district-level from 0.9-67.0%. In only one district was the prevalence of trichiasis below 0.1%. CONCLUSIONS/SIGNIFICANCE: The experience from these zones in Ethiopia demonstrates that impact assessments designed to give a prevalence estimate of TF at sub-district level are possible, although the scale of the work was challenging. Given the assessed district-level prevalence of TF, sub-district-level surveys would have been warranted in only five districts. Interpretation was not as simple as stopping MDA in sub-districts below 5% given programmatic challenges of exempting sub-districts from a highly regarded program and the proximity of hyper-endemic sub-districts.


Asunto(s)
Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Azitromicina/provisión & distribución , Azitromicina/uso terapéutico , Tracoma/tratamiento farmacológico , Tracoma/epidemiología , Preescolar , Quimioterapia/métodos , Etiopía/epidemiología , Femenino , Humanos , Lactante , Masculino , Prevalencia
8.
Med J Aust ; 190(7): 388-9, 2009 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-19351315

RESUMEN

Azithromycin is recommended as the first-line antibiotic for the prophylaxis and treatment of pertussis, a common vaccine-preventable communicable disease. Azithromycin is better tolerated than other macrolide antibiotics. Access to azithromycin is limited, as the product information and the Pharmaceutical Benefits Scheme do not include azithromycin for pertussis. Issues regarding access to azithromycin are highlighted in a case report of pertussis exposure in a tertiary paediatric hospital.


Asunto(s)
Antibacterianos/provisión & distribución , Profilaxis Antibiótica , Azitromicina/provisión & distribución , Infección Hospitalaria/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Tos Ferina/tratamiento farmacológico , Antibacterianos/uso terapéutico , Australia , Azitromicina/uso terapéutico , Trazado de Contacto , Hospitales Pediátricos , Humanos , Programas Nacionales de Salud/normas , Estudios de Casos Organizacionales
9.
BJOG ; 114(12): 1516-21, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-17877773

RESUMEN

OBJECTIVE: To determine willingness of health professionals to adopt new interventions for treating sexual partners of women with chlamydia. DESIGN: Anonymous, self-administered questionnaires of doctors, practice nurses and community pharmacists regarding novel testing/treatment options for partners of women with chlamydia. SETTING: Local (Scotland) and national (UK) clinical meetings in reproductive health, and community pharmacy (Lothian). POPULATION: Doctors (general practice, gynaecology, family planning) and practice nurses who were delegates at selected meetings in reproductive health and community pharmacists attending pharmacy meetings. METHODS: Doctors and nurses were invited to complete a questionnaire indicating their preferred strategy for testing/treating sexual partners of women with chlamydia if given choice of partner notification, postal testing kit (PTK), patient delivered partner medication (PDPM) with azithromycin or combined PDPM and PTK. Community pharmacists were invited to complete a questionnaire regarding their willingness to introduce chlamydia testing and treatment services. MAIN OUTCOME MEASURES: Reported preferences of doctors and nurses for partner testing/treatment strategies and willingness of pharmacists to offer new services. RESULTS: Questionnaires were completed by 211 doctors, 73 practice nurses and 50 pharmacists. The most popular choice of doctors (30%) and nurses (23%) was a combination of PDPM with PTK, with partner notification the least popular (8 and 3%, respectively). One in four doctors had previously used PDPM for treating partners. Most pharmacists were willing to supply free PTKs (98%), offer testing (75%) and treatment services (100%) and give women PDPM for partners (80%). CONCLUSION: Relevant health professionals, who are increasingly involved in managing chlamydia, are largely in favour of introducing new strategies for treating sexual partners.


Asunto(s)
Infecciones por Chlamydia/prevención & control , Trazado de Contacto/métodos , Personal de Salud/normas , Práctica Profesional/normas , Parejas Sexuales , Antibacterianos/provisión & distribución , Actitud del Personal de Salud , Azitromicina/provisión & distribución , Servicios de Planificación Familiar/organización & administración , Medicina Familiar y Comunitaria , Femenino , Ginecología/organización & administración , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Masculino , Enfermeras Practicantes , Planificación de Atención al Paciente/organización & administración , Farmacias/organización & administración , Servicios Postales/estadística & datos numéricos , Encuestas y Cuestionarios , Reino Unido
10.
Bull World Health Organ ; 79(3): 194-200, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11285662

RESUMEN

OBJECTIVE: The study compares the effectiveness of two strategies for distributing azithromycin in an area with mild-to-moderate active trachoma in Nepal. METHODS: The two strategies investigated were the use of azithromycin for 1) mass treatment of all children, or 2) targeted treatment of only those children who were found to be clinically active, as well as all members of their household. FINDINGS: Mass treatment of children was slightly more effective in terms of decreasing the prevalence of clinically active trachoma (estimated by clinical examination) and of chlamydial infection (estimated by DNA amplification tests), although neither result was statistically significant. CONCLUSION: Both strategies appeared to be effective in reducing the prevalence of clinically active trachoma and infection six months after the treatment. Antibiotic treatment reduced the prevalence of chlamydial infection more than it did the level of clinically active trachoma.


Asunto(s)
Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Azitromicina/provisión & distribución , Azitromicina/uso terapéutico , Tracoma/tratamiento farmacológico , Niño , Servicios de Salud del Niño/organización & administración , Preescolar , Humanos , Lactante , Nepal/epidemiología , Tracoma/epidemiología , Tracoma/prevención & control
11.
Bull World Health Organ ; 79(3): 201-7, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-11285663

RESUMEN

OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal. METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma. Resource measures included personnel time required for treatment, transportation, the time that study subjects had to wait to receive treatment, and the quantity of azithromycin used. The costs of the programme were calculated from the perspectives of the public health programme sponsor, the study subjects, and the society as a whole. FINDINGS: Previous studies have indicated no statistically significant differences in effectiveness, and the present work showed no significant differences in total personnel and transportation costs per child aged 1-10 years, the total time that adults spent waiting, or the quantity of azithromycin per child. However, the mass treatment of children was slightly more effective and used less of each resource per child aged 1-10 years than the targeted treatment of households. CONCLUSION: From all perspectives, the mass treatment of children is at least as effective and no more expensive than targeted household treatment, notwithstanding the absence of statistically significant differences. Less expensive targeting methods are required in order to make targeted household treatment more cost-effective.


Asunto(s)
Antibacterianos/economía , Azitromicina/economía , Servicios de Salud del Niño/organización & administración , Análisis Costo-Beneficio , Tracoma/tratamiento farmacológico , Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Azitromicina/provisión & distribución , Azitromicina/uso terapéutico , Niño , Servicios de Salud del Niño/economía , Preescolar , Femenino , Costos de la Atención en Salud , Humanos , Lactante , Masculino , Nepal/epidemiología , Evaluación de Resultado en la Atención de Salud , Tracoma/economía
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