• Behavioural interventions to address rational use of antibiotics in outpatient settings of low‐income and lower‐middle‐income countries

      Nair, MM; Mahajan, E; Burza, S; Zeegers, MP (Wiley, 2021-01-16)
      Objectives To explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low‐income and lower‐middle‐income countries, an underrepresented area in the literature. Methods The systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low‐income and lower‐middle‐income countries. Behavioural interventions were classified as persuasive, enabling, restrictive, structural or bundle (mix of different interventions). In total, 3,514 abstracts were screened and 42 studies were selected for full‐text review, with 13 studies included in the final narrative synthesis. Results Of the 13 included studies, five were conducted in Vietnam, two in Sudan, two in Tanzania, two in India and two in Kenya. All studies were conducted in the outpatient or ambulatory setting: eight took place in primary health centres, two in private clinics and three in pharmacies. Our review found that enabling or educational interventions alone may not be sufficient to overcome the ingrained incentives to link revenue generation to sales of antibiotics, and hence, their inappropriate prescription or misuse. Bundle interventions appear to be very effective at changing prescription behaviour among healthcare providers, including drug sellers and pharmacists. Conclusions Multi‐faceted bundle interventions that combine regulation enforcement with face‐to‐face education and peer influence may be more effective than educational interventions alone at curbing inappropriate antibiotic use.
    • Improving Equitable Access to Essential Medicines: Learning from the Experience of Pharmacists within Médecins Sans Frontières (Doctors Without Borders)

      Connor, S; Forrister, D; Karir, V; Kauffman, Y; Sochacki, M (Wiley, 2020-04-04)
      Two billion people worldwide currently lack access to basic essential medicines. Compounding this challenge, there is also inequity in relation to medication quality, particularly within resource‐constrained settings. Shortages in qualified pharmacy staff exacerbate these problems in poorer countries, with many non‐governmental organizations attempting to fill these gaps. Médecins Sans Frontières (MSF; also known as Doctors Without Borders) is an independent non‐profit organization founded in 1971 that provides free medical humanitarian care for populations in need. Pharmacists are an integral part of MSF's medical activities and are engaged in multiple functions within the organization. They serve as a liaison between logistics, supply, and medical departments, and facilitate delivery of patient care. Moreover, pharmacists ensure the medication use process is intact from project planning to distribution of medications. Pharmacist aid workers within MSF assume many roles including field worker, project manager, project coordinator, access to essential medicines advocate, and many others. We highlight the work of MSF pharmacists via vignettes, sharing their experiences from countries around the world. Working with MSF is a challenging yet rewarding endeavor; becoming an aid worker in the organization preferably requires prior experience working in resource‐limited settings, as well as humanitarian work experience. The role of the pharmacist within MSF is evolving, with increased emphasis on clinical pharmacy services, rational drug use, and antimicrobial resistance. Pharmacists are essential to humanitarian work in ensuring quality and safety in the care of patients served.