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World Health Organization : Year 2001 ; Communicable Diseases and Emerging Infectious Diseases ; Department of Communicable Disease Surveillance and Response Drs, No. 2001.9: Interventions and Strategies to Improve the Use of Antimicrobials in Developing Countries

By John Chalker, Dr.


Description
Medical Reference Publication

Excerpt
1. Introduction The use of antimicrobials1 has contributed to the dramatic fall in morbidity from communicable and infectious diseases over the last 50 years globally (e.g. UNIDO, 1980; WHO, 1988, 1996; Kunin et al., 1990; Richardson, 1992), as to increasingly high levels of expenditure on and consumption of antimicrobials. A substantial proportion of the total drug budget in many countries is dedicated to antibiotics and they are often the largest single group of drugs purchased in developing countries. However, despite the vast advancements brought about since the development of antibiotics and antimicrobials, their widespread availability and use have had several negative implications on global health care, among these the inappropriate use by health care providers and consumers and the increase of drug resistance. The primary economic implication of resistance on the diminishing efficacy of antibiotic treatment includes the need to rely on more expensive drugs that may be practically unaffordable for most primary health care programmes.

Table of Contents
Contents iii WHO/CDS/CSR/DRS/2001.4 DRUG RESISTANC IN MALARIA Abbreviations and acronyms iv Background 1 1. Introduction 2 2. Objectives 4 3. Methodology 5 3.1 Search strategy 5 3.2 Criteria for methodological adequacy 5 3.3 Measuring study effects and effect size 6 4. Results 7 4.1 Overview of results 7 Table 1. Interventions across geographical areas and study settings 8 Table 2. Distribution of studies by type of intervention and design 8 Table 3a. Studies by identified categories and subcategories of intervention types 9 Table 3b. Studies by identified categories and subcategories of intervention types 9 Table 3c. Studies by identified categories and subcategories of intervention types 10 Table 4. Distribution of studies by targeted health care providers, health problems, and practices 10 Table 5. Percentage magnitude of improvement by type of intervention concentrating on the following outcomes: use of antimicrobials, dose of antimicrobials, under-5 mortality rate 11 4.2 Analysis of results 11 4.2.1 Types of interventions tested 11 4.2.2 Targets of interventions: health care providers, health problems, and practices 12 4.2.3 Outcomes measured 12 4.2.4 Impacts of interventions 13 4.3 Evaluating the effectiveness of intervention strategies 13 4.3.1 Educational interventions 13 4.3.2 Combined managerial and educational approaches 14 4.3.3 Managerial approaches 15 4.3.4 Economic interventions 15 5. Discussion 16 5.1 Effectiveness of different types of interventions 16 5.2 Neglected issues 17 5.2.1 Settings 17 5.2.2 Conditions 17 5.2.3 Cost-effectiveness 17 5.3 Limitations of this review 17 6. Conclusion 19 Appendix 1. Characteristics of intervention studies 20 Bibliography 29

 

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