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Objective: To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries.
BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidenc
...
e map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans.
METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review.
CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published.
more
This paper summarizes the evidence about the health effects of air pollution from particulate matter and their implications for policy-makers, with the aim of stimulating the development of more effective strategies to reduce
air pollution and its health effects in the countries of eastern Europe,
...
the Caucasus and central Asia.
more
The main message emerging from this new comprehensive global assessment is that premature death and disease can be prevented through healthier environments – and to a significant degree. Analysing the latest data on the environment-disease nexus and the devastating impact of environmental hazards
...
and risks on global health, backed up by expert opinion, this report covers more than 100 diseases and injuries.
more
The Updated guidelines on Management of tuberculosis in children and adolescents include new recommendations that cover diagnostic approaches for TB, shorter treatment for children with non-severe drug-susceptible TB, a new option for the treatment of TB meningitis, the use of bedaquiline and delama
...
nid in young children with multidrug- and rifampicin-resistant TB and decentralized and family-centred, integrated models of care for TB case detection and prevention in children and adolescents.
more
The World Climate and Security Report 2021
Brock, S.; Barrett, O.L.; Birkman, L.; et al.
International Military Council on Climate and Security
(2021)
CC
The World Climate and Security Report (WCSR) 2021 from the Expert Group of the International
Military Council on Climate and Security is a global assessment of the security dimensions of a changing
climate and effective means to address them. It is intended to inform timely climate and security po
...
licy
and action, and builds upon the analysis in the first WCSR, released in February 2020.
more
Discussions about climate change often focus on the future, but millions of children are experiencing its devastating impacts now. The scale of the crisis is huge, and growing fast. It is children that will bear the brunt of climate change, yet its impact on them is understudied, their voices are no
...
t being heard, and current solutions are woefully inadequate. It is a perfect storm that we must stop in its path – before it is too late.
Available in English, French, Spanish, Portuguese, Arabic
more
The World Climate and Security Report 2021_2
Brock, S.; Barrett, O.L.; Birkman, L.; et al.
International Military Council on Climate and Security
(2021)
C1
The World Climate and Security Report (WCSR) 2021 from the Expert Group of the International Military Council on Climate and Security is a global assessment of the security dimensions of a changing climate and effective means to address them. It is intended to inform timely climate and security poli
...
cy and action, and builds upon the analysis in the first WCSR, released in February 2020.
more
The global burden of disease associated with air pollution exposure exacts a massive toll on human health worldwide: exposure to air pollution is estimated to cause millions of deaths and lost years of healthy life annually. The burden of disease attributable to air pollution is now estimated to be
...
on a par with other major global health risks such as unhealthy diet and tobacco smoking, and air pollution is now recognized as the single biggest environmental threat to human health.
more
Int J Hyg Environ Health. 2019 Jun; 222(5): 765–777. doi: 10.1016/j.ijheh.2019.05.004;
To develop updated estimates in response to new exposure and exposure-response data of the
burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth
infec
...
tions and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours
(WASH) with a focus on low- and middle-income countries.
more
Children without access to safe water are more likely to die in infancy -- and throughout childhood -- from diseases caused by
water-borne bacteria, to which their small bodies are more vulnerable.
This report, which involved input from across WaterAid, in particular from the Programme Support Unit (PSU) of WaterAid UK, includes case studies from a variety of countries, including Bangladesh, Burkina Faso, Eswatini, Ethiopia, Ghana, India and Nepal, each demonstrating what must be done now to i
...
mprove WASH services and address current challenges, in order to increase community resilience to climate change.
more
Climate change has important implications for the health and futures of children and young people, yet they have little power to limit its harm, making them vulnerable to climate anxiety. This is the first large-scale investigation of climate anxiety in children and young people globally and its rel
...
ationship with perceived government response.
more
Compared with other health areas, the mental health impacts of climate change have received less research attention. The literature on climate change and mental health is growing rapidly but is characterised by several limitations and research gaps. In a field where the need for designing evidence-b
...
ased adaptation strategies is urgent, and research gaps are vast, implementing a broad, all-encompassing research agenda will require some strategic focus.
more
The Lancet, Planetary Health Volume 5, ISSUE 11, e766-e774, November 01, 2021
Increasing human demand for water and changes in water availability due to climate change threatens water security worldwide. Additionally, exploitation of water resources induces stress on freshwater environments, leadi
...
ng to biodiversity loss and reduced ecosystem services. We aimed to conduct a spatially detailed assessment of global human water stress for low to high environmental flow (EF) protection.
more
This open access book not only describes the challenges of climate disruption, but also presents solutions. The challenges described include air pollution, climate change, extreme weather, and related health impacts that range from heat stress, vector-borne diseases, food and water insecurity and ch
...
ronic diseases to malnutrition and mental well-being.
more
A view of global supply chains, pressure points, and implications for antimicrobial resistance response
