Strengthening multisectoral coordination on antimicrobial resistance: a landscape analysis of efforts in 11 countries.

BACKGROUND: Increasingly, there has been recognition that siloed approaches focusing mainly on human health are ineffective for global antimicrobial resistance (AMR) containment efforts. The inherent complexities of AMR containment warrant a coordinated multisectoral approach. However, how to institutionalize a country's multisectoral coordination across sectors and between departments used to working in silos is an ongoing challenge. This paper describes the technical approach used by a donor-funded program to strengthen multisectoral coordination on AMR in 11 countries as part of their efforts to advance the objectives of the Global Health Security Agenda and discusses some of the challenges and lessons learned. METHODS: The program conducted a rapid situational analysis of the Global Health Security Agenda and AMR landscape in each country and worked with the governments to identify the gaps, priorities, and potential activities in multisectoral coordination on AMR. Using the World Health Organization (WHO) Joint External Evaluation tool and the WHO Benchmarks for International Health Regulations (2005) Capacities as principal guidance, we worked with countries to achieve key milestones in enhancing effective multisectoral coordination on AMR. RESULTS: The program's interventions led to the achievement of key benchmarks recommended actions, including the finalization of national action plans on AMR and tools to guide their implementation; strengthening the leadership, governance, and oversight capabilities of multisectoral governance structures; establishing and improving the functions of technical working groups on infection prevention and control and antimicrobial stewardship; and coordinating AMR activities within and across sectors. CONCLUSION: A lot of learning still needs to be done to identify best practices for building mutual trust and adequately balancing the priorities of individual ministries with cross-cutting issues. Nevertheless, this paper provides some practical ideas for countries and implementing partners seeking to improve multisectoral coordination on AMR. It also demonstrates that the WHO benchmark actions, although not intended as an exhaustive list of recommendations, provide adequate guidance for increasing countries' capacity for effective multisectoral coordination on AMR in a standardized manner.

Adverse drug events in hospitalized children at Ethiopian University Hospital: a prospective observational study.

BACKGROUND: The nature and magnitude of adverse drug events (ADEs) among hospitalized children in low-income countries is not well described. The aim of this study was thus, to assess the incidence and nature of ADEs in hospitalized children at a teaching hospital in Ethiopia. METHODS: We used prospective observational method to study children that were hospitalized to Jimma University Specialized Hospital between 1 February and 1 May 2011. ADEs were identified using review of treatment charts, interview of patient and care-giver, attendance at ward rounds and/or meetings and voluntary staff reports. Two senior pediatric residents evaluated the severity and preventability of ADEs using preset criteria. Logistic regression analysis was employed to determine predictors of ADEs. RESULTS: There were 634 admissions with 6182 patient-days of hospital stay. There were 2072 written medication orders accounting for 35,117 medication doses. Fifty eight ADEs were identified with an incidence of 9.2 per 100 admissions, 1.7 per 1000 medication doses and 9.4 per 1000 patient-days. One-third of ADEs were preventable; 47% of these were due to errors in the administration stage of medication use process. Regarding the severity of ADEs, 91% caused temporary harms and 9% resulted in permanent harm/death. Anti-infective drugs were the most common medications associated with ADEs. The occurrence of ADEs increased with age, length of hospital stay, and use of CNS, endocrine and antihistamine medicines. CONCLUSION: ADEs are common in hospitalized children in low-income settings; however, one-third deemed preventable. A strategy to prevent the occurrence and consequences of ADEs including education of nurses/physicians is of paramount importance.

The toxicity of extracts of plant parts of Moringa stenopetala in HEPG2 cells in vitro.

The cytotoxicity of extracts from a widely used species of plant, Moringa stenopetala, was assessed in HEPG2 cells, by measuring the leakage of lactate dehydrogenase (LDH) and cell viability. The functional integrity of extract-exposed cells was determined by measuring intracellular levels of ATP and glutathione (GSH). The ethanol extracts of leaves and seeds increased significantly (p < 0.01) LDH leakage in a dose- and time-dependent manner. The water extract of leaves and the ethanol extract of the root did not increase LDH leakage. A highly significant (p < 0.001) decrease in HEPG2 viability was found after incubating the cells with the highest concentration (500 microg/mL) of the ethanol leaf and seed extracts. At a concentration of 500 microg/mL, the water extract of leaves increased (p < 0.01), while the ethanol extract of the same plant part decreased (p < 0.01), ATP levels. The root and seed extracts had no significant effect on ATP levels. The ethanol leaf extract decreased GSH levels at a concentration of 500 microg/mL (p < 0.01), as did the ethanol extract of the seeds at 250 microg/mL and 500 microg/mL (p < 0.05). The water extract of the leaves did not alter GSH or LDH levels or affect cell viability, suggesting that it may be non-toxic, and is consistent with its use as a vegetable. The data obtained from the studies with the ethanol extract of the leaves and seeds from Moringa stenopetala show that they contain toxic substances that are extractable with organic solvents or are formed during the process of extraction with these solvents. The significant depletion of ATP and GSH only occurred at concentrations of extract that caused leakage of LDH. Further investigation with this plant in order to identify the constituents extracted and their individual toxic effects both in vivo and in vitro is warranted. This study also illustrates the utility of cell culture for screening plant extracts for potential toxicity.

Diuretic effect of the crude extracts of Carissa edulis in rats.

Carissa edulis (forssk) vahl (Apocynaceae) is used traditionally for the treatment of headache, chest complaints, rheumatism, gonorrhoea, syphilis, rabies and as a diuretic. In the present study, the diuretic activity of different extracts of Carissa edulis was investigated. The diuretic activity of the different extracts of Carissa edulis in a dose range of 50-1000 mg/kg was assessed orally in rats using hydrochlorothiazide as a standard drug. The root bark maceration extract showed no effect on the urine output up to a dose of 1000 mg/kg, while the root bark soxhlet extract produced a significant increase (P < 0.05) in urine output at a dose of 1000 mg/kg. The root wood maceration and root wood soxhlet extracts produced a significant increase in urine output at a dose of 50 mg/kg, with a P-value of <0.05. Urinary electrolyte excretion was also affected by the extracts: the root bark soxhlet extract increased urinary excretion of sodium, potassium and chloride ions; root wood maceration extract increased excretion of sodium and potassium, while root wood soxhlet extract increased excretion of potassium ion. These findings support the traditional use of Carissa edulis as a diuretic agent.