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Antibiotic Stewardship in Ghana’s Global Health Security Agenda: A Cross-sectoral Assessment of Knowledge Translation into Practice
Get PDFBackground: Resistance of bacterial pathogens to antibiotic therapy threatens to derail progress made to reduce the global burden of infectious diseases, with the largest impact in countries such as Ghana where populations are vulnerable to pathogenic exposures. However, the level of antibiotic use and knowledge about antibiotic resistance among communities is inadequately quantified. This research aimed to identify gaps and priorities for strategies to improve antibiotic stewardship. Methods: A cross-sectional study of four hundred individuals residing in the urban Greater Accra and rural Upper West regions of Ghana was conducted to investigate knowledge, attitudes, and practices regarding antibiotics and antibiotic resistance. The determinants of antibiotic stewardship were assessed through associations between level of knowledge, attitudes, and utilization behaviors and demographic characteristics. Principal component and regression analyses were conducted to determine the different dimensions of knowledge and their association with antibiotic use. Eight semi-structured in-depth interviews with key personnel from the policy, research, and practice programs in Ghana’s public health sector were conducted to investigate stakeholder roles and institutional capacity to promote prudent use of antibiotics at the community level. Results: The results revealed that 70% of study participants (278/400) had used at least one antibiotic in the year prior to the survey. The most frequently used antibiotics were Amoxicillin, Amoxicillin-clavulanic acid, Ampicillin, Ciprofloxacin, and Metronidazole. Women and older adults had higher knowledge compared to their respective counterparts (p < 0.01). Prudent antibiotic use was significantly more prevalent in women than in men (p < 0.05). Most participants (63%) were unaware of antibiotic resistance. The determinants of antibiotic stewardship revealed two main principal components: knowledge about treatment of common illnesses showed that women and older individuals had higher knowledge about appropriate therapies for malaria, headaches, and body aches; and knowledge about prudent use of antibiotics indicated better knowledge about prudent use of antibiotics among older adults, persons with higher educational attainment, and residents of the Greater Accra region. Stakeholder analysis revealed four themes: national burden of disease and antibiotic resistance; policy development; implementation barriers; and strategies. All respondents expressed concern about the increasing proliferation of antibiotic-resistant bacteria, which they attributed in part to the inappropriate use of antibiotics in communities. Stakeholders acknowledged the importance of strengthening cross-sectoral collaboration, and the need to leverage resources from the animal and environmental sectors through a One Health approach. Conclusion: Findings from my research can improve knowledge about the public’s understanding of antibiotic resistance to better inform implementation of the Global Action Plan on Antimicrobial Resistance, particularly in low-resource settings
Preventing Chronic Disease (PCD)
Get PDFIntroductionIncreases in physical activity can lead to decreases in the prevalence of chronic diseases. Parks provide an ideal setting for physical activity. We investigated the effect of a fitness equipment installation on the intensity of park users\u2019 physical activity at a community park.MethodsWe used the System for Observing Play and Recreation in a Community to record physical activity in Eastgate Park in Garden Grove, California, in August 2015 (preintervention [n = 1,650 person-periods]) and in February 2016 (postintervention [n = 1,776 person-periods]). We quantified physical activity in target areas of the park during 15-minute observation periods in 2 ways: 1) we categorized each user\u2019s activity level during the period (sedentary, walking, vigorous), and 2) we converted activity levels to numeric metabolic equivalent task (MET) scores and calculated the period-average score across users. We used mixed-effects regression models to assess 1) the proportional odds of higher activity level at postintervention and 2) the association between intervention status (pre vs post) and mean period-average MET scores.ResultsIn the immediate zone around the fitness equipment, the odds ratio for a higher activity level was 1.58 (95% confidence interval [CI], 1.14\u20132.18; P = .006) and the mean period-average MET score was 0.33 (95% CI, 120.07 to 0.74; P = .11) units higher at postintervention. Across the park as a whole, the odds ratio for a higher activity level was 1.41 (95% CI, 1.21\u20131.63; P < .001), and the mean period-average MET score was 0.34 (95% CI, 0.12\u20130.56; P = .003) units higher at postintervention.ConclusionInstalling fitness zones appears to be an effective intervention for increasing physical activity of park users. Further studies need to be conducted to understand the sustained impact of fitness zones over time.U58 DP005861/DP/NCCDPHP CDC HHS/United State
Tundra Soil Viruses Mediate Responses of Microbial Communities to Climate Warming
Get PDFABSTRACT The rise of global temperature causes the degradation of the substantial reserves of carbon (C) stored in tundra soils, in which microbial processes play critical roles. Viruses are known to influence the soil C cycle by encoding auxiliary metabolic genes and infecting key microorganisms, but their regulation of microbial communities under climate warming remains unexplored. In this study, we evaluated the responses of viral communities for about 5 years of experimental warming at two depths (15 to 25 cm and 45 to 55 cm) in the Alaskan permafrost region. Our results showed that the viral community and functional gene composition and abundances (including viral functional genes related to replication, structure, infection, and lysis) were significantly influenced by environmental conditions such as total nitrogen (N), total C, and soil thawing duration. Although long-term warming did not impact the viral community composition at the two depths, some glycoside hydrolases encoded by viruses were more abundant at both depths of the warmed plots. With the continuous reduction of total C, viruses may alleviate methane release by altering infection strategies on methanogens. Importantly, viruses can adopt lysogenic and lytic lifestyles to manipulate microbial communities at different soil depths, respectively, which could be one of the major factors causing the differences in microbial responses to warming. This study provides a new ecological perspective on how viruses regulate the responses of microbes to warming at community and functional scales. IMPORTANCE Permafrost thawing causes microbial release of greenhouse gases, exacerbating climate warming. Some previous studies examined the responses of the microbial communities and functions to warming in permafrost region, but the roles of viruses in mediating the responses of microbial communities to warming are poorly understood. This study revealed that warming induced changes in some viral functional classes and in the virus/microbe ratios for specific lineages, which might influence the entire microbial community. Furthermore, differences in viral communities and functions, along with soil depths, are important factors influencing microbial responses to warming. Collectively, our study revealed the regulation of microbial communities by viruses and demonstrated the importance of viruses in the microbial ecology research
Cultivating one health antibiotic stewards to bridge translational science gaps in the global action plan
Get PDFScientific evidence for the urgency of curbing the emergence and spread of antimicrobial resistance is incontrovertible. Yet, the translation of knowledge into effective design and implementation of action plans is hampered by gaps in perception, attitudes and practices in the human health, agriculture, and environmental sectors. To fill these gaps in regions where the disease burden attributable to antimicrobial resistance is heaviest, a cadre of One Health Stewards equipped with strategies to translate and meld global and local evidence for knowledge dissemination is deemed necessary. This opinion articulates a case for cultivating and deploying One Health Antibiotic Stewards according to specific actions within the environmental context of antibiotic resistance
Broad spectrum integration of climate change in health sciences curricula
Get PDFIn response to a University of California systemwide initiative to expand the knowledge base of climate change, two half-day workshops were held for faculty in the College of Health Sciences at the UC Irvine. In the first workshop, 20 participants who teach in the Schools of Nursing, Medicine, Pharmacy, and Pharmaceutical Science, or the Program in Public Health convened to explore concepts of sustainability, theoretical models of curriculum integration, challenges to adding new competencies into professional training, and strategies for integrating climate change modules and case studies into the curricula. The second half-day workshop was held a year after the first workshop to review how faculty members have modified their syllabus to integrate climate change information with varying degrees of success. A case study is presented regarding an asynchronous fully online course Introduction to Global Health, which is open to enrollment by students from all campuses of the University of California. The outcomes revealed preferential adoption of models of curriculum integration which minimized disruption of the sequence of topics in pre-existing courses. These include, for example, the use of longitudinal climate datasets for quantitative analysis of disease outcomes, and description of episodic events involving extreme weather conditions to explore differences in social determinants of vulnerability to climate change impacts in different populations. Integration of climate change as a distinct topic seems easier in elective courses in comparison with required courses designed to cover pre-established professional knowledge, competencies, and skills. The emergent requirement for interprofessional training in the health sciences provides an opportunity for the development of a cross-cutting competency domain including climate change as a unifying theme in a stand-alone course or set of courses in a sequenced model of curriculum integration
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One Health and the Environment: From Conceptual Framework to Implementation Science
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Planetary boundaries for recalcitrant materials and toxic chemical pollutants: specifications for sustainable safe operating zones
Get PDFAnnounced as “the greatest and most consequential day of deregulation in U.S. history,” 12 March 2025 marks the retreat of the United States Environmental Protection Agency from remedial and preventive policies that were informed by decades of consequential research in environmental science and public health. The USEPA administrator boasted further: “We are driving a dagger straight into the heart of the climate change religion to drive down cost of living for American families, unleash American energy, bring auto jobs back to the U.S. and more.” The retreat threatens science-based regulations that have commanded the attention of researchers, policymakers, healthcare providers, non-governmental stewards of environments and ecosystems, and the general public. An example of such regulations targets mercury pollution, perhaps the only toxic chemical for which a specific UN action, the Minamata Convention, is dedicated. The linkage of mercury emissions to coal combustion as a source of energy that also drives climate change and particulate matter pollution that transcends national boundaries to cause diseases worldwide implies that the adverse impacts of USEPA’s retreat will not be borne only by the US population, but also by the global human population and wildlife. The retreat from progressive agendas on environmental sustainability is not unique to the US. Note the European Commission’s relaxation of reporting rules in the 2025 Competitiveness Compass. We may very well witness a “race to the bottom” as other countries sacrifice environmental regulations in pursuit of corporate profits
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