Worldwide, antimicrobial resistance is increasing rapidly and is associated with misuse of antimicrobials. The HATUA study (a broader 3-country study) investigated the antibiotic dispensing practices of pharmaceutical providers to clients, particularly the propensity to dispense without prescription. A cross-sectional study using a ‘mystery client’ method was conducted in 1148 community pharmacies and accredited drugs dispensing outlets (ADDO) in Mwanza (n = 612), Mbeya (n = 304) and Kilimanjaro (n = 232) in Tanzania. Mystery clients asked directly for amoxicillin, had no prescription to present, did not discuss symptoms unless asked [when asked reported UTI-like symptoms] and attempted to buy a half course. Dispensing of amoxicillin without prescription was common [88.2, 95%CI 86.3–89.9%], across all three regions. Furthermore, the majority of outlets sold a half course of amoxicillin without prescription: Mwanza (98%), Mbeya (99%) and Kilimanjaro (98%). Generally, most providers in all three regions dispensed amoxicillin on demand, without asking the client any questions, with significant variations among regions [p-value = 0.003]. In Mbeya and Kilimanjaro, providers in ADDOs were more likely to do this than those in pharmacies but no difference was observed in Mwanza. While the Tanzanian government has laws, regulations and guidelines that prohibit antibiotic dispensing without prescription, our study suggests non-compliance by drug providers. Enforcement, surveillance, and the provision of continuing education on dispensing practices is recommended, particularly for ADDO providers.
19 February 2021 in International Journal of Geographical Information Science
Movement analysis has become an integral part of many disciplines, yet with relatively little overlap. A foresight paper in this journal entitled “Towards an integrated science of movement: converging research on animal movement ecology and human mobility science” argued for a better integration of concepts across the divide of animal and human movement, which would lead to the Integrated Science of Movement, but did so from a top-down perspective based on a series of expert workshops. We argue that for a solid establishment of the Integrated Science of Movement, a bottom-up approach is necessary, one based on existing literature which identifies similarities and differences across disciplines. We therefore review, compare, and contrast movement analysis methodologies from GIScience, movement ecology, geography, transportation, public health, computer science, and physics. We structure our review along the dichotomy of individual versus population-based movement or, using terminology from wildlife ecology, between the Lagrangian and Eulerian perspectives. We further introduce a new unifying framework for movement research that is sufficiently general to cover any type of movement study in any discipline and that spans the Lagrangian/Eulerian divide, with the ambitious goal to bridge the gap between disciplines and lay a solid foundation for a new Integrated Science of Movement.
Background: Antibiotic dispensing without prescription is a major determinant of the emergence of Antimicrobial Resistance (AMR) which has impact on population health and cost of healthcare delivery. This study used simulated clients describing UTI like symptoms to explore compliance with regulation, variations in dispensing practices and drug recommendation, and quality of seller-client interaction on the basis of the gender of the client and the type of drug outlets in three regions in Tanzania. Method: A total of 672 Accredited Drug Dispensing Outlets (ADDOs) and community pharmacies were visited by mystery clients (MCs). The study was conducted in three regions of Tanzania namely Kilimanjaro (180, 26.79%), Mbeya (169, 25.15%) and Mwanza (323, 48.07%) in March–May 2020. During data collection, information was captured using epicollect5 software before being analyzed using Stata version 13. Results: Overall, 89.43% (CI: 86.87–91.55%) of drug sellers recommended antibiotics to clients who described UTI like symptoms but held no prescription and 58.93% were willing to sell less than the minimum recommended course. Female clients were more likely than male to be asked if they were taking other medications (27.2% vs 9.8%), or had seen a doctor (27.8% vs 14.7%), and more likely to be advised to consult a doctor (21.6% vs 9.0%); pharmacies addressed these issues more often than ADDOs (17.7% vs 13.2, 23.9% vs 16.6%, 17.7 vs 10.9% respectively). Sellers recommended 32 different drugs to treat the same set of symptoms, only 7 appear in the Tanzanian Standard Treatment Guidelines as recommended for UTI and 30% were 2nd and 3rd line drugs. ADDO sellers recommended 31 drug types (including 2nd and 3rd line) but had permission to stock only 3 (1st line) drugs. The most commonly suggested antibiotics were Azithromycin (35.4%) and ciprofloxacin (20.5%). Azithromycin was suggested more often in pharmacies (40.8%) than in ADDOs (34.4%) and more often to male clients (36.0%) than female (33.1%). Conclusion: These findings support the need for urgent action to ensure existing regulations are adhered to and to promote the continuing professional development of drug sellers at all outlet levels to ensure compliance with regulation, high quality service and better antibiotic stewardship.
Open data initiatives are playing an important role in current city governments. Despite more data being made open, few studies have looked into barriers to open geographic data reuse from a data consumer’s perspective. This article suggests a taxonomy of these barriers for Colombia and Spain, based on a literature review, an online questionnaire, and workshops conducted in four cities of these two countries. The taxonomy highlights that issues such as outdated data, low integration of data producers, published data being difficult to access, misinterpretation and misuse of released data and their terms of use are the most relevant from the data consumer’s point of view. The article ends with some recommendations to open data providers and research as regards steps to make open geographic data more usable in the countries analyzed.
Open data has a profound effect on the working environment within which information is created and shared at all levels. At the local government level, open data initiatives have resulted in higher transparency in policy, a greater engagement between decision‐makers and citizens, and have changed the culture about how data analysis and evidence are used to support local governance. This article, based on data collected through an on‐line survey, participatory workshops with data user communities in four cities (in Colombia and Spain), and interviews with Valencia good‐government office, identifies four elements for a conceptual framework to improve the re‐usability of open geographic data in cities. The essential elements defined in this research are the definition of data user communities and their needs, the creation of the community of reuse, user‐focused metadata, and reuse‐focused legal terms. The definition of these indicators provides a framework for authorities to re‐shape their current open data strategy to include data user requirements. At the end of this article, a roadmap for future research and implementation is presented, considering some reflections on the conceptual framework.
Background: Migratory animals use information from the Earth’s magnetic field on their journeys. Geomagnetic navigation has been observed across many taxa, but how animals use geomagnetic information to find their way is still relatively unknown. Most migration studies use a static representation of geomagnetic field and do not consider its temporal variation. However, short-term temporal perturbations may affect how animals respond - to understand this phenomenon, we need to obtain fine resolution accurate geomagnetic measurements at the location and time of the animal. Satellite geomagnetic measurements provide a potential to create such accurate measurements, yet have not been used yet for exploration of animal migration. Methods: We develop a new tool for data fusion of satellite geomagnetic data (from the European Space Agency’s Swarm constellation) with animal tracking data using a spatio-temporal interpolation approach. We assess accuracy of the fusion through a comparison with calibrated terrestrial measurements from the International Real-time Magnetic Observatory Network (INTERMAGNET). We fit a generalized linear model (GLM) to assess how the absolute error of annotated geomagnetic intensity varies with interpolation parameters and with the local geomagnetic disturbance. Results: We find that the average absolute error of intensity is − 21.6 nT (95% CI [− 22.26555, − 20.96664]), which is at the lower range of the intensity that animals can sense. The main predictor of error is the level of geomagnetic disturbance, given by the Kp index (indicating the presence of a geomagnetic storm). Since storm level disturbances are rare, this means that our tool is suitable for studies of animal geomagnetic navigation. Caution should be taken with data obtained during geomagnetically disturbed days due to rapid and localised changes of the field which may not be adequately captured. Conclusions: By using our new tool, ecologists will be able to, for the first time, access accurate real-time satellite geomagnetic data at the location and time of each tracked animal, without having to start new tracking studies with specialised magnetic sensors. This opens a new and exciting possibility for large multi-species studies that will search for general migratory responses to geomagnetic cues. The tool therefore has a potential to uncover new knowledge about geomagnetic navigation and help resolve long-standing debates.