Stålsby Lundborg Cecilia, Diwan Vishal, Pathak Ashish, Purohit Manju R, Shah Harshada, Sharma Megha, Mahadik Vijay K, Tamhankar Ashok J
Department of Public Health Sciences, Global Health - Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, 171 77, Stockholm, Sweden.
Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India.
BMC Public Health. 2015 Dec 30;15:1321. doi: 10.1186/s12889-015-2632-2.
Antibiotic resistance has been referred to as 'the greatest malice of the 21st century' and a global action plan was adopted by the World Health Assembly in 2015. There is a wealth of independent studies regarding antibiotics and resistant bacteria in humans, animals and their environment, however, integrated studies are lacking, particularly ones that simultaneously also take into consideration the health related behaviour of participants and healthcare providers. Such, 'One health' studies are difficult to implement, because of the complex teamwork that they entail. This paper describes the protocol of a study that investigates 'One health' issues regarding antibiotic use and antibiotic resistance in children and their environment in Indian villages.
METHODS/DESIGN: Both quantitative and qualitative studies are planned for a cohort of children, from 6 villages, and their surrounding environment. Repeated or continues data collection is planned over 2 years for quantitative studies. Qualitative studies will be conducted once. Studies include parents' health seeking behavior for their children (1-3 years of age at the onset), prescribing pattern of formal and informal healthcare providers, analysis of phenotypic antibiotic resistance of Escherichia coli from samples of stool from children and village animals, household drinking water, village source water and waste water, and investigation on molecular mechanisms governing resistance. Analysis of interrelationship of these with each other will also be done as basis for future interventions. Ethics approval has been obtained from the Institutional Ethics Committee R.D. Gardi Medical College, Ujjain, India (No: 2013/07/17-311).
The findings of the study presented in this protocol will add to our knowledge about the multi-factorial nature of causes governing antibiotic use and antibiotic resistance from a 'One health' perspective. Our study will be the first of its kind addressing antibiotic use and resistance issues related to children in a One-health approach, particularly for rural India.
抗生素耐药性被称为“21世纪最大的危害”，世界卫生大会于2015年通过了一项全球行动计划。关于人类、动物及其环境中的抗生素和耐药菌，有大量独立研究，但缺乏综合研究，尤其是那些同时考虑参与者和医疗服务提供者健康相关行为的研究。由于这类“同一健康”研究需要复杂的团队合作，因此难以实施。本文描述了一项研究方案，该研究调查印度村庄儿童及其环境中与抗生素使用和抗生素耐药性相关的“同一健康”问题。
方法/设计：计划对来自6个村庄的一组儿童及其周围环境进行定量和定性研究。定量研究计划在2年内进行重复或持续的数据收集。定性研究将进行一次。研究包括父母为其子女（开始时年龄为1 - 3岁）寻求医疗服务的行为、正规和非正规医疗服务提供者的开药模式、对儿童和村庄动物粪便样本、家庭饮用水、村庄水源水和废水样本中大肠杆菌的表型抗生素耐药性分析，以及对耐药性控制分子机制的研究。还将分析这些因素之间的相互关系，作为未来干预措施的基础。已获得印度乌贾因R.D. Gardi医学院机构伦理委员会的伦理批准（编号：2013/07/17 - 311）。
本方案中提出的研究结果将从“同一健康”的角度增加我们对抗生素使用和抗生素耐药性成因多因素性质的认识。我们的研究将是首次以同一健康方法解决与儿童相关的抗生素使用和耐药问题，特别是针对印度农村地区。
