Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh.
PLoS One. 2020 Jan 27;15(1):e0227947. doi: 10.1371/journal.pone.0227947. eCollection 2020.
Antimicrobial resistance (AMR) has become an emerging issue in the developing countries as well as in Bangladesh. AMR is aggravated by irrational use of antimicrobials in a largely unregulated pluralistic health system. This review presents a 'snap shot' of the current situation including existing policies and practices to address AMR, and the challenges and barriers associated with their implementation.
A systematic approach was adopted for identifying, screening, and selecting relevant literature on AMR situation in Bangladesh. We used Google Scholar, Pubmed, and Biomed Central databases for searching peer-reviewed literature in human, animal and environment sectors during January 2010-August 2019, and Google for grey materials from the institutional and journal websites. Two members of the study team independently reviewed these documents for inclusion in the analysis. We used a 'mixed studies review' method for synthesizing evidences from different studies.
Of the final 47 articles, 35 were primary research, nine laboratory-based research, two review papers and one situation analysis report. Nineteen articles on human health dealt with prescribing and/or use of antimicrobials, five on self-medication, two on non-compliance of dosage, and 10 on the sensitivity and resistance patterns of antibiotics. Four papers focused on the use of antimicrobials in food animals and seven on environmental contamination. Findings reveal widespread availability of antimicrobials without prescription in the country including rise in its irrational use across sectors and consequent contamination of environment and spread of resistance. The development and transmission of AMR is deep-rooted in various supply and demand side factors. Implementation of existing policies and strategies remains a challenge due to poor awareness, inadequate resources and absence of national surveillance.
AMR is a multi-dimensional problem involving different sectors, disciplines and stakeholders requiring a One Health comprehensive approach for containment.
抗菌药物耐药性（AMR）在发展中国家以及孟加拉国已成为一个新出现的问题。在一个基本上不受监管的多元化卫生系统中，抗菌药物的不合理使用加剧了 AMR 的问题。本综述介绍了当前的情况，包括现有的应对 AMR 的政策和实践，以及与实施相关的挑战和障碍。
我们采用系统方法，确定、筛选和选择了有关孟加拉国 AMR 情况的相关文献。我们使用 Google Scholar、Pubmed 和 Biomed Central 数据库，在 2010 年 1 月至 2019 年 8 月期间，在人类、动物和环境领域搜索同行评议文献，并使用 Google 搜索机构和期刊网站上的灰色文献。研究团队的两名成员独立审查了这些文件，以确定是否纳入分析。我们使用“混合研究综述”方法，综合来自不同研究的证据。
最终有 47 篇文章被纳入分析，其中 35 篇为原始研究，9 篇为实验室研究，2 篇为综述论文，1 篇为情况分析报告。19 篇关于人类健康的文章涉及处方和/或抗菌药物的使用，5 篇关于自我用药，2 篇关于不遵守剂量，10 篇关于抗生素的敏感性和耐药性模式。4 篇论文集中在食用动物中使用抗菌药物，7 篇论文集中在环境污染。研究结果显示，该国抗菌药物广泛无处方供应，不合理使用现象普遍存在，导致环境受到污染，耐药性传播。AMR 的产生和传播是由各种供需因素造成的。由于认识不足、资源不足和缺乏国家监测，现有政策和战略的实施仍然是一个挑战。
AMR 是一个涉及不同部门、学科和利益相关者的多维度问题，需要采取一种“同一健康”的综合方法来遏制。
