Nepal Prajwol, Subedee Anup, Shakya Henish, Poudel Sanjaya, Joshi Supriya, Karki Kshitij, Bajracharya Deepak, Prentiss Tyler, Kaljee Linda, Acharya Yubraj
University of North Carolina-Chapel Hill, Chapel Hill, USA.
Public Health Concern Trust, Nepal & Kirtipur Hospital, Nepal.
Contemp Clin Trials Commun. 2023 Jun 21;34:101177. doi: 10.1016/j.conctc.2023.101177. eCollection 2023 Aug.
Antimicrobial resistance (AMR) is one of the top ten threats to global health. There exists limited empirical evidence on effective approaches to address this threat. In low- and middle-income countries (LMICs), one of the primary drivers of AMR is easy access to antibiotics without prescriptions, in particular from community pharmacies. Interventions to reduce non-prescribed use of antibiotics and surveillance systems to track such usage are critically needed. This protocol describes a study that aims to test the effect of an educational intervention targeted to parents of young children on non-prescribed antibiotics consumption in Nepal and to track such consumption using a phone-based application.
The study is a clustered randomized controlled trial, in which we randomly assign 40 urban wards of Kathmandu Valley to either treatment group or control group, and randomly select 24 households in each ward. Households in the treatment group will receive an education intervention consisting of an "AMR pitch" (an in-person interaction that lasts up to an hour) by community nurses, videos and text messages on AMR every two weeks, and a brochure. We will conduct a survey at baseline with the parents of children ages 6 months to 10 years and track consumption of antibiotics and health care use among these children for a period of 6 months using a phone-based application.
While the study will primarily inform future policy and programmatic efforts to reduce AMR in Nepal, the study-both the education intervention and the surveillance system-can serve as a prototype for tackling AMR in other similar settings.
抗菌药物耐药性（AMR）是对全球健康的十大威胁之一。关于应对这一威胁的有效方法，现有的实证证据有限。在低收入和中等收入国家（LMICs），AMR的主要驱动因素之一是无需处方就能轻松获得抗生素，尤其是从社区药店获取。迫切需要采取干预措施减少抗生素的非处方使用，并建立监测系统来追踪此类使用情况。本方案描述了一项研究，旨在测试针对幼儿家长的教育干预对尼泊尔非处方抗生素消费的影响，并使用一款基于手机的应用程序来追踪此类消费情况。
该研究是一项整群随机对照试验，我们将加德满都谷地的40个城市病房随机分为治疗组或对照组，并在每个病房随机选择24户家庭。治疗组的家庭将接受一项教育干预，包括社区护士进行的“AMR宣传”（一次持续长达一小时的面对面互动）、每两周一次关于AMR的视频和短信，以及一本宣传册。我们将在基线时对6个月至10岁儿童的家长进行调查，并使用一款基于手机的应用程序在6个月的时间内追踪这些儿童的抗生素消费和医疗保健使用情况。
虽然该研究主要将为尼泊尔未来减少AMR的政策和项目努力提供信息，但该研究——包括教育干预和监测系统——可作为在其他类似环境中应对AMR的一个范例。
