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The integrity of the antimicrobial supply chain in Bangladesh: assessing the regulatory environment and contextual challenges.

ABSTRACT: Most low- and middle-income countries lack the regulatory capacity to contain substandard and falsified (SF) medicines. Innovations for strengthening regulatory systems are needed to protect public health. We assessed the integrity of the antimicrobial supply chain in Bangladesh. We employed qualitative methods comprising policy content analysis, and literature and database reviews. Using a framework modified from the World Health Organization's and the United States Pharmacopoeia's, the Bangladesh National Drug Policy (BNDP), was evaluated for provisions on medicines quality assurance mechanisms. We used newspaper, peer-reviewed, and post-marketing surveillance reports to assess prevalence of SF antimicrobials. The BNDP contains provisions for quality assurance. Newspaper reports identified circulation of substandard antimicrobials. We identified only six peer-review studies testing antimicrobial product quality with three studies reporting out-of-specifications products. We suggest three strategies for strengthening the regulatory system: community-based surveillance, task shifting, and technology-enabled consumer participation.

SUBMITTER: Orubu ESF

PROVIDER: S-EPMC9646268 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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The integrity of the antimicrobial supply chain in Bangladesh: assessing the regulatory environment and contextual challenges.

Orubu Ebiowei Samuel F ESF Samad Mohammed Abdus MA Rahman Md Tanvir MT Zaman Muhammad H MH Wirtz Veronika J VJ

Journal of public health policy 20221109 4

Most low- and middle-income countries lack the regulatory capacity to contain substandard and falsified (SF) medicines. Innovations for strengthening regulatory systems are needed to protect public health. We assessed the integrity of the antimicrobial supply chain in Bangladesh. We employed qualitative methods comprising policy content analysis, and literature and database reviews. Using a framework modified from the World Health Organization's and the United States Pharmacopoeia's, the Banglad ...[more]

PMID: 36352259

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Project description:IntroductionMaintaining access to antimicrobials while preventing misuse is essential to combating the threat of antimicrobial resistance (AMR). The study objectives are to propose a framework of 16 indicators that can be used at the national level to assess the capacity to ensure access and curtail inappropriate use and to profile the antimicrobial supply chain for Bangladesh.MethodsUsing a framework based on a rational construct, we assessed the antimicrobial supply chain of Bangladesh, with a focus on key players and products using a scoping review to obtain and describe information on 16 indicators. With players, we mapped linkages, manufacturers' production capacity, and ownership, among others, and demand point characteristics-pharmacy and pharmacist density, pharmacy/medicine outlets dispersion, veterinary clinic/hospitals, veterinarians' density, product quality, and regulation. We assessed product characteristics including listing on the World Health Organization (WHO) Model Essential Medicines List (EML) and WHO Access, Watch, and Reserve (AWaRe) classification of the major (top 10) antibiotics for human use; the proportion of medically important antimicrobials (MIAs) in veterinary use; and pricing. Production capacity and price controls were used to assess access and listing on the WHO EML, AWaRe/MIA classification, and a calculated pharmacy-to-pharmacist ratio to assess use.ResultsBangladesh has a high (98%) local antibiotic production capacity with pricing controls indicating the ability to ensure access. The presence of a high proportion of medicine outlets not under the control of pharmacists (4:1) and the high percentages of WHO Watch (54%) and MIAs (90%) of the major antibiotics are indicators of possible misuse.DiscussionMost of the data used in the framework were publicly available. Bangladesh has the capacity to ensure access but needs to strengthen its ability to regulate the quality of antimicrobials and prevent their inappropriate use through antimicrobial stewardship at the community (medicine outlet) levels to check AMR. There may also be a need for more regulations on licensing of MIAs.

Project description:This study aims to investigate the supply chain challenges of public sector agriculture development projects in Bangladesh using the modified Delphi, Best Worst Method (BWM), and Interpretive Structural Modelling (ISM) methods. Based on these three widely acclaimed statistical techniques, the study identified, ranked, and identified interrelationships among the challenges. The study is unique not only in terms of research findings, but also in terms of methodology, as it is the first to use the three MCDM (Multicriteria Decision Making) tools to examine supply chain issues in public sector agriculture development projects in a developing country context. A literature review and two modified Delphi rounds with 15 industry experts' opinions were applied to identify and validate a list of 11 key supply chain challenges. To determine the priority of the challenges, a panel of eight industry experts was consulted, and their responses were analysed using the BWM. Then, another group of 10 experts was consulted using ISM to investigate the contextual relationships among the challenges, resulting in a five-layered Interpretive Structural Model (ISM) and MICMAC (cross-impact matrix multiplication applied to classification) analysis of the challenges. According to relative importance (global weights), "improper procurement planning (0.213), "delay in project initiation (0.177), "demand forecasting error (0.146)", "lack of contract monitoring mechanism (0.097)", and "lack of competent staff (0.095)" are the top five ranked key challenges that have a significant impact on the project supply chain. Regarding contextual relationships, the ISM model and ISM-MICMAC analysis identified the "political influence" challenge as the most influential, and also independent of the other challenges. The findings are critical for project managers in managing challenges because understanding both relative importance and contextual relationships are required to address the challenges holistically. Additionally, these findings will benefit policymakers, academics, and future researchers.

Project description:BackgroundSalmonella enterica is a major cause of foodborne illness and mortality worldwide, but its presence in milk along the milk supply chain and associated public health risks are under-studied. This research was aimed to investigate the occurrence and antimicrobial susceptibility of Salmonella enterica in milk, milking environments, milkers' hands, and diarrheic patients in Wolaita Sodo, Ethiopia.MethodsWe collected 644 samples from 106 dairy farms that include direct milk from cow, bulk tank milk, milkers' hand swabs, teat surfaces swabs, farm floors swabs, milk storage containers swabs, collectors' bulk milk, retailers' bulk milk, and stool from diarrheic patients. Salmonella enterica was isolated using standard microbiological methods (culture-based detection, serology and PCR), and antimicrobial susceptibility was tested using the Kirby-Bauer disk diffusion method against 14 antimicrobials.ResultsThe overall occurrence of Salmonella enterica was 1.86% (12/644). The detection rate was 2.06% (7/339: 95% CI: 1.0-4.20) along the milk supply chain, 1.94% (2/103:95% CI: 0.53-6.81) in diarrheic outpatients and 1.49% (3/202: 95% CI: 0.51-4.27) in the milking environments. Relatively, higher contamination rate (6%, 3/50; 95% CI: 2.06-16.22) was observed in milk samples collected from milk collectors. The isolates exhibit higher resistance to clindamycin (100%), erythromycin (100%), vancomycin (100%), amoxicillin (100%), ceftazidime (100%), and ampicillin (75%). Of the isolates, 92%, 83% and 67% were susceptible to norfloxacin, ciprofloxacin and Trimethoprim, respectively. All the isolates were multidrug resistant (MDR).ConclusionsThe study findings showed the occurrence of a considerable proportion of antimicrobial resistant Salmonella enterica across all sample sources, indicating potential transmission risks between cattle and humans via milk, and the milking environment. The alarming multidrug-resistant strains limit treatment options and complicate pathogen control. To prevent transmission and spread of antimicrobial resistant pathogen, proper hygiene practices, public education, and antimicrobial stewardship are essential. These measures will help ensure the safety of milk and dairy products. Further research on genetic relatedness among isolates, quantifying public health risks of milk consumption, and cost-effective intervention options is needed to reduce Salmonella-related morbidity and mortality.

Project description:In Bangladesh, Covid-19 has wrecked devastation on people's livelihoods and economies. It began with supply chain disruptions affecting a variety of agricultural products, particularly perishable ones. Onion, the most consumed species in Bangladesh and Asia is also fallen into that category. The goal of this study was to shed light on the current onion supply chain as well as the constraints faced by the actors in Bangladesh's major onion-producing area markets (i.e., Pabna, Rajshahi, and Chapainawabganj). The extent to which pre-existing constraints on market actors of onion were discovered and distinguished in pre-covid to covid conditions. The backward supply chain analysis revealed that the local market seller supplied the majority of necessary farm inputs (i.e., seed, seedlings, and fertilizer). Wholesalers, commission agents (aratdars), local wholesalers (beparies), and retailers were all involved in forward connecting. Producers received roughly 71% of the retail price (0.76/kg), followed by retailers (BDT 2.07/kg), wholesalers (BDT 1.22/kg), commission agents (aratdars) (BDT 0.85/kg), and independent wholesalers (beparies) (BDT 0.36/kg). Moreover, a constraint factor index and econometric analysis were utilized to determine the most critical constraints and their influencing factors. Obstacles to onion production and commercialization ranged from moderate (66%) to severe (33.5%), with a few being fairly severe (0.5%). The paucity of high-quality seed, the cost and difficulty of timely transportation, and the market's inaccessibility to government intervention were all significant drawbacks to increased onion output. The primary impediments to onion marketing were a lack of or inability to receive marketing expertise, frequent demand fluctuations, and an insufficient storage facility for other market intermediaries. The findings of the study can assist in establishing a dynamic policy framework that includes procedure for expanding market infrastructure, rehabilitating current onion market actors through adequate training, assuring information abundance, and rapidly addressing market mishaps for ensuring sustainability.

Project description:This study assessed the veterinary drug supply chain in Uganda, the constraints faced by the actors, and how the challenges influence the use of antimicrobial (AMs) by livestock farmers. We carried out stakeholder consultation workshops, key informant interviews and a knowledge, practices, and awareness survey with actors of the veterinary drug supply chain. We also profiled drugs stored in 23 urban and peri-urban drug shops in Lira and Mukono districts to record the commonly sold drugs. The veterinary drug supply chain is made of several actors including wholesalers, retailers, Animal Health Service Providers (AHSP) and farmers. Nearly ninety per cent of drug retailers and veterinary practitioners did not receive specialized training in veterinary medicine, and most of veterinary practitioners have been in the drug business market for more than 10 years. Antibiotics and anti-helminthics were the most stocked drugs by retailers, with antibiotics ranking highest in terms of contribution to annual financial profits, accounting for 33%. The choice of a drug by veterinary practitioners was mainly informed by past success with efficacy of the drug, and financial capacity of the client (the farmer) to meet the treatment cost. Many veterinary practitioners were not conversant with veterinary drug policies of the country, with Mukono having a higher number (72%) compared to Lira (37%). Veterinary practitioners from Lira district compared to Mukono and those mainly serving small scale farmers relative to large scale smallholders were more knowledgeable about antibiotics and AMR. Several supply chain constraints were identified as potential drivers of misuse of antibiotics that could contribute to AMR. These included low level of education of supply chain actors, particularly drug retailers, poor handling of drugs at purchase and administration practices, low enforcement of policies and regulations, and lack of awareness of stakeholders about policies that regulate drug use. Thus, future interventions to reduce misuse of AM drugs in livestock production systems in Uganda such as capacity building, should also target veterinary input suppliers, and deliberately involve a strong policy advocacy component.

Dataset Information

The integrity of the antimicrobial supply chain in Bangladesh: assessing the regulatory environment and contextual challenges.

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The integrity of the antimicrobial supply chain in Bangladesh: assessing the regulatory environment and contextual challenges.

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