Drug Sellers Research Articles

Understanding malaria treatment patronage from informal healthcare providers in Nigerian urban settlements: insights from community members and providers.

Informal Healthcare Providers (IHCPs), including Proprietary Patent Medicine Vendors (PPMVs), drug peddlers, traditional healers, and herbal drug sellers are often the first choice for malaria treatment, especially in urban slums. Unplanned urbanization significantly impacts malaria transmission by creating cities with inadequate safety nets and healthcare access, increasing reliance on IHCPs. While the World Health Organization recognizes IHCP's crucial role and emphasizes integrating them into formal healthcare for improved malaria care, they lack requisite training in malaria management and operate outside official regulations, raising concerns about the quality of care they provide. Understanding IHCPs' perceptions and practices is essential for their proper integration. This study explored the perceived malaria burden, IHCPs' competence in malaria treatment, and reasons for visiting IHCPs in various urban settlements from both community member and provider perspectives. This qualitative cross-sectional study was carried out in Ibadan and Kano metropolises. Eighteen Focus Group Discussions among 157 adult community members and twelve Key-Informant Interviews among PPMVs, drug peddlers, traditional healers and herbal drug sellers were conducted in these cities. Participants were drawn purposively from settlements-designated as formal, informal, and slum based on local definitions-in selected wards within the cities. Data were collected using pre-tested guides and analysed thematically. This study reveals that malaria remains a significant health problem in these Nigerian cities. Patronage of IHCPs generally is driven by affordable treatment, perceived mildness of illness, and access to credit facilities. However, cultural belief was key to patronage of traditional healers and herbal drug sellers, largely among informal and slum residents. Furthermore, while IHCPs had a strong perceived competence in managing malaria cases, inadequate diagnosis and treatment were standard practices. IHCPs remain consistently patronized across urban settlements. IHCPs are continuously patronized in all urban settlement. Educating and equipping IHCPs with diagnostic tools, enhancing access to affordable healthcare, and raising public awareness is crucial for proper malaria management and promoting collaborations with formal healthcare providers.

The use of human antiretroviral drugs (ARVs) in broiler chicken and domestic pig farming in Tanzania

Abstract Background The use of antiretroviral (ARV) drugs in Tanzania has led to a significant reduction in morbidity and mortality and improved quality of life among people living with HIV infection. However, the ease of access and availability of the drugs has, in some cases, led to misuse of the ARV in areas such as animal farming, posing a risk of the emergence of ARV resistance. The study’s objective was to investigate the use of ARV in animal farming and the factors associated with ARV use. We conducted a cross-sectional study in three regions (Dar es Salaam, Iringa, and Mbeya) using focus group discussions. The researchers used NVivo 12 software for qualitative data analysis. Results A total of 113 participants participated in this study. The participants mentioned the use of veterinary, human, and local medicines to be prevalent. The drivers for such usage are disease treatment and prevention, growth promotion, counterfeited drugs, higher cost of animal feeds, profit maximization, market competition, advice from veterinary drug sellers, and easy availability and accessibility of medicines. New Castle, respiratory diseases, and diarrhea were the most common diseases affecting broiler chickens, while limb paralysis, swine fever, and skin diseases were prominent in domestic pigs. The Dar es Salaam region has a scarcity of extension officers compared to the Mbeya and Iringa regions. Almost all FGD participants reported hearing about the use of ARVs and family planning injectable and pills. Some of the participants agreed to use these drugs for growth promotion since they are effective. Conclusion High usage of veterinary, human, and other medicines, including ARVs, in animal production predisposes the Tanzanian community to public health threats, including antibiotic and antiretroviral resistance. We recommend implementing urgent mitigation strategies to control the misuse of human ARVs in animal production.

Are urban residents seeking appropriate care for malaria? evidence from an exploratory qualitative study in two cities in nigeria

BackgroundUnplanned and rapid urbanization within Nigerian cities with the attendant environmental consequences may hinder achieving malaria elimination goal. Presently, there are limited qualitative studies on malaria case management and care-seeking patterns by settlement type in urban areas in Nigeria. This study, investigated malaria-related health seeking behaviours among different settlement types in Ibadan and Kano metropolises, Nigeria.MethodsThis qualitative study involved conduct of nine Focus Group Discussions (FGDs) sessions among community members and 20 Key Informant interviews (KIIs) with healthcare providers and community stakeholders in each metropolis. Participants were purposively drawn from three settlement types – formal, informal and urban slum. Pretested FGD and KII guides were used to collect data. Data were subjected to thematic content analysis.ResultsGovernment-owned health facilities especially Primary Health Care (PHC) facilities was a major place identified as where many community members prefer to seek care for suspected malaria infection. Reasons adduced included proximity of facilities and services affordability. A common viewpoint was that most community members in informal and slum communities in both metropolises often patronize Proprietary Patent Medicine Vendors (PPMVs) or drug sellers as the first point for treatment of suspected malaria infection. Adduced reasons included poverty and non-availability of 24 h services in PHC facilities. High cost of treatment, poor attitude of health workers, long waiting time and cultural beliefs were identified as key factors influencing community members’ decision not to seek care in health facilities. It was noted that the rich prefer to seek treatment in private hospitals, while the poor usually visit PHCs or resort to other options like buying drugs from PPMVs or use herbal drugs.ConclusionThe standard practice of seeking care in health facilities was influenced by diverse factors including treatment cost, health workers’ attitude and waiting time in health facilities. A commoner practice of seeking care from patent medicine vendors and herbal drug sellers among informal settlements and slums dwellers calls for public health interventions. Specifically, the provision of free or affordable malaria care in health facilities and patient-friendly environments; and training of non-formal care providers on appropriate malaria care and referral to health facilities are recommended.

Social norms and maternal health information-seeking behavior among adolescent girls: A qualitative study in a slum of Bangladesh.

Adolescent girls of reproductive age who actively seek information on maternal health often tend to have better health-seeking behaviors and maternal health outcomes. Due to scant research on reproductive aged adolescent girls' maternal health information seeking behavior in slum, in connection with social norms, we aimed for this particular study. Adopting an explorative qualitative research approach, we collected data from purposively selected married and unmarried adolescent girls aged 15-19 of different occupation by implying 12 in-depth interviews (IDIs), 2 focus group discussions (FGDs) with the same categories employed for IDIs, and 2 key informant interviews (KIIs) with a traditional birth attendant and a drug seller. Furthermore, the data were subjected to thematic analysis. Care's Social Norms Analysis Plot (SNAP) framework was undertaken as an interpretative tool for data that was emerging rather than serving as the foundation for the study's conduct and design. Thematic analysis was followed to analyze primary data. Findings show that most girls rely on maternal health-related information from unverified sources, including family members, traditional birth attendants, and drug sellers, which increases health risks. The majority reported that adolescent girls need professional healthcare providers in their area who would work according to their work schedule as most of the girls are engaged in income-generating work for about 9-11 hours, and the scope of work (daily wagers) hardly supports 'leave with pay'. Therefore, there is a critical need for professional healthcare services tailored to the girls' work schedules. Social norms and stigma further restrict access to reliable health information, especially for unmarried girls. Socioeconomic disparities also shape health-seeking behaviors, with wealthier adolescents having greater access to formal healthcare services. Addressing these barriers is crucial for improving maternal health outcomes. The results might be useful for informed policy formulation and program design to ensure better health outcomes for marginalized adolescents.

Risk and Reward Perceptions in Acquisitive Crime: A Comparative Analysis of Credit Fraud, Drug Dealing, Burglary, and Robbery

Acquisitive crimes share a common thread in that they focus on obtaining some form of benefit. There is considerable variation in the potential risks and rewards inherent in each crime type, however. This study assessed whether perceptions of risk, rewards, and social costs differentially predict engagement in four acquisitive crimes: credit fraud, drug selling, burglary, and robbery. This study also examined specialization within these offenses. The results suggested that increased risk perceptions reduced the odds of engagement in burglary and drug selling. Reward perceptions increased odds of engagement in fraud, burglary, and robbery. There was limited specialization, with some exception for drug selling. Understanding the perceptual dynamics of acquisitive crime is important for developing policies tailored to specific crime types.

Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs.

Risk management is an important component of service delivery in supportive housing and Housing First programs. However, there is no evidence on the implementation of risk management approaches in these settings. This qualitative study examined what service providers working in supportive housing and Housing First programs in Canada identify as the programmatic and organizational factors that affect the prevention and management of high-risk behaviours and challenges (e.g., overdose, suicide attempts, non-suicidal self-injury, falls and fall-related injuries, fire-setting, hoarding, apartment takeovers, violence, property damage, drug selling) in their programs. In-depth interviews were completed with a purposive sample of 32 service providers. Data were analyzed using an integrative approach that incorporated techniques from qualitative description and thematic analysis. Four thematic factors, which were comprised of various barriers and facilitators, that affected management of high-risk issues in supportive housing and Housing First programs were identified: [1] flexibility in addressing risk issues; [2] early identification of risk issues; [3] built environment and housing location; and [4] resource availability. Overall, the findings underscore how service providers aim to identify high-risk issues promptly, beginning as early as referral, and that their capacity to effectively do this and intervene accordingly is dynamically shaped by various aspects of the program model, environment, and availability of internal and external resources. Yet, the findings also highlight how risk management approaches may conflict with other programmatic goals and values, and the importance of considering these collectively. Systems-level changes to strengthen programs' capacity to prevent risk and implications for future research are discussed.

Prevalence and correlates of fentanyl test strip use among people who use drugs in Rhode Island

BackgroundIllicitly manufactured fentanyl accounts for a majority of overdose fatalities in the US. Research has demonstrated that fentanyl test strips (FTS) help people who use drugs (PWUD) avoid unintended exposure to fentanyl and overdose. This study assesses characteristics associated with FTS use among PWUD in Rhode Island. Such findings may shed light on whether there are subgroups of PWUD who are less likely to be using FTS and therefore may benefit from their use. MethodsFrom September 2020 - February 2023, participants were recruited to participate in RAPIDS, a clinical trial assessing whether FTS provision can reduce overdose rates. Baseline data were used to assess correlates of lifetime FTS use through bivariable and multivariable analyses. We also examined drug testing patterns relating to FTS use in the past month. ResultsOf 509 people enrolled, 376 (73.9 %) had heard of FTS before enrollment. Among this group, 189 (50.3 %) reported lifetime FTS use and 98 (26.1 %) reported use in the last month. In bivariable analyses, lifetime injection drug use, responding to an overdose, and drug selling were associated with FTS use. Solitary drug use was not associated with FTS uptake. In the multivariable analysis, gender and lifetime naloxone administration were associated with FTS use. Of those who used FTS in the past month, 76.5 % had at least one test that was positive for fentanyl. ConclusionsWe found high uptake of FTS use among PWUD in Rhode Island. Our results also suggest a need for targeted outreach to increase FTS uptake among sub-groups of PWUD. Clinical trial registrationThe Rhode Island Prescription and Illicit Drug Study is a registered clinical trial, NCT043722838

Exploring Antibiotic Use in the Community: A Household-Based Survey Using the Drug Bag Method in Rural Burkina Faso.

In Burkina Faso, there is lack of awareness of antibiotic use at the community level. This study aims to generate information on the commonly used antibiotics along with the reasons for which they have been used in rural Burkina Faso. The drug bag method was employed to collect information from 423 households in the health district of Nanoro. Descriptive analyses were performed using R software version 4.2.1. Of the 33 antibiotics inventoried, amoxicillin tablets and oxytetracycline were the most recognized and used antibiotics. This study indicated that antibiotics were used for a range of health problems in the community, some of which were administered as painkillers. While primary healthcare facilities constituted the primary source of drugs for households (76.8%), informal drug sellers constituted an additional option (61.5%) for community members. This is a significant concern, given that some antibiotics classified as "Watch"-such as norfloxacin-were readily available in these outlets, despite not being included on the country's Essential Medicines List. This study underscores the necessity of considering the role played by formal providers in the inappropriate use of antibiotics and the importance of understanding the circumstances and logical reasoning underlying communities' access to and use of antibiotics.

Drug market risk environment and navigational strategies of street-level dealers in Nigeria

Background Researchers have investigated drug market risks and navigational strategies of drug dealers in western societies. Less is known about this phenomenon in Africa. This study explores drug market risk environment and navigational strategies of street drug dealers in Nigeria. Methods The study uses qualitative data from in-depth interviews with street-level dealers (n = 31) recruited through snowball sampling in Uyo, Nigeria. Thematic analysis of transcripts generated three major themes (‘policing,’ ‘rivalry’ and ‘indiscretion’) as risk factors for police harassment, arrest and violence. Results Accounts identified policing, rivalry between drug dealers and indiscretion (e.g., exchanging drugs for potentially stolen items) as risk factors for police harassments, arrest and violence. Drug dealers navigate risks in different ways, including through bribing police officers, using police proxies in partisan negotiation of drug market conflicts, and non-exchange of drugs for potentially stolen items. Conclusion The findings underscore an ecological view of drug market risks where factors operating at different levels interact to shape risks, with policing featuring as an overarching macro-level risk factor. The failure of law enforcement to absolutely deter drug selling due to dealer’s navigational strategies such as informal privatization of police, indicates a need for alternative approaches to controlling street-level drug markets.

Prevalence of antibiotic use for childhood diarrhoea in Uganda after an ORS scale-up intervention: a repeated cross-sectional study

BackgroundDiarrhoea kills 500,000 children every year despite availability of cheap and effective treatment. In addition, a large number are inappropriately treated with antibiotics, which do not benefit the patient but can contribute to the development of antibiotic resistance. We investigated whether the prevalence of antibiotic use among children under the age of five with diarrhoea in Uganda changed following a national intervention to increase the use of oral rehydration salts (ORS), and whether any socioeconomic characteristics were associated with antibiotic use.MethodsA cross-sectional survey was conducted among caregivers of children under the age of five and among private health care providers and drug sellers in Uganda in 2014. This was compared to a similar survey among private health care providers, and the national demographic and health survey in Uganda in 2016. Logistic regression was used to find associations between antibiotic use and socioeconomic characteristics, and chi-square test and independent sample t-test were used to find significant differences between groups.ResultsThe prevalence of antibiotic use among children under the age of five with diarrhoea in Uganda decreased from 30.5% in 2014 to 20.0% (p < 0.001) in 2016. No associations between socioeconomic characteristics and the use of antibiotics were significant in both 2014 and 2016.ConclusionsThe use of antibiotics in children with diarrhoeal disease decreased significantly in Uganda between 2014 and 2016. However, the extent of the contribution of the ORS scale-up programme to this decrease cannot be determined from this study.

“Expected to happen”: perspectives on post-release overdose from recently incarcerated people with opioid use disorder

BackgroundOpioid-related overdose is the leading cause of death for people recently released from incarceration, however treatment with medications for opioid use disorder (MOUD) during incarceration can reduce the mortality risk. This study seeks to qualitatively analyze perceptions of post-release overdose risk from the perspectives of people who received MOUD while incarcerated in one of eight Massachusetts jails during 2021–2022 using the Risk Environment Framework to guide analyses.MethodsN = 38 participants with lived experience of MOUD treatment during incarceration who are now living in the community were interviewed on factors that may contribute to or protect against post-release overdose risk. Themes were identified inductively and deductively using the Risk Environment Framework and its domains, which organizes themes along physical, social, economic, and policy environments on both the micro- and macro- scales.ResultsThe physical risk environment included loss of opioid tolerance during incarceration, polysubstance use, and the toxicity of the regional drug supply as key producers of increased risk for post-release overdose. Social drivers of risk included peer group risk norms—including peer-driven harm reduction practices and interpersonal relationships between drug sellers and buyers—as well as macro-level social determinants of health such as housing insecurity and availability of mental health services. Economic drivers of post-release overdose risk included lack of income generation during incarceration and employment challenges. Participants discussed several aspects of policy that contribute to post-release overdose risk, including availability of harm reduction supplies, public health services, and broader policy around MOUD.ConclusionsThe perspectives of people with lived experience are vital to understanding the disproportionate risks of overdose for those recently released from incarceration. Our results highlight the intersectional factors that produce and reproduce the post-release overdose risk environment, providing support for interventions across each domain of the Risk Environment Framework. By capturing perspectives from people with lived experience of OUD and incarceration during this critical period of risk, we can better identify interventions that target and mitigate overdose-related harm in this population.

Epidemiology of drug arrests in the United States: Evidence from the national survey on drug use and health, 2015–2019

ObjectiveFollowing changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S. MethodsSerial cross-sectional data from the National Survey on Drug Use and Health (2015–2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression. ResultsPast-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84]. ConclusionDespite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.

Distribution Deviation Of Limited Over-The-Counter Medicines And Prescription Medicines In Grocery Storesin X Village, Tarakan

Regarding the distribution of medicines to pharmaceutical facilities, there are several problems that are often found in the community, namely, there are still many places such as grocery stores that do not have permits to sell medicines, in fact quite a few of these stalls sell hard medicines without service and information about good treatment. This research aims to obtain an overview of irregularities in the distribution of restricted over-the-counter medicines including precursors and Obat-Obat Tertentu (OOT) and hard medicines in grocery stores in the amal beach area. This study used descriptive qualitative method. The sample for this research was all grocery stores in the X sub-district area that were willing to be respondents, namely 28 stores. The research results showed that all respondents sold limited over-the-counter drugs including precursors and OOTs as well as hard drugs. The most limited over-the-counter drug sold is Paramex, the most common precursor and oot drug is Mixagrip flu, and the most hard drug is mefenamic acid with various types of brand names. Based on the results of interviews with shop owners, it is known that most drugs are obtained by purchasing directly from pharmacies, sales and drug stores. Based on the results of this research, it can be concluded that there are irregularities in drug distribution in the X Village area, Tarakan City, because there are still grocery stores selling limited over-the-counter drugs, OOT, precursors and hard drugs.

The Gut Feeling of Rational Acting: Differentiation in Cognitive Strategies Within Commercial and Recreational Sellers in Hybrid Digital Social Media Markets

In the realm of cybercrime, technologies that facilitate illicit activities also produce uncertainties based on the hybridity between digital communication and offline presence. Social media platforms have blurred the lines between types of drug sellers, bringing the recreational and the commercial into the same marketplace. In the Nordic data used in this paper, 52 text-based qualitative interviews with recreational and commercial sellers are analyzed via process and variance analysis to identify the relationship between cognitive strategies and seller positions. We ask how sellers’ decision-making processes differ and intersect. Theoretically, we use cognitive sociology to enrich understanding of culture, trust, and rational decision-making in this context. Our findings reveal that recreational sellers often adopt a low-risk, low-gain strategy rooted in cognitive biases, reflecting the recreational nature of their engagement. In contrast, commercially competent sellers employ more complex cognitive strategies, including gut feelings, thus adjusting their decisions with less reliance on initial assessments, leading to a more calculated approach with higher risk tolerance. We conclude with a discussion of intervention strategies; here, we argue for the need for a dual strategy that targets and capitalizes on the differences in cognitive biases in an effective way that poses less harm to recreational sellers.

Assessment of self-medication with analgesics among rural community of South India

World Health Organization defines self-medication (SM) as the self-administration of a medication in the absence of a current prescription and/or without consulting a healthcare professional. Analgesics are the most commonly abused drug as a self-medication for relieving pain of any kind among the people. Our aim was to assess the prevalence of self- medication with analgesics and find the social factors associated among the rural people in Southern India. A community based cross sectional study using cluster sampling technique, four villages (clusters) were randomly selected in a rural District and among 460 respondents belonging to age group 18 to 60 years were interviewed. The mean age in years was 48.4 ± 15.5. About 182(39.6%) were illiterates and many respondents belonged to Agricultural laborers 350(76.1). Self-medication with analgesics is practiced by 24.8% of the respondents. Reason for self-medication was to reduce the out-of-pocket expenditure (72.4%). About 65.8% respondents purchased analgesics over the counter from pharmacy. The prevalence of self‑medication with analgesics was relatively high which is a threat for the community and can lead to multi organ damage to among rural people. Universal policy on drug selling over the pharmacy counter should be strictly implemented.

Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda.

Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviour, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Using data from 6,388 patients, we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Among those with microbiologically confirmed UTI (n = 1,946), we used logistic regression to assess the relationship between treatment seeking behaviour, AB use, and the likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathway for UTI-like symptoms in this sample involved attending health facilities, rather than other providers like drug sellers. Patients from sites in Tanzania and Uganda, where over 50% of patients had an MDR UTI, were more likely to report treatment failures, and have repeat visits to providers than those from Kenyan sites, where MDR UTI proportions were lower (33%). There was no strong or consistent relationship between individual AB use and likelihood of MDR UTI, after accounting for country context. The results highlight the hurdles East African patients face in accessing effective UTI care. These challenges are exacerbated by high rates of MDR UTI, suggesting a vicious cycle of failed treatment attempts and sustained selection for drug resistance. Whilst individual AB use may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of variations in ABR.

Social and biological evaluation of antimicrobial resistance (SOBEAR) in rural India: a study protocol.

Antimicrobial resistance (AMR) has been one of the biggest global health threats in recent years, mostly in low- and middle-income countries, which requires urgent research using a multidisciplinary research approach. The use of large quantities of antimicrobial drugs inappropriately for humans, poultry and agriculture has been recognized as a leading cause of antibiotic resistance and the predominance of drug-resistance pathogens in the environment. This protocol aims to describe the use/misuse of antibiotics (ABs) in the community and evaluate clinical samples from healthcare settings to detect genes associated with antimicrobial resistance. We will conduct a community-level survey in different villages of the Tigiria block to assess knowledge and awareness on ABs and AMR. We will conduct in-depth interviews (IDIs) with doctors, pharmacists, nurses and drug sellers, as well as focus group discussions (FGDs) with ASHA and ANM workers who are involved in antibiotic supplies to the community. Quantitative data from the community survey and qualitative data of IDIs and FGDs will be linked and analyzed using statistical modeling and iterative thematic content analysis. Specimens (stool, urine, blood and wound/pus) will be collected from clinically diagnosed patients of different healthcare centers of Tigiria block. The samples will be cultured for bacterial isolation and antibiotic sensitivity testing. Genomic DNA will be isolated from positive bacterial cultures and sequenced using PCR to evaluate high-threat multi-drug resistance organisms (MDROs), screening of plasmid-mediated quinolone resistance (PMQR) genes, antimicrobial genes responsible for MDR and quinolone resistance-determining regions (QRDRs). This is the community-based protocol to evaluate the knowledge, attitudes, awareness and practices regarding ABs and AMR. The study protocol establishes a foundation for evaluating population-based prevalence and risk factors for AMR and MDROs in rural areas of the Odisha state, India.

Healthcare seeking behavior and delays in case of Drug-Resistant Tuberculosis patients in Bangladesh: Findings from a cross-sectional survey.

The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.

Easier, faster and safer: The social organization of drug dealing through encrypted messaging apps

AbstractEncrypted messaging apps like Telegram have become an increasingly attractive tool for drug dealing. The combination of easy opening and closing of user communities, powerful anonymity features, and operability on smartphones is changing the way drugs are delivered at the end of the chain. However, much of the recent research on Internet‐based drug markets has focused on cryptomarkets, but also on social media and the clear web. Drawing on economic sociology literature on marketplaces and partial organizations, this article fills this gap by analyzing the social organization of drug economies based on messaging apps. We argue that this form of drug trade enhances the experience of both selling and consuming drugs. Based on a unique set of in‐depth interviews with drug sellers and users belonging to four different Telegram groups in Argentina, this article shows that Telegram communities offer a wider variety of substances, speed up drug delivery, create the perception that police detection is unlikely, and promote drug specialization among sellers. This research expands our understanding of how technology and specific organizational forms transform both drug provision and consumption.

Traditional Uses of Medicinal Plants by Ethnic Peoples of Salboni Block in the Paschim Medinipur District, West Bengal, India

This survey was aimed to find out the ethno-medicinal plants of Salboni Block in the Paschim Medinipur District, West Bengal, India. These ethno-medicinal plants are used by the tribal communities like Santal, Lodha, Bhumij and Munda etc. to treat various disorders and diseases. In this study, forty-two medicinal plants belonging to twenty-five families used as ethno-medicine have been identified. The information about the traditional knowledge of uses of medicinal plants was collected by interaction with the tribal oldaged people, local herbal drug sellers etc. in this rural area. These ethno-medicinally important plants can be used as common cough and cold, asthma, antiseptic, stimulant, stomachic, dyspepsia, antifungal, antibacterial, carminative, abdominal pain, amoebic dysentery etc. by ethnic peoples. The sustainable utilization of medicinal plants in this area may open up a new avenue for getting new ethnomedicine for the society in future.