Drug Sellers Research Articles

Effect of aqua-drugs and chemicals on shrimp health and production in Khulna, Bangladesh

Present study was conducted in three different Upazilas viz., Batiaghata, Dacope and Rupsha of Khulna district, Bangladesh from August 2016 to May 2017. Data were collected through personal contact, farms and market survey and discussion with shrimp farmers and drug sellers. Farmers of the research areas used Oxolinic acid, Renamucin, Oxytetracucline, Lime, Salt, Formalin, Eco-solution, Basudin and Timsen to treat the viral, bacterial and fungal diseases. Average recovery of 55-60% and 35-40% were recorded from bacterial and fungal diseases of shrimp respectively, but there was no recovery in case of viral diseases. Shrimps of nontreated ghers were affected by WSSV, Black gill disease, Black spot disease, Zoothumnium and external fouling but almost no disease were observed in aqua drugs-treated ponds. Histological findings showed that shrimp muscles and hepatopancreas in drug treated ponds and ghers had some pathological changes like necrosis, vacuums and hemorrhages which were severe in winter season, whereas, normal structure of muscle and hepatopancreas were observed during summer season. Production of shrimp in the study areas was recorded 6916 Kg/ha in probiotics and aqua-drugs treated ponds, whereas, 543 Kg/ha in non-treated ghers. From the present study it could be concluded that aqua-drugs and chemicals have positive effect on shrimp health and production except some pathological changes in the investigated organgs of shrimp especially during winter season.

How Community and Individual Risk Factors Mutually Impact Youth’s Perceived Safety: A Syndemic Analysis Using Structural Equation Modeling

The purpose of this study was to evaluate the mutual impact of community and individual factors on youth's perceptions of community safety, using structural equation modeling (SEM) conceptualized by syndemic theory. This study used survey data collected from a county wide sample of middle and high school students (N=25,147) in West Central Florida in 2015. The outcome variable was youth's perceptions of community safety. Predictors were latent individual and community factors constructed from 14 observed variables including gun accessibility, substance use, depressive symptoms, and multiple neighborhood disadvantage questions. Three structural equation models were conceptualized based on syndemic theory and analyzed in Mplus 8 using weighted least squares (WLS) estimation. Each model's goodness of fit was assessed. Approximately seven percent of youth reported feeling unsafe in their community. After model modifications, the final model showed a good fit of the data and adhered to the theoretical assumption. In the final SEM model, an individual latent factor was implied by individual predictors measuring gun accessibility without adult's permission (β=0.70), sadness and hopelessness (β=0.52), alcohol use (β=0.79), marijuana use (β=0.94), and illegal drug use (β=0.77). Meanwhile, a community latent factor was indicated by multiple community problems including public drinking (β=0.88), drug addiction (β=0.96), drug selling (β=0.97), lack of money (β=0.83), gang activities (β=0.90), litter and trash (β=0.79), graffiti (β=0.91), deserted houses (β=0.86), and shootings (β=0.93). A second-order syndemic factor that represented the individual and community factors showed a very strong negative association with youth's safe perception (β=-0.98). This study indicates that individual risk factors and disadvantaged community conditions interacted with each other and mutually affected youth's perceptions of community safety. To reduce these co-occurring effects and improve safe perceptions among youth, researchers and practitioners should develop and implement comprehensive strategies targeting both individual and community factors.

An unsupervised machine learning approach for the detection and characterization of illicit drug-dealing comments and interactions on Instagram

Background: Growing use of social media has led to the emergence of virtual controlled substance and illicit drug marketplaces, prompting calls for action by government and law enforcement. Previous studies have analyzed Instagram drug selling via posts. However, comments made by users involving potential drug selling have not been analyzed. In this study, we use unsupervised machine learning to detect and classify prescription and illicit drug-related buying and selling interactions on Instagram. Methods: We used over 1,000 drug-related hashtags on Instagram to collect a total of 43,607 Instagram comments between February 1st, 2019 and May 31st, 2019 using data mining approaches in the Python programming language. We then used an unsupervised machine learning approach, the Biterm Topic Model (BTM), to thematically summarize Instagram comments into distinct topic groupings, which were then extracted and manually annotated to detect buying and selling comments. Results: We detected 5,589 comments from sellers, prospective buyers, and online pharmacies from 531 unique posts. The vast majority (99.7%) of comments originated from drug sellers and online pharmacies. Key themes from comments included providing contact information through encrypted third-party messaging platforms, drug availability, and price inquiry. Commonly offered drugs for sale included scheduled controlled substances such as Adderall and Xanax, as well as illicit hallucinogens and stimulants. Comments from prospective buyers of drugs most commonly included inquiries about price and availability. Conclusions: We detected prescription controlled substances and other illicit drug selling interactions via Instagram comments to posts. We observed that comments were primarily used by sellers offering drugs, and typically not by prospective buyers interacting with sellers. Further research is needed to characterize these “social” drug marketplace interactions on this and other popular social media platforms.

Knowledge, Attitude, and Practices on Antimicrobial Use and Antimicrobial Resistance among Poultry Drug and Feed Sellers in Bangladesh.

Poultry production has boomed in Bangladesh in recent years. The poultry sector has contributed significantly to meet the increased demand for animal source proteins in the country. However, increased use of antimicrobials appeared to be a significant threat to food safety in the poultry sector. The poultry drug and feed sellers are at the frontline position involving selecting and delivering the antimicrobials to the poultry farmers. Studies assessing the poultry drug and feed sellers’ knowledge, attitudes, and practices (KAPs) are limited. The current study aimed to assess the community poultry drug and feed sellers’ KAPs of antimicrobial use (AMU) and antimicrobial resistance (AMR) in some selected areas of Bangladesh. We determined the respondents’ (drug and the feed sellers) KAPs of AMU and AMR using a tested and paper-based questionnaire. The study demonstrated that most respondents have insufficient knowledge, less positive attitudes, and inappropriate practices regarding AMU and AMR. The factor score analysis further showed that the type of respondents and their years of experience, level of education, and training on the drug were the significant factors impacting the current knowledge, attitudes, and practices of AMU and AMR. The adjusted logistic regression analysis revealed that the drug sellers who completed their education up to 12th grade and had training on the drug had adequate knowledge of AMU and AMR. The data also showed that the drug sellers belong to the age group 31–35 and 36–40 years and who completed 12th grade had good attitudes on the same. Likewise, the analysis further determined that drug sellers belonging to the age category 18–25 and 26–30 years, and interestingly, the respondents who completed education up to 12th grade, had better practices. Spearman’s rank-order correlation revealed a positive association between each pair of the KAPs scores for the respondents. The correlation was fair between knowledge–attitudes, knowledge–practices, and attitudes–practices. Based on the current study results, we recommend educational interventions and appropriate training for the poultry drug and feed sellers to raise awareness and to upgrade their current knowledge on the appropriate use of antimicrobials. This will ultimately lead to reducing the chances of developing AMR in the poultry sectors of the country.

Contested Colonial Metrological Sovereignty: The daching riot and the regulation of weights and measures in British Malaya

AbstractDrawing on materials from the National Archives of Malaysia, newspapers, literature on historical metrology, and the colonial history of Malaya, this article weaves a social history of Malaya's colonial metrological reform by taking into account the roles of both European and Asian historical actors. Prior to the 1894 reform, people in Malaya used customary scales and weight units, which varied across districts, for commercial transactions. Initiated by colonial administrators, the reform was both welcomed and resisted. In 1897, a riot against the Sanitary Board broke out in Kuala Lumpur for its attempt to mandate that previously exempted traders use only government-verified and -stamped scales. The colonial government managed to maintain order and restore its authority at the end of the riot, but four types of merchants—goldsmiths, silversmiths, opium dealers, and drug sellers—managed to remain exempted. Metrological reform continued to be contested in the following century, but the central concerns of the regulation moved from easing taxation, facilitating cross-district trade, and taming Chinese traders to protecting consumers. More emphasis was placed on educating the public to be able to read scales, in addition to using police force to raid businesses. The enforcement was, however, compromised due to inadequate funds. The reality on the ground contradicts the image of an omnipresent colonial authority and reveals the fragility of colonial administration.

Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey

Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6–4.4)], versus secondary education (8–10 grade) [AOR = 1.8 (95% Cl = 1.0–3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.

Sexual and Reproductive Health Literacy, Misoprostol Knowledge and Use of Medication Abortion in Lagos State, Nigeria: A Mixed Methods Study

Little is known about the link between health literacy and women's ability to safely and successfully use misoprostol to self‐induce an abortion. While abortion is only allowed to save a woman's life in Nigeria, misoprostol is widely available from drug sellers. We interviewed 394 women in 2018 in Lagos State, Nigeria, who induced abortion using misoprostol obtained from a drug seller to determine their sexual and reproductive health literacy (SRHL) and misoprostol knowledge levels; and how these were associated with ending the pregnancy successfully or seeking care for (perceived) complications. Our results show that women's misoprostol knowledge (measured both quantitatively and qualitatively) was low, but that almost all women were nevertheless able to use the drug effectively and safely. Higher SRHL was associated with being more likely to end the pregnancy successfully and also seeking postabortion health care. Our study is the first to examine this association and adds to the scarce literature examining the relationship between health literacy and self‐use of misoprostol to induce abortions in restrictive settings.

Drug sellers’ knowledge and practices, and client perspectives after an intervention to improve the quality of safe abortion care outside of formal clinics in Nigeria

BackgroundIn Nigeria, where abortion is legally restricted, individuals seek medication abortion drugs, including misoprostol, directly from pharmacies or drug sellers. However, knowledge of drug sellers or patent medicine vendors (PMVs)...

Effectiveness of peer-supervision on pediatric fever illness treatment among registered private drug sellers in East-Central Uganda: An interrupted time series analysis.

Rationale, aims, and objectivesAppropriate treatment of pediatric fever in rural areas remains a challenge and maybe partly due to inadequate supervision of licensed drug sellers. This study assessed the effectiveness of peer‐supervision among drug sellers on the appropriate treatment of pneumonia symptoms, uncomplicated malaria, and non‐bloody diarrhea among children less than 5 years of age in the intervention (Luuka) and comparison (Buyende) districts, in East‐Central Uganda.MethodsData on pneumonia symptoms, uncomplicated malaria, and non‐bloody diarrhea among children less than 5 years of age was abstracted from drug shop sick child registers over a 12‐month period; 6 months before and 6 months after the introduction of peer‐supervision. Interrupted time series were applied to determine the effectiveness of the peer‐supervision intervention on the appropriate treatment of pneumonia, uncomplicated malaria, and non‐bloody diarrhea among children less than 5 years of age attending drug shops in East Central Uganda.ResultsThe proportion of children treated appropriately for pneumonia symptoms was 10.84% (P < .05, CI = [1.75, 19.9]) higher, for uncomplicated malaria was 1.46% (P = .79, CI = [−10.43, 13.36]) higher, and for non‐bloody diarrhea was 4.00% (P < .05, CI = [−7.95, −0.13]) lower in the intervention district than the comparison district, respectively.Post‐intervention trend results showed an increase of 1.21% (P = .008, CI = [0.36, 2.05]) in the proportion appropriately treated for pneumonia symptoms, no difference in appropriate treatment for uncomplicated malaria, and a reduction of 1% (P < .06, CI = [−1.95, 0.02]) in the proportion of children appropriately treated for non‐bloody diarrhea, respectively.ConclusionsPeer‐supervision increased the proportion of children less than 5 years of age that received appropriate treatment for pneumonia symptoms but not for uncomplicated malaria and non‐bloody diarrhea. Implementation of community‐level interventions to improve pediatric fever management should consider including peer‐supervision among drug sellers.

Drug Policy in India: An Analysis

AbstractThe Narcotic Drugs and Psychotropic Substances Act, or NDPS Act, was enacted to control addictive drugs and prohibit their possession, dispersion, sale, import, and trade in India. Psychotropic agents have the potential to change an individual’s consciousness, while narcotic drugs relieve anxiety. The Indian Parliament passed the NDPS Act on November 14, 1985. Nonetheless, these types of drugs are important in the practice of medicine. Consequently, the Act contains provisions for the cultivation of cannabis, poppy, and coca seeds and the production of certain psychotropic medicines used for medical purposes. The Act’s primary objective is to regulate the manufacturing, ownership, selling, and transportation of narcotics and psychotropic drugs. The Act forbids the selling of nearly 200 psychotropic medications, resulting in these drugs being inaccessible over the counter to the general public. These medications are only available for use with a prescription. Violations of this law can result in a sentence of incarceration or a fine, or both, depending on the offense’s severity, which is determined by the severity of the situation at hand. If the drugs are being used for personal benefit, the penalty can be minimized. Furthermore, the legislation has been revised several times since its inception.

Speculative Carcinogenicity Assessment of Polycyclic Aromatic Hydrocarbons Found in Some Anti-Diarrheal Herbal Drugs Sold in Ondo State of Nigeria

The conviction that herbal drugs have enormous health benefits has led to increase the rate of their consumption by Nigerians. The aim of this study was to assess the carcinogenic property of some popularly consumed anti-diarrheal herbal drugs via polycyclic aromatic hydrocarbons (PAHs) quantification. Three prevalent anti-diarrhea herbal drugs , Odunmo herbal drug (Hibiscus rosa-sinensis and Bacopamonnieri), Orogun herbal mixture (Hibiscus sabdariffaI and Hedera helix), and Alora herbal syrup (Aloe vera and Hibiscus sabdariffaI) were bought for the purpose of this study and they were coded as samples A, B, and C, respectively. The ultrasonic extraction of the herbal drugs was carried out using standard procedures. The crude extracts obtained were purified using a chromatographic method. The concentrations of PAHs were quantified using gas chromatography flame ionization detector (GCFID). The diagnostic indices, group distribution, toxicity equivalence and exposure dosage were estimated. The cancer risk values were theoretically speculated based on concentrations of PAHs in the tested herbal drugs, associated with the published estimates of each concentration to cause cancer and the calculated exposure doses of the anti-diarrhea herbal drug samples were within three age groups (children, Preteen and adult). The highest concentration of total PAHs was observed in sample A (58.2815mg/kg) and the lowest concentration in sample B (44.1898mg/kg), but the concentration of total PAHs in sample C was 47.4169 mg/kg. The highest percentage of carcinogenic PAHs in the anti-diarrheal herbal drugs was found in sample C (48.66%) and the lowest in sample B (38.17%). The diagnostic indices confirmed a pyrogenic source of PAHs. Group distribution of PAHs showed that the herbal drugs are weakly carcinogenic due to high concentrations of low and moderate molecular weight PAHs. The cancer risk estimated for all the age groups where below the limit established by the United State Environmental Protection Agency (USEPA) for cancer (1 x 10-6). This ascertained that the use of these herbal drugs cannot cause cancer. However, consumers of these herbal drugs should take necessary precautions as excessive intake can lead to dangerous health implications.

“You never feel so Black as when you're contrasted against a White background”: Black students' experiences at a predominantly White institution in the UK

Abstract“Old” universities in the UK are typically populated with White middle‐class students who hail from White majority hometowns, whilst “new” universities have more diverse cohorts from diverse hometowns. Our research conducted with 17 Black students at a predominantly White university, examined the initial encounters in which Black students first realise their minority status on campus. We found that White numerical dominance combined with White students' racialised place‐based assumptions about who belongs where, had an immediate and powerful impact on our participants. Importantly, our findings suggest that for Black students coming from diverse hometowns, experiences such as being the only Black person in lecture halls, being told that you are the first Black person your peers have met, and being expected to use urban street slang and sell drugs constituted both a denial of their student identity and a misrecognition of their Black identity. Our analysis highlights the importance of considering the diversity within institutions alongside Black and White students' place‐based histories with diversity; and how these are consequential for Black students' experiences of (mis)recognition and (non)belonging on campuses. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Navigating post-eviction drug use amidst a changing drug supply: A spatially-oriented qualitative study of overlapping housing and overdose crises in Vancouver, Canada

BackgroundNorth American cities are experiencing intersecting housing and overdose crises as illicit drug markets become marked by the proliferation of fentanyl and methamphetamine. Despite recent research documenting associations between evictions and drug-related risks and harms, including overdose, the mechanisms through which these occur remain poorly understood. This study to examines how evictions shape the drug use practices of people who use drugs in Vancouver’s Downtown Eastside – a neighbourhood with an established drug scene – as the illicit drug supply changed. MethodsQualitative interviews and geo-spatial data collection were conducted with 56 recently evicted PWUD. Data were analyzed by interfacing qualitative and geo-spatial data, and interpreted focusing on how structural vulnerability shaped spatial practices and drug-related risks post-eviction. ResultsFindings demonstrate how post-eviction spatial practices and routines produced risk and harm as participants navigated the uncertainties of housing vulnerability and drug supply changes. Post-eviction disruptions complicated participants’ ability to engage with trusted drug sellers. Changes to spatial patterns and access to private spaces rendered public drug use inevitable, though this was mitigated to some degree by harm reduction supports. Abrupt changes to drug use patterns occurred due to post-eviction disruptions and included instrumental uses of methamphetamine to increase alertness and navigate survival amidst severe hardship. ConclusionsFindings demonstrate how post-eviction changes to routines and spatial patterns are framed by structural vulnerability and can exacerbate drug-related harms, particularly in the context of a changing drug supply. There is an urgent need for structural interventions and harm reduction responses to mitigate harms associated with evictions.

Usage and knowledge of antibiotics of fish farmers in small‐scale freshwater aquaculture in the Red River Delta, Vietnam

This study focussed on the use and knowledge of antibiotics of tilapia and traditional freshwater species fish farmers in Hai Duong province, the major freshwater fish producing area in Red River Delta, Vietnam. As found from this cross-sectional survey, antibiotics were used by 91.7% of a total 60 surveyed farmers for the purposes of disease prevention and treatment. However, 98.2% of these farmers carried out no form of antibiotic susceptibility testing before choosing, buying and using antibiotics. Additionally, 78.9% of the respondent farmers who experienced significant mortalities in their stocks immediately treated with antibiotics without any diagnostic analysis or support. Within those surveyed, whilst 76.7% believed that antibiotics could be used to treat bacterial diseases, 13.3% farmers thought that antibiotics could also be used to treat viral diseases. The use of antibiotics by surveyed farmers can be influenced by unreliable sources of information, such as sometimes given by drug manufacturers and sellers. Several antibiotics listed as ‘critically important’ in human medicine, along with antibiotics prohibited by the government, were used by surveyed farmers. Findings from this study indicate that government, academia and private sectors should work collaboratively together to improve consultative services, provide training on disease diagnosis, promote responsible use of antibiotics and develop alternative solutions/treatments replacing antibiotics. The authorities concerned should look to other national country models for monitoring and regulation of antibiotics use in aquaculture and identify constituent parts which can be appropriate, relevant and implementable in the context of Vietnamese aquaculture.

Behavioural interventions to address rational use of antibiotics in outpatient settings of low-income and lower-middle-income countries.

ObjectivesTo explore the current evidence on interventions to influence antibiotic prescribing behaviour of health professionals in outpatient settings in low‐income and lower‐middle‐income countries, an underrepresented area in the literature.MethodsThe systematic review protocol for this study was registered in PROSPERO (CRD42020170504). We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies relating to antibiotic prescribing of health professionals in outpatient settings in low‐income and lower‐middle‐income countries. Behavioural interventions were classified as persuasive, enabling, restrictive, structural or bundle (mix of different interventions). In total, 3,514 abstracts were screened and 42 studies were selected for full‐text review, with 13 studies included in the final narrative synthesis.ResultsOf the 13 included studies, five were conducted in Vietnam, two in Sudan, two in Tanzania, two in India and two in Kenya. All studies were conducted in the outpatient or ambulatory setting: eight took place in primary health centres, two in private clinics and three in pharmacies. Our review found that enabling or educational interventions alone may not be sufficient to overcome the ingrained incentives to link revenue generation to sales of antibiotics, and hence, their inappropriate prescription or misuse. Bundle interventions appear to be very effective at changing prescription behaviour among healthcare providers, including drug sellers and pharmacists.ConclusionsMulti‐faceted bundle interventions that combine regulation enforcement with face‐to‐face education and peer influence may be more effective than educational interventions alone at curbing inappropriate antibiotic use.

Desistance in Context: Understanding the Effects of Subculture on the Desistance Process During Reintegration

Abstract Despite a growth in desistance research, our understanding of how local external factors may affect the desistance process as people transition from prison to society remains limited. Drawing on qualitative data from two neighbourhoods in Northern Ireland, it is argued that subcultural factors in neighbourhoods can play a key role in influencing desistance during reintegration by shaping the opportunities that individuals have to access, use and sell drugs, their experiences of social integration/exclusion and processes of surveillance and collective efficacy. It is argued that there is a need to better incorporate the effects of local external factors, including subcultural norms and values, into existing desistance theories if we are to fully understand how neighbourhood context can affect desistance during reintegration.

Health sufferings, healthcare seeking behavior, awareness about health insurance, and health related rights of ready made garments workers in Bangladesh: Findings from a cross-sectional study.

ObjectivesThis study aimed at examining health sufferings of readymade garments (RMG) workers, the factors that affect their health sufferings, their healthcare seeking pattern, knowledge about health insurance and health related rights in Bangladesh.MethodsA cross‐sectional study was conducted among 486 RMG workers recruited randomly from eight garments factories located on the periphery of Dhaka, Bangladesh. The prevalence of musculoskeletal pain, headache, fever and abdominal pain was estimated and multivariable logistic regression analysis was performed to examine association between these illnesses of workers and their socio‐demographic characteristics and other work related information. We also explored their healthcare seeking patterns, knowledge about health insurance and health related rights.ResultsThe prevalence of musculoskeletal pain, headache, fever and abdominal pain was found to be 78.1%, 57.9%, 52.2% and 24.6%, respectively, among the RMG workers. Factors that increased the odds of: musculoskeletal pain were working for more than 10 h per day (adjusted odds ratio [AOR]: 2.3, 95% confidence interval [CI]: 1.1–4.7) and being female [AOR: 4.6, 95% CI: 2.0–10.6]; fever was living in slums [AOR: 1.9, 95% CI: 1.1–3.5]; and abdominal pain was being female [AOR: 3.6, 95% CI: 1.4–9.3]. The workers commonly reported visiting drug sellers in local pharmacies for reported illnesses. They also had better knowledge of health related rights but poor knowledge of health insurance.ConclusionIn order to address the overall health and well‐being of the RMG workers, it is imperative to lay out a blueprint for a safe and healthy workplace.

The rejection of cannabis legalization in New Zealand: issues with the Cannabis Legalization and Control Bill or wider concerns?

The rejection of cannabis legalization in New Zealand: issues with the Cannabis Legalization and Control Bill or wider concerns?

Pattern of antibiotics use and health seeking behavior among low income urban under five children in Bangladesh

Background: Access to affordable health care is limited in low income settings. Inappropriate use of antibiotics, both overuse & underuse can influence several factors related to child health and overall development. The objective of the study was to explore the pattern of antibiotics use and health-seeking behavior among low income under five urban children in Bangladesh. Methods and materials: During February 2018 to April 2019, the study conducted a cross sectional study among 516 low income urban under five children's’ parents in Bangladesh. We used a semi structured questionnaire to collect information related to pattern of antibiotics use and health seeking behaviors among the low income urban community. The bi-variate and multivariate analysis was done to see the associated risk factor of antibiotics use and health seeking behaviors among the mothers of <5 children. Results: The majority (437/516) of the respondents were female. One-third of them had no formal education and 64% had only 5 years of education. Around one-fourth of children frequently or always suffered from some kind of illness. Common illness among low-income under-five children was identified as cold and fever (73%) diarrhea (22%), loss of appetite (31%). The study also identified that one third (168/516) of the children were suffering from severe malnutrition. More than half of the respondents (52%) first health care center is local drug store where they go and tell about the health problem and get medicine. Though, the majority (89%) of the drug sellers in Bangladesh do not have formal medical education. More than half (56%) of the respondents acquired from the local pharmacy and 45% (237/516) of antibiotics were obtained from local drug sellers without a prescription by a qualified physician. Irrational use of antibiotics found a significant association with the educational background (p = 0.004), social-economic condition (p = 0.03) and treatment dependency (p = 0.05) at the local drug store. Conclusion: More hospital and community clinic is required to provide basic health services to low-income urban population. Policy implementation is necessary to stop unnecessary and irrational use of antibiotics in Bangladesh.

Farmer perceptions of antimicrobial use (AMU) in small and medium-scale broiler farms in Indonesia

Background: Inappropriate use of antibiotics in poultry farming is one of the contributing factors causing antimicrobial resistance (AMR). The purpose of this study was to measure farmer perception on the use of antibiotics in broiler farms related to antimicrobial resistance. Methods and materials: A cross-sectional survey was conducted on 523 broiler farms in Central Java, Lampung and West Kalimantan Provinces in 2018. Enumerators from District Veterinary Service Offices within the provinces interviewed farmers using a structured questionnaire with Likert scales. Data were analyzed using descriptive statistics. Results: Results of the survey indicated that 55% of farmers did not have basic knowledge on AMR, but 59% were aware that excessive use of antibiotics can trigger AMR. About 43% of farmers felt that many antibiotics were no longer effective for treatment, while 31% of farmers assumed that AMR would never be a problem on their farms and 53% thought AMR is only a problem in the human health sector. More than 60% of farmers agreed that the amount of antibiotics used in animals and humans needs to be decreased. The likelihood of using antibiotics on farms was positively influenced by veterinarians (40%), veterinary drug sellers (25%) and other farmers (20%). Farmers were also more likely to use antibiotics for disease prevention (40%) and increased production (28%). More than 70% of farmers agreed that inappropriate use of antibiotics is very costly and that an appropriate antibiotic withdrawal time should be applied before animals are sold. However, 80% of farmers also thought that using antibiotics will provide economic benefits through increased productivity, healthier chickens, reduced mortality and disease prevention. Conclusion: This study shows that broiler farmers only have partial understanding and limited perception of the significance of antibiotic use on AMR. Therefore, an antibiotic stewardship program is critically needed to provide comprehensive knowledge and guidance on antimicrobial use in broiler farms.