Implementing new health interventions in developing countries: why do we lose a decade or more?

BACKGROUND: It is unclear how long it takes for health interventions to transition from research and development (R&D) to being used against diseases prevalent in resource-poor countries. We undertook an analysis of the time required to begin implementation of four vaccines and three malaria interventions. We evaluated five milestones for each intervention, and assessed if the milestones were associated with beginning implementation. METHODS: The authors screened WHO databases to determine the number of years between first regulatory approval of interventions, and countries beginning implementation. Descriptive analyses of temporal patterns and statistical analyses using logistic regression and Cox proportional hazard models were used to evaluate associations between five milestones and the beginning of implementation for each intervention. The milestones were: (A) presence of a coordinating group focused on the intervention; (B) availability of an intervention tailored to developing country health systems; (C) international financing commitment, and; (D) initial and (E) comprehensive WHO recommendations. Countries were categorized by World Bank income criteria. RESULTS: Five years after regulatory approval, no low-income countries (LICs) had begun implementing any of the vaccines, increasing to an average of only 4% of LICs after 10 years. Each malaria intervention was used by an average of 7% of LICs after five years and 37% after 10 years. Four of the interventions had similar implementation rates to HepB, while one was slower and one was faster than HepB. A financing commitment and initial WHO recommendation appeared to be temporally associated with the beginning of implementation. The initial recommendation from WHO was the only milestone associated in all statistical analyses with countries beginning implementation (relative rate = 1.97, P > 0.001). CONCLUSIONS: Although possible that four milestones were not associated with countries beginning implementation, we propose an alternative interpretation; that the milestones were not realized early enough in each intervention's development to shorten the time to beginning implementation. We discuss a framework built upon existing literature for consideration during the development of future interventions. Identifying critical milestones and their timing relative to R&D, promises to help new interventions realize their intended public health impact more rapidly

The Frequency of Antibiotics Sold without A Prescription and the Appropriateness of Antibiotic Use in Sanliurfa

AIM: The aim of this study was to determine the frequency with which antibiotics were sold without a prescription, to examine factors related to such practices and to determine the appropriateness of antibiotics sold with a prescription in Sanliurfa city center in Turkey. METHOD: This cross-sectional study was carried out between September and December 2010, on patients who visited the pharmacies to ask for antibiotics with or without prescription. To determine the research sample the cluster sampling method was used and from 186 pharmacies, 25 pharmacies were selected at random. The pharmacies were visited and asked to complete a structured questionnaire. RESULTS: 373 patients obtained antibiotics from pharmacies. The patients who received antibiotics by prescription comprised 98.6% (n=359) of all patients. A total 36 different antibiotics had been prescribed to the patients. Inappropriate prescription of antibiotics was documented in 63.7%. The most-prescribed antibiotic was co-amoxiclav (28.8%). The rate of inappropriate antibiotic prescriptions with the diagnosis of upper respiratory tract infection (77.8%) was highest, while the rate was lowest with the diagnosis of urinary tract infection (23.3%) (&#967;2: 68.8, P<0.001). The rate of inappropriate prescribed antibiotics in state hospitals (53.7%) was lower than the rate in primary health care centers (72.1%) and private hospitals and clinics (64.7%) (&#967;2: 10.4, P=0.05). There was no diagnosis of infection in 17 (4.7%) patients with prescriptions. CONCLUSION: These results indicate that the use of antibiotics without prescription was low, while the rate of inappropriate antibiotic use was high in Sanliurfa. The use of antibiotics without prescription can potentially be prevented through interventions in the healthcare system. To prevent inappropriate antibiotic prescription, improvements to physicians&#8217; education must be implemented, even after graduation. [TAF Prev Med Bull 2012; 11(2.000): 173-180

Diverging strategies to planning an ecologically coherent network of MPAs in the North Sea : The roles of advocacy, evidence and pragmatism in the face of uncertainty

The North Sea is one of the most economically important seas in the world due to productive fisheries, extensive oil and gas fields, busy shipping routes, marine renewable energy development and recreational activity. Unsurprisingly, therefore, the use of marine protected areas (here defined widely to include fisheries closed areas and no-take marine reserves) in its management has generated considerable controversy—particularly with regards to the design of a regional ecologically coherent MPA network to meet international obligations.Drawing on three MPA processes currently occurring in the UK North Sea, we examine the real-world problems that make the designation of MPA networks challenging. The political problems include: disagreement among (and within) sectors over policy objectives and priorities, common access to fisheries resources at the EU level increasing the scale at which decisions have to be made and lack of an integrated strategy for implementing protected areas in the North Sea. The scientific problems include the patchy knowledge of benthic assemblages, limited knowledge of fishing gear–habitat interactions, and the increased risk of unforeseen externalities if human activity (predominantly fishing) is displaced from newly protected sites. Diverging stakeholder attitudes to these problems means that there is no consensus on what ecological coherence actually means.Ultimately, we caution against ‘quick-fix’ solutions that are based on advocacy and targets, as they create confusion and undermine trust in the planning process. We argue for a more pragmatic approach to marine protection that embraces the complexity of the social and political arena in which decisions are made