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    • br We recently reported associations between maternal

    2019-06-21


    We recently reported associations between maternal age at childbirth and outcomes in the offspring, using data from five birth cohorts (COHORTS collaboration) in low-income and middle-income countries (LMICs), in . Young maternal age (<19 years) was associated with lower offspring birthweight, gestational age, childhood nutritional status (weight-for-age and height-for-age at 2 years), and attained schooling, and higher adult glucose concentration, compared with offspring of mothers aged 20–24 years. These associations were independent of maternal socioeconomic status, height, and parity.
    Antimicrobial resistance is recognised as a serious global health threat requiring global action. However, much work remains to translate global strategies to combat antimicrobial resistance into national policy and action. In low-income and middle-income countries where vulnerable health-care systems require investment within constrained budgets, antimicrobial resistance strategies might not be prioritised, and indeed equitable versus restricted access to Tazobactam sodium salt present a conflicting challenge. Engaging the right stakeholders nationally and contextualising scientific evidence to address concrete policy issues moves antimicrobial stewardship strategies into action. High-burden diseases present an important starting point. In Vietnam, severe acute respiratory tract infections and chronic obstructive pulmonary disease (COPD) together account for 8% of mortality. However, antibiotic prescribing is often inappropriate in preclinical and clinical disease stages, and is commonly done against local and international evidence-based guidelines. The Ministry of Health (MOH), Vietnam, issued a national action plan on antimicrobial resistance in June, 2013, supported by WHO. Building on their situation analysis of antimicrobial resistance and surveillance, and previous MOH success to establish national quality standards for acute stroke, Oxford University Clinical Research Unit and the Vietnam MOH convened a working group to develop evidence-informed quality standards for appropriate inpatient antibiotic prescribing for community-acquired pneumonia and acute exacerbation of COPD. Quality standards translate best practice recommendations from international guidelines into high-priority, implementable, and measurable clinical activities relevant for the local context, through local stakeholder collaboration. In June, 2016, we presented the draft of the quality standards for community-acquired pneumonia and acute exacerbation of COPD to a national committee convened by MOH, comprising MOH officials, and over 40 managers, physicians, pharmacists, and microbiologists from central and provincial hospitals across Vietnam. Although there was rapid consensus to adopt international principles of matching route of administration to duration of administration, matching breadth of spectrum to disease severity, and justifying any deviation, there was equal recognition that international standards need local adaptation. Thus, the committee agreed on the need for thorough clinical diagnostic assessment, including medical and antibiotic histories, using locally available microbiological tests to inform antibiotic prescription. However, in an environment with high prevalence of antimicrobial resistance, patients self-medicating with over-the-counter antibiotics before presenting to hospital, and absence of national surveillance, determining appropriate first-line therapy was more challenging than establishing the standards for thorough clinical diagnostic assessment. Further collection and analysis of susceptibility data from the Vietnam resistance network of 16 hospitals will allow formal standards to be recommended.
    Pakistan has a population of 194 million people, of which approximately 182 million live in malaria-endemic regions. In Pakistan there are 500 000 new cases of malaria and 50 000 deaths caused by malaria each year. is the culprit in 88% of malaria admissions, although often takes the spotlight, given its more severe course. Chloroquine has long been the drug offered to patients with unconfirmed malaria and those diagnosed with infection. Given the rise of drug resistance in many infectious agents due to poorly regulated drug use, it is no surprise that resistance has occurred in the organism that so frequently infects us. The time has come to recognise the threat of chloroquine-resistant in Pakistan, an entity that has been largely ignored.