The Institute for Global Health and Development
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9
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Item Problematizing the “global” in global health: An assessment of the global discourse of safety(Springer, 2015-09-30) Kadetz, PaulThe practice of global health assumes that there are no differences between what is decided at a global level of policy making and what is implemented at a given local level. However, this research reveals a marked disconnect between the normative assumptions and understandings of global health and their appropriateness for local level implementation. The normative discourse of safety, embedded in global health, provides a case example by which to critically examine the importance of recognizing the differences between global and local understandings of health. The lack of a hegemonic understanding of safety and the dangers and risks that are generated when imposing foreign understandings of safety onto local levels, serve to problematize the ethnocentric assumptions embedded in the discourse of global health.Item Identifying key influences on antibiotic use in China: A systematic scoping review and narrative synthesis(BMJ, 2022-03-24) Coope, Caroline; Schneider, Annegret; Zhang, Tingting; Kadetz, Paul; Feng, Rui; Lambert, Helen; Wang, DeBin; Oliver, Isabel; Michie, Susan; Cabral, ChristieIntroduction: The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. Methods: Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). Results: Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. Conclusions: Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.