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Background Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. Methods We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016–Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. Findings Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. Interpretation Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. Funding Wellcome Trust and Volkswagen Foundation. more...

Vietnamese rural mountains are undergoing a significant transformation process in agriculture-based economy nowadays. A challenge facing ethnic minorities is identifying more appropriate way of life to cope with unpredictable risks associated with agriculture. This paper deals with livelihood diversification by the Dzao, an indigenous ethnic minority group in the Vietnamese Northern Mountains. One hundred and six Dzao households from 11 villages are surveyed with a systematic random sampling. The Simpson diversity index and the Average Agricultural Livelihood Diversification Index are used to measure the livelihood diversification of villages. Eighteen survey questions are developed from six determinants of livelihood diversification such as seasonality, risk strategies, labor markets, credit market failures, asset strategies and coping behavior and adaptation. The results show that livelihood diversification aligns Dzao farmers’ goals to the short-term economic feasibility and long-term sustainability. Farmers diversify their livelihood by combining livelihood strategies for agricultural intensification, agricultural extensification and migration. Diversification should range from a temporary change in the household livelihood portfolio (occasional diversification) to a deliberate attempt to optimize the household capacity taking advantage of opportunities and coping with unexpected constraints (strategic diversification). more...

Objectives To review community-level consumption of antibiotics in rural Vietnam, according to the WHO Access, Watch, Reserve (AWaRe) classification of 2019, and identify factors associated with the choice of these antibiotics. Methods In this cross-sectional study, data on antibiotic purchases were collected through a customer exit survey of 20 community antibiotic suppliers in Ba Vi District, Hanoi, between September 2017 and July 2018. Antibiotic consumption was estimated through the number of antibiotic encounters, the number of DDDs supplied and the number of treatment days (DOTs) with antibiotics, and analysed according to the AWaRe classification. The factors associated with watch-group antibiotic supply were identified through multivariable logistic regression analysis. Results In total, there were 1342 antibiotic encounters, with access-group antibiotics supplied in 792 encounters (59.0%), watch-group antibiotics supplied in 527 encounters (39.3%) and not-recommended antibiotics supplied in 23 encounters (1.7%). No reserve-group antibiotics were supplied. In children, the consumption of watch-group antibiotics dominated in all three measures (54.8% of encounters, 53.0% of DOTs and 53.6% of DDDs). Factors associated with a higher likelihood of watch-group antibiotic supply were: private pharmacy (OR, 4.23; 95% CI, 2.8–6.38; P Conclusions High consumption of watch-group antibiotics was observed, especially for use in children. The frequent supply of watch-group antibiotics at private pharmacies reconfirms the need for implementing pharmacy-targeted interventions in Vietnam. more...

International audience; Thermoresponsive statistical copolymers of N-vinylcaprolactam and N-vinylpyrrolidone of controlled average molar masses and composition were synthesized by RAFT/MADIX polymerization. The cloud point temperature was finely tuned in the range of temperature 36-70 degrees C. DSC measurements combined with statistical calculations suggest that the whole polymer chain is involved in the hydration/dehydration process rather than short polymer sequences. At high concentration, these polymers enable the formation of thermoresponsive hydrogels. Cryo-SEM analysis of these solutions showed the presence of globular substructures, with a looser 3-D network at higher VP content. This decrease of density of entanglements in the gel network could explain the decrease of mechanical properties and faster rehydration kinetics of the thermogelling polymer. more...

Heiman Wertheim and colleagues describe the diagnosis and management of two patients who developed rabies after butchering and consuming a dog or a cat.