Antimicrobial Usage Unveiled: Exploring its Impact on Resistance

Proposed interventions in Myanmar's healthcare system aim to combat antimicrobial resistance (AMR) and improve One Health by establishing surveillance systems in GP to monitor antimicrobial usage (AMU) and prescription practices, ensure compliance with standardized guidelines, and develop effective strategies for AMR containment at the community level.

Dr. Moe Ko Oo is a highly experienced healthcare professional with over 25 years of expertise in public health. His work spans international disease surveillance, AMR, and partner collaborations.

Key challenges to be addressed in Myanmar (Burma) are the escalating threat of AMR, exacerbated by socio-political upheavals and porous borders facilitating the movement of diseases and drug-resistant pathogens. With over 53 million people, the scale of the problem is significant, especially considering the high utilization of private and public healthcare providers, where more than half seek care. This trend was more pronounced in urban areas compared to rural areas (70% vs. 48%) and among those in the wealthiest quintile compared to the poorest quintile (65% vs. 45%). The overuse and abuse of antibiotics are among the causes, as are porous borders that permit the spread of disease and the flow of illicit drugs. The proposed approach focuses on setting up surveillance systems at clinics to monitor AMU and prescribing practices. This intervention addresses the lack of data and standardized guidelines in private healthcare settings, aiming to improve antimicrobial resistance awareness and containment strategies. By leveraging existing collaborations with healthcare providers from GPs across 13 out of 15 states and regions, the initiative aims to have a widespread impact on addressing AMR in Myanmar's challenging healthcare landscape, fostering meaningful collaboration among healthcare providers to effectively address AMR.

The proposed initiatives in Myanmar (Burma) target GPs, healthcare providers, and the general public to combat AMR. By establishing AMU monitoring systems and raising AMR awareness, healthcare providers gain insights into common AMU practices, facilitating informed decision-making and guideline compliance. Integrating new data with existing sources fosters collaboration and enhances understanding of AMR among healthcare networks. Additionally, public awareness campaigns promote responsible antibiotic usage, benefiting health programs in Myanmar. Engaging multi-sectoral stakeholders through collaboration, communication, and training sessions ensures active participation and addresses concerns. Myanmar faces challenges due to limited research data on resistant organisms, lagging health indicators, and a high burden of infectious diseases like HIV and malaria, with elevated rates of multidrug-resistant TB. AMR originates from various sectors and requires understanding of socio-cultural, systemic, and policy factors for effective interventions. Despite a national action plan, data limitations hinder the assessment of the impact of antibiotic usage. Analyzing drug usage trends and the appropriateness of prescriptions is crucial, with past studies demonstrating the usefulness of health provider network databases. Addressing these challenges is vital for combating AMR and improving public health outcomes in Myanmar.

The following public goods are expected to enhance understanding, awareness, and response to AMR, ultimately benefiting the well-being of the public in Myanmar and beyond.

a) Findings from the innovative data collection methods and analysis can be published, contributing to the global knowledge base on combating AMR. 

b) Any developed predictive models or algorithms can be made freely available for use by other researchers or organizations tackling AMR.

c) A dashboard displaying real-time AMU data could be accessible to the healthcare providers, and policymakers, aiding in decision-making.

d) Training materials, such as the AMR curriculum, could be distributed at minimal cost to ensure wide dissemination and uptake among healthcare professionals.

e) The social media campaign can raise awareness about AMR, its implications, and preventive measures among the general population, contributing to improved public health outcomes.

Proposed solutions will able to create tangible impacts by improving data accuracy, enhancing healthcare providers' capacity, raising public awareness, and facilitating strategic planning and decision-making processes. Additionally, the provision of training materials and the dissemination of information through various channels will ensure wide uptake and utilization of the solutions, ultimately leading to improved public health outcomes and the effective containment of AMR in Myanmar

a) Developing solutions for AMU landscaping and electronic medical records (EMR) will ensure accurate and timely data collection, enabling a better understanding of AMU patterns and their impact on public health. 

b) Implementing electronic data collection tools and providing training on AMR curriculum will empower primary clinics to make informed decisions regarding antibiotic prescriptions, promoting responsible usage and minimizing the risk of AMR development.

c) The social media campaign and dissemination of information through AMR websites will raise awareness about AMR among the general population, encouraging responsible antibiotic use and contributing to improved public health outcomes.

d) Predictive modeling based on AMU data and policy briefings will aid in developing more effective strategies to combat AMR, ensuring prompt responses to emerging threats and fostering a more comprehensive approach to AMR containment.

Over the first year, preparation involves setting up the AMU surveillance system and developing AMR curriculum and awareness materials. The second and third years focus on implementing the electronic data collection tool, training clinics, and monitoring compliance. Additionally, AMR websites and social media campaigns will raise awareness, while a prediction model based on AMU data will be developed. The project concludes with policy briefings and a project completion report.

Q1-Q2: Preparation of AMU surveillance system (software development, server setup, etc.)

Q2-Q8: Development and implementation of electronic data collection tool in selected clinics

Q2-Q8: Data management: assess accuracy and timeliness of data entry into the electronic tool

Q1-Q2: Development of AMR curriculum (MBDS has identify the standardized topics of modules)

Q1-Q2: Prepare AMR awareness documents in local language (based on WHO references)

Q3-Q5: Training of AMR curriculum through in-person and online training sessions for clinics

Q2-Q8: Development of AMR websites and social media campaign for AMR awareness

Q2-Q8: Monitor compliance with AMR curriculum and AMU surveillance data collection

Q9-Q10: Prediction model development for AMU to AMR base on collective AMU data

Q10-Q11: Policy brief and debriefing of project

Q12: Project completion report

Monitoring plan will include the following components:

a) Establish a regular monitoring and evaluation framework.

b) Assign dedicated staff for monitoring and evaluation tasks. 

c) Regularly collect and analyze data on activities and outcomes. 

d) Conduct periodic reviews and assessments for improvement.

Potential indicators to be measured for M&E purposes:

1. The number of areas prepared for AMU surveillance system
2. The number of clinics trained for AMU monitoring system
3. Integration of AMU tracking tool with Electronic Medical Record (EMR)
4. Accuracy and timeliness of data entry into the electronic tool
5. Availability and accessibility of AMR curriculum
6. The number of healthcare professionals trained on AMR curriculum
7. The number of clinics implementing AMU monitoring system
8. Engagement metrics of the social media campaign for AMR awareness
9. Development and validation of the prediction model for AMU to AMR
10. Accessibility and utilization of the real-time AMU and AMR dashboard
11. Number of relevant policy briefs developed and stakeholders briefed
12. Availability and functionality of the developed credible AMR websites

Potential barriers to establishing surveillance systems in private GP clinics for antimicrobial usage (AMU) monitoring and prescription practices in Myanmar include:

a) Availability of resources for setting up AMU surveillance system, technology implementation and training programs, including its sustainability.

b) Availability of infrastructure and technical expertise for AMU data collection and analysis.

c) Regulatory constraints and privacy concerns regarding data collection and sharing.

d) Resistance or reluctance to change and cultural norms affecting antibiotic prescription practices and to implement AMU monitoring systems.

To overcome these barriers, the plan involves:

a) Foster partnerships with relevant multi-sectoral stakeholders, including government agencies, professional associations, and community organizations, to leverage resources and expertise.

b) Provide technical assistance and training programs to healthcare providers on AMR curriculum and electronic AMU data collection tools, to support the AMU monitoring implementation.

c) Closely work and coordination with legal experts to ensure adherence to data protection laws and establish clear guidelines for effective data accuracy, timeliness, and data sharing processes.

d) Conduct outreach and awareness campaigns to address cultural barriers and garner support from healthcare providers and the public, followed by language-specific translations materials.

The proposed project aligns with The Trinity Challenge's mission to address global health challenges through data analytics and collaboration. By establishing AMU monitoring systems and strengthening AMR awareness in Myanmar, the project aims to contribute to pandemic preparedness and response efforts, particularly in combating AMR. The Trinity Challenge provides a platform for recognition, support, and significant awards to initiatives that promote the public good through data and analytics. By applying The Trinity Challenge, the proposed project can benefit from public recognition through extensive outreach and engagement with global leaders from various sectors, providing unparalleled support and resources. The Trinity Challenge can help overcome barriers faced by the project, including the need for recognition, support, and resources to scale up initiatives aimed at AMR containment and pandemic preparedness. Through its network and resources, The Trinity Challenge can facilitate collaboration, provide funding, and offer expertise to support the successful implementation of the proposed project to combat AMR and improve One Health by establishing surveillance systems in GP to monitor antimicrobial usage (AMU) and prescription practices, ensure compliance with standardized guidelines, and develop effective strategies for AMR containment at the local level.

Incorporating expertise in data science and analytics into the proposed project would enhance its ability to collect, manage, and analyze data on antimicrobial usage. Expertise in public health policy and advocacy would also support the proposed project by informing policy interventions, advocating for evidence-based strategies, and ensuring alignment with national health priorities. Collaboration with a dedicated group of collaborators would further enhance the project's impact by providing guidance, resources, and support to navigate the policy landscape and mobilize stakeholders. Together, these efforts would contribute to the effective containment strategies of AMR in Myanmar, ultimately improving public health outcomes and promoting responsible antibiotic use.