Implementation of AMSP using Application (App) for School Children

The increasing antimicrobial resistance(AMR) is worrisome, mainly in LMIC.  Moreover, pediatric groups are conducive to the spread of infections. To increase the knowledge of AMR, we will design the web-based friendly application “AMROCOM” and train school-going children for AMSP and hand hygiene practices. We will also evaluate AMR in emergency-ward

Dr. Purva Mathur

Professor and In-charge, Infection Control Unit

Department of Lab Medicine

JPN Apex Trauma Centre, AIIMS 

New Delhi

Antimicrobial resistance (AMR) is one of the biggest threats to public health throughout the world, mainly when it comes to children. According to WHO data, infections caused by multidrug resistant bacteria cause 700,000 deaths across all ages, of which 200,000 are newborns. This surging issue has multipronged roots that are specific to children. For instance, the problematic overuse and misuse of antibiotics is also fuelled by a lack of paediatric-specific data and trials. The paediatric population is also affected by the contraindications of tetracyclines and fluoroquinolones, and by congenital malformations, which often require repeated hospitalizations and pharmacological and surgical treatments from a very young age. Emerging threats for the paediatric age are MRSA, VRSA, ESBL-producing Enterobacteriacea, carbapenem-resistant Enterobacterales, and the alarming colistin resistance. Urgent action is needed in order to step back from a now likely post-antibiotic era where simple infections might cause childhood deaths once again. Moreover, the data on AMR in community settings in a developing countries like India is very limited.

Awareness and education in children: Community acquired-AMR in children is concerning. It refers to development of resistance to commonly used drugs, therefore, providing educational campaigns aimed at raising awareness among the population about the responsible use of antibiotics. This serves the need for informed decision-making and behavior's change in the community. Inadequate hygiene conditions can facilitate the spread of resistant bacteria contributing to AMR. Children in schools and daycare centers can facilitate the spread of resistant bacteria through close contact. Therefore, training the school-going children will increase their awareness on AMR and importance of hand hygiene.

Proper Antibiotic Use for Children: The adverse impact of incomplete dosage is unknown within general-public. Therefore educating parents/caregivers about the appropriate use of antibiotics and consequences of misuse is essential. The knowledge on importance of using antibiotics appropriately for children should be disseminated in parents, which will help them to understand when antibiotics are necessary, completing prescribed courses and avoiding self-medication.

General public awareness: The application AMROCON will help in raising the awareness among the general public health about the responsible use of antibiotics,the importance of proper hygiene practices. This serves the need for informed decision-making and behavior's change in community.     

Considering the increasing burden of community acquired infection, the rise in severity of illness, complexity, and failure of treatment, superimposed by multi-drug resistant pathogen infections, the basics of infection prevention measures like hand hygiene and personal hygiene will reduce life threatening diarrheal and respiratory infections among schoolchildren and will also reduce the risk of cross-contamination of infections and thus antimicrobial resistance. Schoolchildren frequently carry infections home, subsequently transmitting them to the elderly individuals in their households. This dynamic serves to disrupt the transmission cycle as well.

Our solution can enhance overall public health by reducing the spread of infections, thereby lowering the burden on healthcare systems. It will also promote individual well-being by fostering better hygiene practices and preventing illness. It may contribute to the global effort to combat antibiotic resistance by educating individuals on the appropriate use of antibiotics, thus helping to preserve their effectiveness for future generations. Ultimately, these initiatives support a healthier population and a more sustainable healthcare system.

Health Awareness: Our mobile application can educate about the importance of hand-hygiene, personal hygiene and antimicrobial resistance to mitigate infection spread. By promoting IPC practices, it can help reduce the incidence of infections in community settings.

Reduced Antibiotic Misuse: The app will raise awareness about the appropriate use of antibiotics and the dangers of antibiotic resistance. By providing information on when antibiotics are necessary and emphasizing the importance of completing prescribed courses, it can help reduce the misuse of antibiotics among schoolchildren, teachers, school staffs and their families.

Healthier Environment: By promoting good hygiene practices, the application can contribute to creating a healthier environment with lower rates of illness. This can lead to fewer absences due to sickness in schools and a more conducive atmosphere for learning.

Community Impact: Children often spread infections to family members, so instilling good hygiene habits in school can have a ripple effect, leading to improved health outcomes for families and community at large.

Data Insights: Through the app, data on hand hygiene and antibiotic use among schoolchildren can be collected and analysed. This data can provide valuable insights into trends and areas for improvement in public health initiatives targeting this demographic.

Scaling up impacts over the next year:

• Developing, testing and training our mobile application and conduct user testing to gather feedback and make necessary improvements based on user preferences.
• Design a scalable backend infrastructure to handle increased user loads as the application gains popularity.
• Implement robust security measures to protect user data, especially sensitive health information related to antibiotic monitoring.
• Provide training materials and support resources for users to ensure they understand how to use the application effectively.
• Foster a community around the application by encouraging user engagement, sharing success stories, and facilitating peer-to-peer support networks.

Scaling up impacts over the next three years:

• Collaborate with more schools, and healthcare facilities to conduct workshops and seminars on proper handwashing techniques, personal hygiene, antimicrobial use and resistance and use of our mobile application.
• Organize community events in schools such as health fairs or hand hygiene/personal hygiene awareness days where people can learn about IPC practices.
• Provide access to affordable hand hygiene/personal hygiene products and facilities, in schools and emergency department of HCF.
• Conduct regular surveys and assessments to gauge awareness levels and identify areas for improvement.
• Use data analytics to track progress and adjust strategies as needed.

We will measure success against our impact goals through the following:

• Number of downloads/installations of the application.

• Frequency and duration of app usage by our users.
• Active user engagement metrics, such as interactions with educational content, completion of handwashing challenges, or participation in antibiotic awareness activities within the mobile app.
• Surveys to measure changes in knowledge, attitudes, and behaviours related to hand hygiene/personal hygiene, and antibiotic use before and after using the app.
• Observation of handwashing practices to assess improvements in compliance with proper hygiene techniques.
• Reductions in rates of infectious diseases, incidence of antibiotic-resistant infections, or absenteeism due to illness among schoolchildren.
• Gathering feedback through surveys, reviews, or user ratings to assess user satisfaction with the app's features, usability, and effectiveness in promoting hand hygiene and antibiotic stewardship.
• Conducting interviews to gather qualitative insights into users' experiences, challenges, and suggestions for improvement.
• Assessing the extent of partnerships and collaborations established with schools and other community settings to promote the app and its educational initiatives.
• Analyzing app usage data and trends to identify patterns, preferences, and areas for optimization.
• Utilizing data on hand hygiene compliance, antibiotic use, and user interactions within the app to inform targeted interventions and content updates.

• Developing a user-friendly mobile app demands expertise in app development, UI design, and data management, along with compatibility across devices and OS. Partnering with professional app development firms aids in navigating technical hurdles. Continuous testing and iteration are pivotal for addressing emerging issues.
• Creating and validating educational content on hand hygiene and antibiotics, tailored to users' needs, is challenging. Collaboration with public health and medical experts ensures content accuracy. Piloting studies and focus groups offer vital feedback.
• Data privacy and security are paramount. Strict protocols and encryption safeguard user data. Legal counsel ensures compliance with regulations.
• User adoption hinges on effective promotion and engagement strategies. Outreach programs and educational partnerships, along with gamification and incentives, boost user engagement.
• Sustainability relies on securing ongoing funding. Exploring grants, sponsorships, and partnerships sustains the app beyond development.

Applying to the Trinity Challenge for a project offers several benefits:

• Global Impact: The Trinity Challenge is a global initiative aimed at addressing global health challenges. One can contribute to tackling significant health issues that affect communities worldwide.
• Resources and Support: The Trinity Challenge provides access to resources, expertise, and networks that can support the development and implementation of innovative solutions. This can include funding, mentorship, and collaboration opportunities with other stakeholders.
• Validation and Recognition: The Trinity Challenge can validate the importance and potential impact of our project. It provides recognition from a reputable organization, which can enhance credibility and attract further support and collaboration.
• Access to Partnerships: The Trinity Challenge fosters collaborations between different sectors, including academia, industry, governments, and NGOs. It can help us establish valuable partnerships that can accelerate the development and deployment of our mobile application and training programs.
• Learning and Growth: It will expose us to diverse perspectives, knowledge, and experiences from experts and peers across various fields. This can enrich our understanding of the problem and potential solutions, leading to continuous learning and improvement.

Overall, applying to the Trinity Challenge aligns with our initiative's goals and can provide significant opportunities for impact, support, recognition, and collaboration.

Firstly, we will partner with the Directorate of Education, Government of NCT Delhi, one of the most prominent public education boards in India. By collaborating with this institution, we aim to scale up and integrate our initiatives into the educational framework, empowering students and educators with the knowledge and tools to promote infection prevention and control practices. Through training workshops, and awareness campaigns, we aspire to instill a culture of health and hygiene within schools and communities and make them drivers of change, ultimately contributing to the reduction of healthcare-associated infections (HAIs) and the enhancement of public health outcomes.

Additionally, we will engage with the Emergency Department (ED) of the JPNA Trauma Center to embark on a pioneering initiative focused on estimating the burden of microbial resistance within the community. By leveraging the expertise and resources available to us, we will conduct comprehensive surveillance and analysis to assess the prevalence and patterns of antimicrobial resistance among local populations. Through multidisciplinary collaboration and data-driven interventions, we aim to mitigate the threat of antimicrobial resistance and safeguard the effectiveness of antimicrobial therapies in the community.

We were invited to the one-day hackathon on antimicrobial resistance by Dr. Kamini Walia, ICMR, New Delhi, India. It was an interesting meetup conducted by members of The Trinity Challenge with the support of ICMR in Delhi.