Community-Based Surveillance of Antimicrobial Use and ...

8. Lessons learnt and recommendations8. Lessons learnt and recommendations8.1 BackgroundAs part of the global effort to contain the rising trends in AMR rates, a pilot project wasinitiated with the long‐term aim of collecting data on the pattern and the quantity of ABMuse and its association with changes in susceptibility patterns of bacteria prevalent inresource‐poor communities. The data collected could help in developing targetedinterventions and could be used later in evaluating the impact of interventions designed tocontain AMR. Multidisciplinary capacity building was another intended outcome.Since AMR changes require several years to be measurable and data collected at several timepoints are needed to understand the association, it was necessary to establish sustainablesurveillance systems in various parts of developing countries and in areas assumed to havedifferent patterns of ABM use and AMR rates. The areas chosen had differing modes ofhealth‐care delivery, and the health systems were all weaker compared to systems inindustrialized countries. The health‐seeking behaviour of the populations also differed.Therefore, it was necessary to develop protocols best suited to each of these areas to collectdata on ABM use and AMR. These differing experiences were intended to help in makingrecommendations on methodologies suitable for community surveillance of ABM use andAMR in resource‐constrained settings. Comparison between the data collected in thedifferent sites was not part of the objectives.8.2 AchievementsThe following achievements of the pilot projects were noted.1. Pilot projects were carried out at sites in South Africa and India to ascertain the feasibilityof undertaking long‐term surveillance of AMR and ABM use in communities in theseareas.2. Data on ABM use and AMR were collected from all sites for a minimum period of 12months. From some sites data were available over a two‐year period.3. The information gathered will be useful to start locally relevant interventions. Thecooperation established with the sites will help in pilot testing such interventions.4. Useful information on methods to study ABM use and AMR in communities wasgenerated.5. Several issues related to logistics of long‐term surveillance were identified and practicalsolutions suggested.6. Recommendations for expanding such systems in the future could be made.7. The mere fact of involving several health‐care facilities at the community level in datacollection itself increases awareness regarding the issue of increasing resistance toantibacterial therapy and its relation to ABM use.87