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Fulltext Social sciences research in neglected tropical diseases 1: the ongoing neglect in the neglected tropical diseases

Allotey P, Reidpath DD, Pokhrel S

Health Res Policy Syst, 2010 Oct 21;8:32.
PMID: 20961461 DOI: 10.1186/1478-4505-8-32

Centuries of scientific advances and developments in biomedical sciences have brought us a long way to understanding and managing disease processes, by reducing them to simplified cause-effect models. For most of the infectious diseases known today, we have the methods and technology to identify the causative agent, understand the mechanism by which pathology is induced and develop the treatment (drugs, vaccines, medical or surgical procedures) to cure, manage or control.Disease, however, occurs within a context of lives fraught with complexity. For any given infectious disease, who gets it, when, why, the duration, the severity, the outcome, the sequelae, are bound by a complex interplay of factors related as much to the individual as it is to the physical, social, cultural, political and economic environments. Furthermore each of these factors is in a dynamic state of change, evolving over time as they interact with each other. Simple solutions to infectious diseases are therefore rarely sustainable solutions. Sustainability would require the development of interdisciplinary sciences that allow us to acknowledge, understand and address these complexities as they occur, rather than rely solely on a form of science based on reducing the management of disease to simple paradigms.In this review we examine the current global health responses to the 'neglected' tropical diseases, which have been prioritised on the basis of an acknowledgment of the complexity of the poverty-disease cycle. However research and interventions for neglected tropical diseases, largely neglect the social and ecological contextual, factors that make these diseases persist in the target populations, continuing instead to focus on the simple biomedical interventions. We highlight the gaps in the approaches and explore the potential of enhanced interdisciplinary work in the development of long term solutions to disease control.
Fulltext Social sciences research in neglected tropical diseases 2: A bibliographic analysis

Reidpath DD, Allotey P, Pokhrel S

Health Res Policy Syst, 2011 Jan 06;9:1.
PMID: 21210997 DOI: 10.1186/1478-4505-9-1

BACKGROUND: There are strong arguments for social science and interdisciplinary research in the neglected tropical diseases. These diseases represent a rich and dynamic interplay between vector, host, and pathogen which occurs within social, physical and biological contexts. The overwhelming sense, however, is that neglected tropical diseases research is a biomedical endeavour largely excluding the social sciences. The purpose of this review is to provide a baseline for discussing the quantum and nature of the science that is being conducted, and the extent to which the social sciences are a part of that.
METHODS: A bibliographic analysis was conducted of neglected tropical diseases related research papers published over the past 10 years in biomedical and social sciences. The analysis had textual and bibliometric facets, and focussed on chikungunya, dengue, visceral leishmaniasis, and onchocerciasis.
RESULTS: There is substantial variation in the number of publications associated with each disease. The proportion of the research that is social science based appears remarkably consistent (<4%). A textual analysis, however, reveals a degree of misclassification by the abstracting service where a surprising proportion of the "social sciences" research was pure clinical research. Much of the social sciences research also tends to be "hand maiden" research focused on the implementation of biomedical solutions.
CONCLUSION: There is little evidence that scientists pay any attention to the complex social, cultural, biological, and environmental dynamic involved in human pathogenesis. There is little investigator driven social science and a poor presence of interdisciplinary science. The research needs more sophisticated funders and priority setters who are not beguiled by uncritical biomedical promises.
Fulltext The fallacy of the equity-efficiency trade off: rethinking the efficient health system

Reidpath DD, Olafsdottir AE, Pokhrel S, Allotey P

BMC Public Health, 2012;12 Suppl 1:S3.
PMID: 22992346 DOI: 10.1186/1471-2458-12-S1-S3

In the health systems literature one can see discussions about the trade off between the equity achievable by the system and its efficiency. Essentially it is argued that as greater health equity is achieved, so the level of efficiency will diminish. This argument is borrowed from economics literature on market efficiency. In the application of the economic argument to health, however, serious errors have been made, because it is quite reasonable to talk of both health equity being a desirable output of a health system, and the efficient production of that output. In this article we discuss notions of efficiency, and the equity-efficiency trade off, before considering the implications of this for health systems.
Fulltext Behaviour Change in Public Health: Evidence and Implications

Pokhrel S, Anokye NK, Reidpath DD, Allotey P

Biomed Res Int, 2015;2015:598672.
PMID: 26380284 DOI: 10.1155/2015/598672
A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal

Jha N, Thapa B, Pathak SB, Pandey A, Pokhrel S, Shankar PR, et al.

Kathmandu Univ Med J (KUMJ), 2022;20(79):351-358.
PMID: 37042379

Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.