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(1) Background: Antimicrobial resistance causes significant disease burden in low- and middle-income countries. The objective of this paper is to describe antibiotic dispensing/prescribing practices and underlying factors associated with these practices among community-based healthcare workers. (2) Methods: Cross-sectional survey data were collected from private and public health facilities in 14 union councils, Lahore Pakistan. Respondents included physicians, nurses, lady health workers/volunteers, midwives, pharmacy and medicine shop employees, and medical technicians. Descriptive and bivariate analysis are used to present the data; (3) Results: 177 respondents completed the survey. In terms of weekly dispensing of antibiotics, the most common were Amoxicillin/Augmentin (2.3 [SD 1.5]), Cefixine (2.4 [SD 1.6]), and Azithromycin (2.5 [SD 2.1]). For children, antibiotics were more likely to be prescribed/dispensed for sore throat (54.3%/95) and diarrhea (48.9%/86). For adults, antibiotics were more likely to be prescribed/dispensed for sore throat (67.0%/118), diarrhea (59.7%/105) and burning sensation when urinating (55.7%/176). In total, 55.4% of respondents stated that they have sold partial antibiotic courses to patients/customers. A total of 44.6% of respondents incorrectly answered that antibiotics could be used for viral infections; (4) Conclusions: Data from this study and similar research emphasize the urgent need to implement community-based stewardship programs for all healthcare workers.
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INTRODUCTION: Vaccination coverage is low in Nigeria, partly due to poor demand for the vaccines. Till date, there is limited understanding of what works to improve demand for vaccination. A Vaccine Indicator and Reminder (VIR) band was designed to be worn on a child's ankle to serve as a constant reminder to parents/caregivers on when to bring their children for vaccinations. This study assessed the acceptability of the band as a wearable reminder for infant vaccination in Kebbi State, Nigeria. METHODS: A total of 503 infants who met the eligibility criteria were enrolled between August 2017 and February 2018. The intervention involved 1) sensitisation and mobilisation of community gatekeepers to advocate for immunisation; 2) engaging traditional birth attendants (TBAs) to refer mothers for vaccination and VIR bands; and 3) training facility-based health workers to secure the band on an eligible child. Focus group discussions and in-depth interviews were conducted at baseline (May 2016) and end-line (July 2018) with purposively selected participants. These interviews were analysed thematically. RESULTS: There was general acceptability of the band at all levels, especially among community members who likened it to a "wristwatch" that constantly reminds mothers when next to vaccinate their children. The strong support from community leaders, TBAs and participating health workers increased acceptability of the band. Similarly, the VIR band's aesthetics, ease of use and perceived benefits contributed to its acceptability. Wearing the VIR band was not perceived as an impediment because similar accessories are worn on new-borns. However, there were concerns about wearing accessories on the ankle, the red indicator colour, and the malfunctioning of some bands. CONCLUSIONS: This study demonstrates that cultural adaptability of interventions and engagement with community structures are important in facilitating acceptability of new innovations. Further studies will evaluate the effectiveness of VIR band in improving vaccination coverage.