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Antimicrobial resistance is a major global health challenge. It threatens the achievement of multiple SDGs with disproportionately negative consequences for LMICs. AMR is associated with the misuse of antibiotics, which is especially dominant in livestock farming. On-farm biosecurity has been identified as an effective way to prevent diseases. This requires a change in the daily behaviours of farmers. While the application of social-psychological models gained immense popularity in veterinary and agricultural research, these models lack predictive and explanatory character, leading to the so-called intention-action gap. The emerging field of behavioural sciences likely offers a better explanation of human behaviour, however, studies published often lack use of an explicit theoretical framework. Therefore, this exploratory study aims to address this gap by using Kahneman’s Dual-Process Theory as a theoretical framework for behaviour science studies. To this end, a qualitative study with 15 smallholder poultry farmers in rural Ghana was conducted. The findings suggested the presence of cognitive biases and heuristics that hinder farmers’ uptake of biosecurity measures, such as temporal discounting, social cues, cognitive overload, psychological inertia and habits. However, all factors must be considered, including knowledge gaps, as well as practical and economic constraints. It is clear from the study that farmers are not a homogenous group and that any promotion of biosecurity is destined to fail if they do not take farmers' psychological and contextual reality into consideration. Therefore, this thesis concludes that additional insights and hypotheses can be generated using behavioural science and that it offers a better and more holistic theoretical framework than currently used behavioural change models. Suggestions for further work include more empirical study in farmer decision-making related to on-farm biosecurity from a behavioural lens. Specifically, the use of quantitative and experimental methods to investigate and confirm the hypotheses that emerged from this study.

Antibiotic resistance is one of the greatest global threats we face today. Human overuse ofantibiotics is a contributing factor and major behaviour change around antibioticconsumption is needed, but several challenges exist in communicating antibiotic resistanceto the public. In 2018 the UK Government relaunched a national television advertisement aspart of the ‘Keep Antibiotics Working’ campaign which aimed to raise awareness of antibioticresistance and reduce public demand for antibiotics. This study evaluates what role theframing of antibiotic resistance in the advertisement played in increasing publicunderstanding of antibiotic resistance and motivating behaviour change. The study isgrounded in behaviour change and health communication theory from the field ofCommunication for Development, and health and social psychology theory, reflecting theneed for multidisciplinary approaches to addressing antibiotic resistance. A textual analysisidentified how the issue was framed in the advertisement and surveys and interviews wereconducted with members of the target audience groups to analyse what effect theadvertisement had on their understanding of, and attitude towards antibiotic resistance.The findings show that the framing of antibiotic resistance in the TV advertisement led to anincrease in misunderstandings of what becomes resistant to antibiotics. The advertisementwas helpful in highlighting the vulnerability of antibiotics and for creating a new social normaround being a responsible antibiotic user, however was interpreted as childish byparticipants. It did not communicate the severity of antibiotic resistance or specific risk ofantibiotic overuse to the audience, or accurately reflect the audience’s existing knowledge ofantibiotic resistance and current behaviours. As the severity of antibiotic resistance was notconveyed, the advertisement did not motivate a change in antibiotic seeking behaviours orattitude amongst the majority of participants. The findings did highlight knowledge gapsamongst study participants including the importance of completing a course of antibiotics asprescribed, and that it is the bacteria itself, not the person, that develops resistance, andhopes this research can inform the development of future campaigns.

Introduktion: Antimikrobiell resistens är en av de stora utmaningarna för folkhälsan i världen. Enligt synsättet One Health är kunskap viktig för att antibiotikaresistens ska kunna bromsas. I Sverige finns en låg men dock tilltagande förekomst av multiresistenta bakterier. Tidigare studier visa att personer som är bärare av multiresistenta bakterier upplever okunskap och otillräckligt och inadekvat bemötande, främst bland hälso- och sjukvårdspersonal. Sår är en riskfaktor för Meticillinresistenta Staphylococcus aureus MRSA, Extended spectrum betalactamase ESBL, Extended spectrum beta-lactamase ESBL-CARBA och Vancomycinresistenta enterokocker VRE. Syfte: Att beskriva hur personer som har sår och som har smittats av någon typ av multiresistent bakterie upplever bemötandet från sin omgivning på grund av smitta. Metod: En kvalitativ intervjustudie med induktiv ansats. Åtta semistrukturerade intervjuer genomfördes med studiedeltagare som hade svårläkta sår och som var bärare av en eller flera multiresistenta bakterier. Resultat: Den kvalitativa innehållsanalysen visade två övergripande teman: Bemötande från omgivningen och Bärarskap av multiresistenta bakterier påverkar omgivningen. Kategorierna för temat Bemötande från omgivningen var: Bemötande av hälso- och sjukvård; Bemötande från familj och vänner och Bemötande från övriga i samhället. Kategorierna till Bärarskap av multiresistenta bakterier påverkar omgivningen var: Överkonsumtion av skyddsutrustning; Personer som är bärare av multiresistenta bakterier har ett eget ansvar mot sin omgivningoch Samhällets ansvar för information om multiresistenta bakterier.  Slutsats: De flesta av studiedeltagarna upplever att de blev bra bemötta eller att reaktion saknades från omgivningen, dock förekom det enstaka situationer där multiresistensen påverkade bemötandet. Det fanns en kunskapsbrist, både hos de personer som är bärare av multiresistenta bakterier och från omgivningen. / Introduction: Antimicrobial resistance is a major challenge for public health globally. Out of a One Health approach, knowledge is important for slowing down spread of antibiotic resistance. In Sweden, the prevalence of multi-resistant bacteria is low but, however, is increasing. Previous studies show that people who are carrier of multi-resistant bacteria perceive lack of knowledge and incompetent and inadequate encountering mainly with health care professionals. Ulcer is risk factor for Methicillin-resistant Staphylococcus aureus, Extended-Spectrum-Beta-Lactamase, Extended-Spectrum-Beta-Lactamase- Carba and Vancomycin-resistant Enterococcus. Aim: To describe how people who have been infected by some type of multi-resistant bacteria experience the treatment from their surroundings due to infection. Method: A qualitative content analysis with inductive approach. Eight semistructured interviews were conducted with patients who had ulcer and were carriers of one och more multi-resistant bacteria. Results: The qualitative content analysis showed two overarching themes: Treatment from the enviroment and Carrier of multi-resistant bacteriaaffect the enviroment. The categories for the theme Treatment from the enviroment were: Treatment from health care; Treatment from family and friends and Treatment from others in the community. The categories for Carrier of multi-resistant bacteria affect the enviroment were Overconsumption of protective equipment; People who are carrier of multi-resistant bacteria have a responsibility for the environment and Society’s responsibility for information on multi-resistant bacteria. Conclusion: Most of the study participants felt that they were treated well or that there was no reaction from the environment, however, there were occasional situations when the multi-resistance affected the treatment. There was at lack of knowledge, both among the people who are carriers of multi-resistant bacteria and from the enviroment.

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Thesis (M.Sc.(Medical Sciences)) -- University of Limpopo, 2022 / Background: Wound infections continue to be problematic in clinical practice where empiric treatment of infections is a routine, with non-healing wounds being a burden to the health care system. A gap has been noted between antimicrobial resistance and demographic factors as an existing relationship. This necessitates an investigation of patterns of isolates and susceptibility profiles of microorganisms in wounds to modify the preventative and therapeutic strategies against the resistant strains leading to the stall of wound healing, which could aid in empiric treatment. Objective: The aim of this study was to determine the antimicrobial patterns and their associated demographic determinants in bacteria isolated from patients with non healing wounds at Pietersburg and Mankweng Hospitals, Limpopo Province. Methods: The study was conducted using antimicrobial susceptibility data collected from National Health Laboratory Service through Academic Affairs and Research Management System for the period 2016-2020. A total of 797 Antimicrobial Susceptibility Test results were analysed using Statistical Package for Social Sciences version 27.0. The susceptibility rates for the bacterial isolates by age and gender were calculated. The mean percentages for sensitivity and resistance were also calculated. Pearson’s Chi-square test was used to compare age and gender with drug susceptibility. A p-value of ≤ 0.05 was considered significant. Results: Of the 797 patient Antimicrobial Susceptibility Test results, 372 (46.7%) were males and 425 (53.3%) females, with mean age of 31.42 ± 21.75 years. The most common isolates were, Klebsiella pneumoniae (23%), Pseudomonas aeruginosa (21.7%), Escherichia coli (16%) and Proteus mirabilis (13.5%). Highest percentage of resistance to any antibiotic was amoxicillin, ampicillin (85.15%) then trimethoprim sulfamethoxazole (60.85%), amoxicillin ampicillin (49.1%), tigecycline (46.35%), cefepime (32.7%), gentamycin (25.4%), ciprofloxacin (22.5%), colistin (17.6%), and meropenem (12.3%). Furthermore, the general view of the study is no statistically clinical significance on the effect of age and gender on bacterial resistance although statistical significance was noted on age the resistance Acinetobacter baumannii vi (p=0.018), and gender on K. pneumoniae (p=0.015), P. mirabilis (p=0.024). Major resistance to A. baumannii, K. pneumoniae and P. mirabilis were from female patients. Conclusions: The most effective antibiotics were meropenem, colistin, and ciprofloxacin. The highest number of isolates were K. pneumoniae, E. coli, P. aeruginosa, P. mirabilis and A. baumannii with the most effective antibiotics gentamycin, meropenem, ciprofloxacin, and cefepime. Although the general view of the study is that no statistically clinical significance was noted on the effect of age and gender on bacterial resistance, it is important to note the significant observation that there was an observed relation of age to amoxicillin-clavulanic acid and Ciprofloxacin and gender to amoxicillin ampicillin. As such, there is insufficient evidence that supports the effect of age and gender on antimicrobial susceptibility. The study suggests caution against the use of amoxicillin ampicillin in the treatment of wound infections as it confers low levels of efficacy and high resistance and ultimately the call to revise minimum inhibitory concentrations and critical concentrations of all less effective drugs to increase their efficacy. / National Research Foundation (NRF)

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Yes / The sustained and controlled delivery of antimicrobial drugs has been largely studied using nanomaterials, like metal organic frameworks (MOFs), and various polymers. However, not much attention has been given to combining MOFs and biodegradable polymers towards the potentially more sustained release of active pharmaceutical ingredients. Herein, we report a comparative study of two widely used antimicrobial drugs, cephalexin and metronidazole, from zinc-based MOF-5 incorporated into biodegradable polycaprolactone (PCL) and poly-lactic glycolic acid (PLGA) composites. Cephalexin and metronidazole were separately loaded into MOF-5 post-synthetically, followed by their integration into biodegradable PLGA and PCL composites. The pristine MOF-5 and the loaded MOFs were thoroughly characterised using Fourier-transformed infrared (FT-IR) spectroscopy, scanning electron microscopy (SEM), thermogravimetric analysis (TGA) and powder X-ray diffraction (PXRD). Ultraviolet-visible (UV-Vis) spectroscopy studies were carried out to assess the release of the drugs in PBS for up to 72 h, showing a cumulative release of 24.95 wt% and 27.84 wt% for cephalexin and metronidazole, respectively. The antibacterial properties of the pristine MOF, pure drugs, drug-loaded MOFs and the loaded composites were assessed against Gram-positive and Gram-negative bacterial strains, Staphylococcus aureus or Staphylococcus epidermidis and Escherichia coli or Acinetobacter baumanii, respectively. A cephalexin-loaded MOF-5 composite of PCL (PCL-ceph@MOF-5) showed the best efficiency for the controlled release of drugs to inhibit the growth of the bacteria compared to the other composites. This study demonstrates that the combination of MOFs with biodegradable polymers can provide an efficient platform for the sustained release of antimicrobial drugs and can be a promising tool to manage antimicrobial resistance (AMR).