Search

The diminishing effectiveness of antimicrobials raises serious concerns for\ud human health. While policy makers grapple to reduce the overuse of\ud antimicrobial medicines to stem the rise of antimicrobial resistance,\ud insufficient attention has been paid to how this applies to low-resource\ud contexts. We provide an in-depth portrayal of antimicrobial prescribing\ud at primary health care level in rural Chikwawa District, Malawi.\ud Ethnographic fieldwork took place over 18 months (2018–2020). We\ud surveyed 22 health facilities in the district, observed 1348 health\ud worker-patient consultations, and carried out 49 in-depth interviews\ud with staff and patients. Care was centred around provision of an\ud antimicrobial. Amid chronic lack of essential medicines and other\ud resources, clinic interactions were tightly scripted, providing patients\ud little time to question or negotiate their treatment. We develop the\ud concept of ‘antibiotic vulnerabilities’ to reveal multiple ways in which\ud provision of antimicrobials in rural Malawi impacts care in conditions of\ud extreme scarcity. Antibiotics are central and essential to primary care.\ud As targets for optimal antimicrobial prescribing take a more central role\ud in global policy, close attention is required of the ramifications for the\ud delivery of care to ensure that efforts to stem resistance do not\ud undermine the goal of improved health for all.

This manuscript contains the Appendix to the paper Contreras L-F, Linero-Molina S, Dixon J (2022) Bayesian Approach To Improve The Confidence Of The Estimation Of The Shear Strength Of Coarse Mine Waste Using Barton’s Empirical Criterion. Aust Geomechanics Journal 57–2:https:/ /doi.org/10.56295/agj5728

Background Overuse of antibiotics is one of the main drivers for antimicrobial resistance (AMR). Globally, most antibiotics are prescribed in the outpatient setting. This survey aimed to explore attitudes and practices with regards to microbiology tests, AMR and antibiotic prescribing among healthcare providers at public primary health clinics in Harare, Zimbabwe. Methods This cross-sectional survey was conducted in nine primary health clinics located in low-income suburbs of Harare between October and December 2020. In Zimbabwe, primary health clinics provide nurse-led outpatient care for acute and chronic illnesses. Healthcare providers who independently prescribe antibiotics and order diagnostic tests were invited to participate. The survey used self-administered questionnaires. A five-point Likert scale was used to determine attitudes and beliefs. Results A total of 91 healthcare providers agreed to participate in the survey. The majority of participants (62/91, 68%) had more than 10 years of work experience. Most participants reported that they consider AMR as a global (75/91, 82%) and/or national (81/91, 89%) problem, while 52/91 (57%) considered AMR to be a problem in their healthcare facilities. A fifth of participants (20/91, 22%) were unsure if AMR was a problem in their clinics. Participants felt that availability of national guidelines (89/89, 100%), training sessions on antibiotic prescribing (89/89, 100%) and regular audit and feedback on prescribing (82/88, 93%) were helpful interventions to improve prescribing. Conclusions These findings support the need for increased availability of data on AMR and antibiotic use in primary care. Educational interventions, regular audit and feedback, and access to practice guidelines may be useful to limit overuse of antibiotics.

The advent of antibiotics transformed the global public health landscape, dramatically improving health outcomes. Drawing on historical and ethnographic research on sex work in Zimbabwe, we examine the role of antibiotics in the management of sexually transmitted infections among sex workers, from punitive colonial approaches to "empowerment"-based discourses. We illustrate how programs for sex workers, while valued by these women, are narrow, exclusionary, and enact a pharmaceuticalized form of governance that hangs on the efficacy of antibiotics. With antibiotics' efficacy under threat, we consider how latent colonial logics are in danger of being reactivated to control both infections and women.

As life expectancies rise globally, the number of people living with multiple chronic health conditions – commonly referred to as ‘multimorbidity’ – is rising. Multimorbidity has been recognised as especially challenging to respond to in countries whose health systems are under-funded, fragmented, and designed primarily for acute care, including in sub-Saharan Africa. A growing body of research in sub-Saharan Africa has sought to better understand the particular challenges multimorbidity poses in the region and to develop context-sensitive responses. However, with multimorbidity still crystallising as a subject of enquiry, there remains considerable heterogeneity in conceptualising multimorbidity across disciplines and fields, hindering coordinated action. In June 2022, 60 researchers, practitioners, and stakeholders with regional expertise from nine sub-Saharan African countries gathered in Blantyre, Malawi to discuss ongoing multimorbidity research across the region. Drawing on insights from disciplines including epidemiology, public health, clinical medicine, anthropology, history, and sociology, participants critically considered the meaning, singular potential, and limitations of the concept of multimorbidity in sub-Saharan Africa. The workshop emphasised the need to move beyond a disease-centred concept of multimorbidity to one foregrounding patients’ values, needs, and social context; the importance of foregrounding structures and systems rather than behaviour and lifestyles; the value of a flexible (rather than standard) definition of multimorbidity; and the need to leverage local knowledge, expertise, resources, and infrastructure. The workshop further served as a platform for exploring opportunities for training, writing, and ongoing collaboration.

The utilisation of three-dimensional limit equilibrium in evaluating open pit slope stability is becoming increasingly common in the industry. Implementation of this assessment approach requires developing new assessment workflows associated with the model inputs to ensure confidence in the modelling outcomes and leveraging the full benefits of the approach. Several challenges also exist in terms of understanding data reliability and software capability; a particular limitation identified was the practical application of the disturbance zone behind the slope. This paper provides a workflow adopted to ensure high confidence in the modelling outcomes and communication of the assessment results using a case study and highlights the software developments to address limitations.

Exploration, resource definition, and active mining operations can be located in terrains that contain geohazards such as rockfalls or landslides from natural slopes. To mitigate risks associated with working within these environments, controls such as hazard rating sheets have been developed for use by field personnel that enable escalation of assessment and implementation of mitigation measures as may be required to manage the risk. Where these risks are present in active mining operations, assessment of the natural geohazards must be integrated with ground control management tools such as ground awareness training, trigger action response plans, and geotechnical hazard plans. This paper provides an example of a site-specific framework for natural slope hazard management in the Pilbara and how GIS-based susceptibility mapping and rockfall hazard rating field assessment sheets are integrated into the operations ground control management system.

Closure planning is a fundamental requirement for all existing and planned future mines. However, there are no accepted industry guidelines for how to geotechnically and hydrogeologically assess options for open pit and waste dump closure or for advancement of the closure plan in parallel stages with overall project development and operation. Ideally, closure planning needs to consider the site setting, develop the “big-picture” strategy, and work downward from there, balancing the objectives of the operator, regulator and community. At present, too much binding detail is being included in “early-stage” closure plans that, when approved, become committed. This paper outlines the “State-of-Practice” geotechnical and hydrogeological guidelines for closure planning and implementation being developed by the Large Open Pit (LOP) project research group. The new Guidelines are intended for use by geotechnical and hydrogeological mining professionals addressing closure design criteria, risk management, detailed planning and implementation. Benchmarks are provided for stakeholders, including regulators and the community, to judge whether adequate investigations and planning have been completed for appropriate stages of overall project development. Three case studies are provided to illustrate how changes of closure approach produced a substantially better outcome

Rising concerns around antimicrobial resistance (AMR) have led to a renewed push to rationalise antibiotic prescribing in low- and middle-income countries (LMICs). There is increasing unease in conceptualising antibiotic use as individuals behaving '(ir)rationally' and recognition that rising use is emergent of and contributing to wider economic and political challenges. But in between these individual and societal 'drivers' of antibiotic use is an everyday articulation of care through these substances, written-in to the scripts, delivery chains and pedagogics of global healthcare. This article focuses on this everyday 'architecture' that over time and across spaces has knitted-in antibiotics and rhetorics of control that inform current responses to AMR. Based on historically informed ethnographic research in Zimbabwe, we examine points of continuity and change between 20th Century rational drug use (RDU) discourses and contemporary socio-political formations around AMR and antimicrobial stewardship (AMS), paying particular attention to their co-evolution with the process of pharmaceuticalisation. We illustrate how the framework and techniques of RDU were embedded within programmes to increase access to essential medicines and as such complemented the building of one of Africa's strongest postcolonial health systems in Zimbabwe. Whilst 20th Century RDU was focused on securing the health and safety of patients and affordability for systems, AMS programmes aim to secure medicines. Continuous through both RDU and AMS programmes is the persistent rhetoric of 'irrational use'. Health workers in Harare, attuned to the values and language of these programmes, enact in their everyday practice an architecture in which antibiotics have been designed-in. This research illustrates the struggle to optimise antibiotic use within current framings for action. We propose a reconfiguring of the architecture of global health such that frontline prescribers are able to provide 'good' care without necessarily turning to antibiotics. To design-out antibiotic reliance would require attention beyond '(ir)rationality', to the redrafting of blueprints that inscribe practice.

Regulatory approval frameworks, such as that of the Department of Mines, Industry, Regulation and Safety (DMIRS) in Western Australia Mining Proposal approval process, require detailed design reports for waste rock dumps for mining projects. Determination of waste rock shear strength parameters for waste rock dump design at a feasibility project level is often challenging as a result of factors such as spatial variation, lack of representative data and limited knowledge of waste rock movement schedules. Trial open pits or blasted representative material are rarely available. A practical approach to derive design material parameters using the Barton–Kjaernsli criterion (Barton & Kjaernsli 1981; Barton 2008) is provided, based on available site-specific feasibility level geotechnical data for a case study site in the Pilbara region of Western Australia. Stability assessments for various scenarios including for possible unfavourable conditions such as earthquake and storm events expected in the long-term are required to demonstrate that safe operational conditions and effective mine closure designs can be facilitated.

Background Overuse of antibiotics is one of the main drivers for antimicrobial resistance (AMR). Globally, most antibiotics are prescribed in the outpatient setting. This survey aimed to explore attitudes and practices with regards to microbiology tests, AMR and antibiotic prescribing among healthcare providers at public primary health clinics in Harare, Zimbabwe. Methods This cross-sectional survey was conducted in nine primary health clinics located in low-income suburbs of Harare between October and December 2020. In Zimbabwe, primary health clinics provide nurse-led outpatient care for acute and chronic illnesses. Healthcare providers who independently prescribe antibiotics and order diagnostic tests were invited to participate. The survey used self-administered questionnaires. A five-point Likert scale was used to determined attitudes and beliefs. Results A total of 91 healthcare providers agreed to participate in the survey. The majority of participants (62/91, 68%) had more than 10 years of work experience. Most participants reported that they consider AMR as a global (75/91, 82%) and/or national (81/91, 89%) problem, while 52/91 (57%) considered AMR to be a problem in their healthcare facilities. A fifth of participants (20/91, 22%) were unsure if AMR was a problem in their clinics. Participants felt that availability of national guidelines (89/89, 100%), training sessions on antibiotic prescribing (89/89, 100%) and regular audit and feedback on prescribing (82/88, 93%) were helpful interventions to improve prescribing. Conclusions These findings support the need for increased availability of data on AMR and antibiotic use in primary care. Educational interventions, regular audit and feedback, and access to practice guidelines may be useful to limit overuse of antibiotics.

Although access to healthcare has improved since South Africa’s democratic transition, neoliberal reforms have had detrimental effects on clinic-community and nurse-patient relationships, undermining efforts to control tuberculosis (TB). This article focuses upon the work of nurses in three public health clinics in the Western Cape, South Africa. We explore how they experienced, made sense of and grappled with the challenges of TB control, especially patients “defaulting” on medication. Paying particular attention to confrontations between nurses and patients, we build upon previous qualitative studies that have contested popular constructions of nurses as “rude” and “uncaring.” We argue that patient blaming and scolding need to be understood in light of nurses having to tread a fine line between compassion and assertiveness, individual and public good against the backdrop of a dissonance between the theory and reality of TB control. Nurses’ confrontational approaches are responses to the messy reality of TB control on the ground, solutions to which require attention to the socioeconomic and historical context of nursing and primary healthcare. In the absence of such attention, animosities between clinics and communities could continue being cyclically reproduced.

During ethnographic research at a tuberculosis vaccine trial site in South Africa, trial participants often evoked the idiom of "clean blood." In this article, we illustrate how the trials enacted a form of moral triage in which "objective" bioscientific knowledge and moral subjectivity were coproduced. Participation created possibilities to demonstrate healthiness, respectability, and godliness in a context where positive self-imaginings were hard won, but could also lead to dejection and shame. We suggest that struggles to be recognized as virtuous are often overlooked in anthropological critiques of clinical trials and bioethics, but are important for understanding how trials meld with local moral worlds.

This study compares three different liquid cooling technologies to determine which of the three methods is able to cool the highest power density processor chips.

Much of the current social science literature on the clinical trials industry focuses on the profit-seeking practices adopted by pharmaceutical companies and the contract research organisations they employ to enable the mass production and distribution of their products. However, what the current literature demands is further ethnographic engagement with the particularities of the diseases being investigated, the local contexts and histories in which they are entwined, and how these impact the affective relationships between clinical research organisations and their participants. On the basis of ethnographic research with a nonprofit clinical research organisation specialising in TB vaccinations in South Africa, I argue that the complexities of TB mean that research into it necessitates frequent and often intimate interactions with research participants. These were perceived by researchers to yield opportunities to take an interest in the physical and psychosocial wellbeing of research participants which went beyond and sometimes ran into conflict with the requirements of protocol. The aim of this paper is to advocate more finely tuned attention to the challenges posed by the clinical trials industry today, an attention sensitive to the particularities of the contexts of clinical trials.

Understanding memory performance under different operational conditions is critical in many occupational settings. To examine the effect of physical exertion on memory for a witnessed event, we placed two groups of law-enforcement officers in a live, occupationally relevant scenario. One group had previously completed a high-intensity physical-assault exercise, and the other had not. Participants who completed the assault exercise showed impaired recall and recognition performance compared with the control group. Specifically, they provided significantly less accurate information concerning critical and incidental target individuals encountered during the scenario, recalled less briefing information, and provided fewer briefing updates than control participants did. Exertion was also associated with reduced accuracy in identifying the critical target from a lineup. These results support arousal-based competition accounts proposing differential allocation of resources under physiological arousal. These novel findings relating to eyewitness memory performance have important implications for victims, ordinary citizens who become witnesses, and witnesses in policing, military, and related operational contexts.

Despite a steady global decline in the incidence of tuberculosis (TB), progress towards health targets has been slow and a crisis of drug-resistant strains of TB continues unabated. The United Nations high-level meeting on TB in September 2018 resulted in a renewed push to invest in drugs, diagnostics and vaccines to “reach” those most vulnerable to the disease. Yet, an overriding focus on biomedical technologies to manage TB at the expense of meaningful engagement with the social threatens to further consolidate its reputation as a “silent killer.” Drawing on anthropological contributions from South Africa and one from neighbouring Zimbabwe, this special issue explores how human action produces, shapes, names, experiences and resists the disease in its fullest breadth within local conditions. The articles recognise TB as a “global” object of biomedical knowledge and intervention, on the one hand, and as intricately tied to a legacy of colonial and apartheid governance, on the other. Each article deals with different aspects of understanding the interface between global and national policies and their unintended effects in local worlds.