Public-targeted interventions addressing antimicrobial resistance and antibiotic use in Sub-Saharan Africa: a scoping review

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Antimicrobial resistance (AMR) is a global health threat, with sub-Saharan Africa (SSA) experiencing the heaviest health burden and the highest AMR-related mortality.

“Antimicrobial resistance (AMR) is a global health threat, with sub-Saharan Africa (SSA) experiencing the heaviest health burden and the highest AMR-related mortality.”

• cites [3] sourceSupported

May combine two claims.

Using behavioural change theories can help understand public behaviour around antibiotic usage and develop theoretically based interventions to maximise effectiveness.

“However, using behavioural change theories can help us understand public behaviour around antibiotic usage and how to develop theoretically based interventions to maximise effectiveness.”

• cites [22] sourcePartly supported

  The Introduction says that understanding behaviour through theory can help designers identify what to target in interventions and maximise their potential effectiveness. The paper discusses public-health behaviours generally; its Results list the behaviours reviewed but do not identify public antibiotic use. It therefore supports the general rationale, not the antibiotic-specific application. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [23] Gourlan, 2016, Efficacy of theory-based interventions to promote physical activity. A meta-analysis of randomised controlled trials, Health Psychol Rev sourceNot checked — no full text of the source

May combine two claims.

The integration of theoretical frameworks enhances the understanding of behavioural determinants and supports the development of effective, targeted interventions.

“The integration of theoretical frameworks enhances the understanding of behavioural determinants and supports the development of effective, targeted interventions.”

• cites Glasgow and Linnan34Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Davis et al (2015) sourceSupported
• cites Gourlan et al (2016) sourceNot checked — no full text of the source

May combine two claims.

Persons living with disabilities are disproportionately affected by infectious diseases and are more vulnerable to AMR due to factors such as limited access to healthcare services, barriers to information and education and often, higher rates of comorbidities.

“Persons living with disabilities are disproportionately affected by infectious diseases46 and are more vulnerable to AMR due to factors such as limited access to healthcare services, barriers to information and education and often, higher rates of comorbidities.”

• cites [46] Gréaux, 2023, Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services, Int J Equity Health sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

This result appears consistent with findings from other systematic reviews both within and outside SSA, as none of the reviews reported AMR interventions specifically tailored to accommodate persons living with disabilities.

“This result appears consistent with findings from other systematic reviews both within and outside SSA, as none of the reviews reported AMR interventions specifically tailored to accommodate persons living with disabilities.11 13 16 20 21”

• cites [11] Gilham, 2024, Assessment of global antimicrobial resistance campaigns conducted to improve public awareness and antimicrobial use behaviours: a rapid systematic review, BMC Public Health sourceCould not verify

  The Results > Target population section lists the campaigns’ main audiences, but it does not assess whether interventions were tailored to accommodate persons living with disabilities. Searches for disability, disabled people, and accessibility found no passage addressing that question, so the absence of such an intervention from the list does not establish the claim. (LLM, conf=0.72)

  Experimental — accuracy not yet measured
• cites [13] Otieno, 2022, A Systematic Review of Pharmacist-Led Antimicrobial Stewardship Programs in Sub-Saharan Africa, Int J Clin Pract sourceCould not verify

  The Results (section 3.1) describe the included hospital studies and their clinical focuses, but do not address whether any intervention was tailored for persons living with disabilities. Searches for disability and tailored interventions found no passage making that finding. This review also cannot establish what the other reviews within or outside SSA reported. (LLM, conf=0.72)

  Experimental — accuracy not yet measured
• cites [16] sourceSupported

May combine two claims.

Actively involving communities in intervention design fosters ownership, promotes sustainable behaviour change and enables them to devise solutions relevant to their specific circumstances.

“Actively involving communities in intervention design fosters ownership, promotes sustainable behaviour change and enables them to devise solutions relevant to their specific circumstances.40”

• cites [40] Mitchell, 2022, Community engagement: The key to tackling Antimicrobial Resistance (AMR) across a One Health context?, Glob Public Health sourcePartly supported

  The Introduction and ‘Toward a shared understanding of community’ section describe co-designed, locally meaningful solutions and say co-development builds community ownership. They do not establish that involving communities in intervention design produces sustained behaviour change; the Introduction says only that awareness-raising and education alone are insufficient for long-term change. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S4 (based).

Community-centred AMR interventions often lack a theoretical framework.

“community-centred interventions often lack a theoretical framework.”

May combine two claims.

Three of the seven included studies were conducted in Ghana; the remaining studies were conducted in other SSA countries including Nigeria, Cameroon and Uganda.

“Three of the seven studies were conducted in Ghana with the remaining studies conducted in other SSA countries including Nigeria, Cameroon and Uganda.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Appiah et al (2022) involved parents in their investigation of the effectiveness of animation as an intervention strategy.

“Similarly, Appiah et al (2022) involved parents in their investigation of the effectiveness of animation as an intervention strategy.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Appiah et al (2022) explored the use of AMR animations involving schoolchildren to influence parental knowledge and attitudes.

“To illustrate awareness, Appiah et al (2022) explored the use of AMR animations involving schoolchildren to influence parental knowledge and attitudes.”

May combine two claims.

In Appiah et al (2022), the animation improved parents' knowledge significantly, but its effects on attitudes and beliefs were less pronounced.

“While the animation improved parents’ knowledge significantly, its effects on attitudes and beliefs were less pronounced.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Tsekleves et al (2023) reported limited awareness among participants about broader health risks of dust, variations in cleaning practices across socioeconomic groups, and strong role of social norms in shaping behaviours.

“For example, there was limited awareness among participants about the broader health risks of dust, variations in cleaning practices across socioeconomic groups and the strong role of social norms in shaping behaviours.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

SAS has established research training hubs and leadership programmes, fostering collaboration with academic institutions and industry partners.

“SAS has established research training hubs and leadership programmes, fostering collaboration with academic institutions and industry partners.”

May combine two claims.

In Appiah et al (2022), the animation targeted parents, addressing information through relatable scenarios, motivation by highlighting risks of AMR and behavioural skills by promoting practical actions like proper antibiotic disposal.

“The animation targeted parents, addressing ‘information’ through relatable scenarios, ‘motivation’ by highlighting the risks of AMR and ‘behavioural skills’ by promoting practical actions like proper antibiotic disposal.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Appiah et al (2021) focused on school children in their intervention.

“For example, Appiah et al (2021) focused on school children in their intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Appiah et al (2021), behavioural skills were developed by encouraging children to act out their understanding through role-plays and explanations.

“‘Behavioural skills’ were developed by encouraging children to act out their understanding through role-plays and explanations.”

May combine two claims.

In Appiah et al (2021), picture drawing had a substantial positive impact on AMR knowledge, attitudes and beliefs among schoolchildren, whereas storytelling showed a statistically significant negative effect on knowledge and did not significantly influence beliefs and attitudes.

“The study yielded mixed outcomes: picture drawing had a substantial positive impact on AMR knowledge, attitudes and beliefs among schoolchildren, whereas storytelling showed a statistically significant negative effect on knowledge and did not significantly influence beliefs and attitudes.”

May combine two claims.

In Ngoh and Shepherd (1997), patients demonstrated the ability to interpret and comprehend the images accurately, enhancing medication adherence.

“Patients demonstrated the ability to interpret and comprehend the images accurately, enhancing medication adherence.”

May combine two claims.

Public-centred interventions in SSA are diverse and often underpinned by a range of theoretical frameworks.

“This scoping review reveals that public-centred interventions in SSA are diverse and often underpinned by a range of theoretical frameworks.”

May combine two claims.

Appiah et al (2021, 2022) both adopted the information-motivation-behavioural skills (IMB) model to structure their interventions.

“Appiah et al (2021, 2022) both adopted the information-motivation-behavioural skills (IMB) model to structure their interventions.”

May combine two claims.

Adebisi et al (2020) employed outreach programmes and social media campaigns to raise awareness and correct misconceptions about AMR and engaged 380 respondents who completed a web-based questionnaire.

“As a case in point for behavioural determinants and community-based initiatives, Adebisi et al (2020) employed outreach programmes and social media campaigns to raise awareness and correct misconceptions about AMR and engaged 380 respondents who completed a web-based questionnaire, achieving significant engagement metrics.”

May combine two claims.

Kaawa-Mafigiri et al (2023)'s T&C package significantly improved prescription adherence, increased awareness about risks of alternative treatment practices and reduced medication sharing, incomplete dosages and self-medication, subsequently reducing resource wastage.

“Their subsequent development of a comprehensive T&C package significantly improved prescription adherence, increased awareness about the risks of alternative treatment practices and reduced medication sharing, incomplete dosages and self-medication, subsequently reducing resource wastage.”

May combine two claims.

The majority of intervention studies reviewed targeted the general public, but certain interventions within each study were specifically tailored to distinct population categories.

“Although the majority of intervention studies reviewed targeted the general public, certain interventions within each study were specifically tailored to distinct population categories.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Nkaiwuatei (2022) highlighted the SAS Africa initiative, which incorporates stewardship activities, research, community engagement and participation in global awareness campaigns.

“Also, Nkaiwuatei (2022) highlighted the SAS Africa initiative, which incorporates stewardship activities, research, community engagement and participation in global awareness campaigns.”

May combine two claims.

Adebisi et al (2020) achieved 800,000 potential reaches and over 200,000 engagements on Facebook.

“Despite 800 000 potential reaches and over 200 000 engagements on Facebook”

Probably not a substantial claim: may not pass S3 (load-bearing).

Tsekleves et al (2023) introduced the Dust Bunny project, focusing on household hygiene practices to mitigate environmental sources of bacterial infections.

“Tsekleves et al (2023) introduced the Dust Bunny project, focusing on household hygiene practices to mitigate environmental sources of bacterial infections.”

May combine two claims.

In Appiah et al (2022), engagement interventions positively influenced parents' knowledge, though the picture-drawing intervention had no significant effects on parental knowledge or beliefs.

“The engagement interventions positively influenced parents’ knowledge, though the picture-drawing intervention had no significant effects on parental knowledge or beliefs.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The interventions reviewed demonstrate innovative strategies, from culturally tailored communication materials to community engagement initiatives, designed to meet the unique needs and contexts of SSA.

“The interventions reviewed demonstrate innovative strategies, from culturally tailored communication materials to community engagement initiatives, designed to meet the unique needs and contexts of SSA.”

May combine two claims.

Findings highlight the contextual challenges and the scarcity of research on community interventions in addressing AMR.

“Findings highlight the contextual challenges and the scarcity of research on community interventions in addressing AMR.”

May combine two claims.

Current AMR interventions often adopt an individualistic approach, focusing on non-disabled individuals without considering the broader social, structural and relational contexts that influence health outcomes.

“Current AMR interventions often adopt an individualistic approach, focusing on non-disabled individuals without considering the broader social, structural and relational contexts that influence health outcomes.”

May combine two claims.

Most AMR interventions in SSA focus on hospital settings and provider behaviour.

“However, many of these interventions have been implemented in high-income countries or are primarily focused on healthcare settings, targeting physicians, pharmacists and other healthcare workers.1113”

• cites [1113]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

By linking intervention activities directly to theoretical constructs, the Appiah et al studies demonstrate how the IMB model can guide development of contextually relevant AMR interventions, although challenges remain in ensuring all components are addressed effectively.

“By linking intervention activities directly to theoretical constructs, these studies demonstrate how the IMB model can guide the development of contextually relevant AMR interventions, although challenges remain in ensuring all components are addressed effectively.”

• AssumptionThe authors state this as an assumption: The IMB model holds that health-related behaviour depends on information, motivation and behavioural skills.

May combine two claims.

The outcomes in Kaawa-Mafigiri et al (2023) were assessed immediately after the intervention and are reliant on self-reported data.

“These outcomes were assessed immediately after the intervention, providing an indication of the intervention’s effectiveness, though the study is reliant on self-reported data.”

May combine two claims.

The self-reported changes in Tsekleves et al (2023) were assessed immediately after the intervention and show positive shifts in behaviour, but lack of long-term follow-up and reliance on self-reported data limit ability to assess sustained behaviour change.

“These self-reported changes, assessed immediately after the intervention, show positive shifts in behaviour. However, the lack of long-term follow-up and reliance on self-reported data limit the ability to assess sustained behaviour change.”

May combine two claims.

The outcomes in Ngoh and Shepherd (1997) were observed immediately postintervention, and the study did not assess long-term adherence or sustainability.

“These outcomes were observed immediately postintervention, suggesting the importance of clear and contextually relevant educational materials. However, the study did not assess long-term adherence or the sustainability of these improvements, indicating a need for follow-up evaluations to determine lasting impact for similar interventions.”

May combine two claims.

The outcomes in Appiah et al (2021) are based on self-assessment immediately postintervention, which may not reflect long-term impacts.

“These outcomes are based on the study’s self-assessment immediately postintervention, which may not reflect long-term impacts.”

May combine two claims.

The scope of the review was restricted to studies in English, which may exclude relevant research published in other languages across the continent.

“This study has the following limitations, including a limited number of reviewed studies, as the scope of the review was restricted to studies in English, which may exclude relevant research published in other languages across the continent.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Actively involving community members in the design, implementation and evaluation of interventions, theory-driven approaches can tap into local knowledge, values and social norms, thereby enhancing their relevance and effectiveness.

“Overall, actively involving community members in the design, implementation and evaluation of interventions, theory-driven approaches can tap into local knowledge, values and social norms, thereby enhancing their relevance and effectiveness.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Behavioural incentives, such as targeted outreach and social media campaigns, align with the health belief model's emphasis on perceived benefits and threats as motivators for behaviour change.

“Additionally, behavioural incentives, such as targeted outreach and social media campaigns, align with the health belief model’s emphasis on perceived benefits and threats as motivators for behaviour change.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Theories such as the IMB model can provide a comprehensive framework for understanding how individual awareness, motivation and behavioural skills influence antibiotic use practices.

“For instance, theories such as the IMB model can provide a comprehensive framework for understanding how individual awareness, motivation and behavioural skills influence antibiotic use practices.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This emphasis does not address other significant drivers of AMR, such as overprescription by healthcare providers or inappropriate use of higher-line antibiotics in clinical settings.

“While this emphasis highlights critical aspects of community-level AMR and antibiotic misuse outside hospital environments, it does not address other significant drivers of AMR, such as overprescription by healthcare providers or inappropriate use of higher-line antibiotics in clinical settings.”

Probably not a substantial claim: may not pass S2 (checkable).

Theory-driven community-based interventions may have the potential to address the multifaceted nature of AMR and antibiotic use by targeting individual, interpersonal and environmental factors influencing behaviour.

“Moreover, theory-driven community-based interventions may have the potential to address the multifaceted nature of AMR and antibiotic use by targeting individual, interpersonal and environmental factors influencing behaviour.”

May combine two claims.

Inadequate healthcare infrastructure and weak regulatory enforcement contribute to antibiotic misuse in SSA, with many individuals purchasing antibiotics informally.

“At the systemic level, inadequate healthcare infrastructure and weak regulatory enforcement contribute to antibiotic misuse in SSA (Sono et al),42 with many individuals purchasing antibiotics informally.”

• cites Sono et alNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [42] Sono, 2023, Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance, Expert Rev Anti Infect Ther sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Interventions informed by the health belief model can address perceptions of susceptibility and severity of AMR, while those guided by social cognitive theory can focus on enhancing self-efficacy and social support for responsible antibiotic use.

“For example, interventions informed by the health belief model can address perceptions of susceptibility and severity of AMR, while those guided by social cognitive theory can focus on enhancing self-efficacy and social support for responsible antibiotic use.”

Classified as probably not a substantial claim. May combine two claims.

The study focuses solely on public-targeted interventions, deliberately excluding areas such as institutional prescribing practices and antibiotic use in veterinary and agricultural settings.

“Also, the study focuses solely on public-targeted interventions, deliberately excluding areas such as institutional prescribing practices and antibiotic use in veterinary and agricultural settings.”

Probably not a substantial claim: may not pass S2 (checkable).

Combating AMR requires coordinated efforts across healthcare, media, agriculture and education sectors.

“Furthermore, combating AMR requires coordinated efforts across healthcare, media, agriculture and education sectors.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

The effectiveness of such interventions perhaps can be greatly enhanced by grounding them in relevant theoretical frameworks that provide a systematic understanding of behaviour change processes and inform intervention design and implementation.

“However, the effectiveness of such interventions perhaps can be greatly enhanced by grounding them in relevant theoretical frameworks that provide a systematic understanding of behaviour change processes and inform intervention design and implementation.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

Involving persons with disabilities in the design and implementation of interventions ensures their needs and perspectives are adequately represented, fostering a sense of inclusion and engagement.

“Additionally, involving persons with disabilities in the design and implementation of interventions ensures their needs and perspectives are adequately represented, fostering a sense of inclusion and engagement.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Incorporating theoretical frameworks into community-based interventions may be useful in providing more insights into the underlying mechanisms driving behaviour change and in ensuring well-tailored interventions to address specific determinants of AMR-related behaviours.

“Incorporating theoretical frameworks into community-based interventions may be useful in providing more insights into the underlying mechanisms driving behaviour change and in ensuring well-tailored interventions to address specific determinants of AMR-related behaviours.”

Classified as probably not a substantial claim.

The focus on English language studies was necessary to ensure accessibility and feasibility within the scope of this research.

“However, the focus on English language studies was necessary to ensure accessibility and feasibility within the scope of this research.”

May combine two claims.

These studies emphasise the crucial role of culturally relevant and community-engagement approaches in effectively conveying messages about AMR and antibiotic use, fostering ownership and promoting sustainable behaviour change.

“These studies emphasise the crucial role of culturally relevant and community-engagement approaches in effectively conveying messages about AMR and antibiotic use, fostering ownership and promoting sustainable behaviour change.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

By fostering local ownership and participation, interventions can be made culturally appropriate and sustainable in the long run.

“First, by fostering local ownership and participation, interventions can be made culturally appropriate and sustainable in the long run.”

Probably not a substantial claim: may not pass S2 (checkable).

The identified AMR intervention factors highlight the need for culturally tailored interventions that resonate with local communities.

“The identified AMR intervention factors (figure 4) highlight the need for culturally tailored interventions that resonate with local communities.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Community-based interventions may offer several advantages in the context of AMR.

“Community-based interventions may offer several advantages in the context of AMR.”

May combine two claims.

This perspective fails to account for the unique challenges faced by persons with disabilities, thereby perpetuating health disparities.

“This perspective fails to account for the unique challenges faced by persons with disabilities, thereby perpetuating health disparities.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

By aligning interventions with such theories, researchers, particularly social scientists, can develop targeted strategies to enhance these key determinants and promote responsible antibiotic use within communities.

“By aligning interventions with such theories, researchers, particularly social scientists, can develop targeted strategies to enhance these key determinants and promote responsible antibiotic use within communities.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The community (public) becomes a critical site for intervention because it is at this level that behaviours related to antibiotic use are formed and can be effectively influenced.

“The community (public), therefore, becomes a critical site for intervention because it is at this level that behaviours related to antibiotic use are formed and can be effectively influenced.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Community-based interventions guided by relevant theory may perhaps facilitate the scalability and replicability of interventions across diverse settings.

“Additionally, community-based interventions guided by relevant theory may perhaps facilitate the scalability and replicability of interventions across diverse settings.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

By addressing these key factors, AMR interventions in SSA can achieve greater impact, ensuring that behaviour change efforts are sustainable and responsive to local needs.

“By addressing these key factors, AMR interventions in SSA can achieve greater impact, ensuring that behaviour change efforts are sustainable and responsive to local needs.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Mapping these interventions to theoretical frameworks reveals how theory-aligned interventions can shape successful interventions, offering structured methods to address key behavioural determinants and contributing to global efforts to combat AMR.

“Mapping these interventions to theoretical frameworks reveals how theory-aligned interventions can shape successful interventions, offering structured methods to address key behavioural determinants and contributing to global efforts to combat AMR.”