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      Evaluation of the forum theatre approach for public engagement around antibiotic use in Myanmar

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          Abstract

          Introduction

          The risk of emergence and spread of antibiotic resistance is high in Southeast Asian countries and various strategies are being used to raise awareness about appropriate antibiotic use and antibiotic resistance within communities. Public engagement in science has not been widely practised in Myanmar. We describe the use of a forum theatre to engage with the community about antibiotic use.

          Methods

          The engagement activities took place in a peri-urban township in Yangon, Myanmar. Five preliminary story gathering workshops with the community were carried out to develop scripts and songs for the forum theatre. After that, we organised forum theatre plays between September and October 2018. Following each play we provided four simple key messages based on WHO’s world antibiotic awareness week advocacy materials; 1) Antibiotics are medicines used to treat bacterial infections 2) Antibiotics are not useful for coughs and colds 3) Never use leftover antibiotics or share antibiotics with others 4) Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, and keeping vaccinations up to date. We evaluated the engagement activities by conducting focus group discussions (FGD) with audience members.

          Results

          Ten forum theatre plays were performed on two topics; “Fever and antibiotics” and “Mixed medicines”, reaching 1175 community members. Four themes emerged from our thematic analysis: 1) Knowledge dissemination, 2) Enjoyment and fun, 3) Willingness to support and recommendations for future engagement activities and 4) Preference over traditional methods of health education. We found improvement of antibiotic related knowledge and enjoyment among audience who were also willing to support future engagement activities and preferred forum theatre approach over formal health talks.

          Conclusions

          We conclude that forum theatre is an effective innovative approach to engage and disseminate knowledge on appropriate use of antibiotics with the community in a participatory way.

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          Most cited references21

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          Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

          Significance Antibiotic resistance, driven by antibiotic consumption, is a growing global health threat. Our report on antibiotic use in 76 countries over 16 years provides an up-to-date comprehensive assessment of global trends in antibiotic consumption. We find that the antibiotic consumption rate in low- and middle-income countries (LMICs) has been converging to (and in some countries surpassing) levels typically observed in high-income countries. However, inequities in drug access persist, as many LMICs continue to be burdened with high rates of infectious disease-related mortality and low rates of antibiotic consumption. Our findings emphasize the need for global surveillance of antibiotic consumption to support policies to reduce antibiotic consumption and resistance while providing access to these lifesaving drugs.
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            Risk assessment for antibiotic resistance in South East Asia

            Fanny Chereau and colleagues assess the risk of the emergence and spread of antibiotic resistance in South East Asia and suggest it is the highest of the World Health Organization regions
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              Community engagement and ethical global health research

              ABSTRACT Community engagement is increasingly recognized as a critical element of medical research, recommended by ethicists, required by research funders and advocated in ethics guidelines. The benefits of community engagement are often stressed in instrumental terms, particularly with regard to promoting recruitment and retention in studies. Less emphasis has been placed on the value of community engagement with regard to ethical good practice, with goals often implied rather than clearly articulated. This article outlines explicitly how community engagement can contribute to ethical global health research by complementing existing established requirements such as informed consent and independent ethics review. The overarching and interlinked areas are (1) respecting individuals, communities and stakeholders; (2) building trust and social relationships; (3) determining appropriate benefits; minimizing risks, burdens and exploitation; (4) supporting the consent process; (5) understanding vulnerabilities and researcher obligations; (6) gaining permissions, approvals and building legitimacy and (7) achieving recruitment and retention targets.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: Project administrationRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                9 July 2020
                2020
                : 15
                : 7
                : e0235625
                Affiliations
                [1 ] Myanmar Oxford Clinical Research Unit (MOCRU), Yangon, Myanmar
                [2 ] Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
                [3 ] Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
                [4 ] Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
                Ravensburg-Weingarten University of Applied Sciences, GERMANY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-6044-8718
                http://orcid.org/0000-0002-0004-2572
                http://orcid.org/0000-0002-0383-9624
                Article
                PONE-D-20-04885
                10.1371/journal.pone.0235625
                7347174
                32645036
                49faa853-1f50-424a-bb82-a18c1360b5d0
                © 2020 Swe et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 19 February 2020
                : 18 June 2020
                Page count
                Figures: 0, Tables: 4, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 096527
                Award Recipient :
                This project was supported by a Wellcome Trust Provision for Public Engagement grant and a Wellcome Trust Strategic Award (096527). The Mahidol Oxford Tropical Medicine Research Unit is funded by the Wellcome Trust (106698).
                Categories
                Research Article
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Antimicrobials
                Antibiotics
                Biology and Life Sciences
                Microbiology
                Microbial Control
                Antimicrobials
                Antibiotics
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Biology and Life Sciences
                Microbiology
                Microbial Control
                Antimicrobial Resistance
                Antibiotic Resistance
                Medicine and Health Sciences
                Pharmacology
                Antimicrobial Resistance
                Antibiotic Resistance
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Fevers
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Fevers
                People and Places
                Geographical Locations
                Asia
                Myanmar
                Biology and Life Sciences
                Microbiology
                Microbial Control
                Antimicrobial Resistance
                Medicine and Health Sciences
                Pharmacology
                Antimicrobial Resistance
                Social Sciences
                Sociology
                Education
                Medical Education
                Medicine and Health Sciences
                Medical Humanities
                Medical Education
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Learning
                Human Learning
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Learning
                Human Learning
                Social Sciences
                Psychology
                Cognitive Psychology
                Learning
                Human Learning
                Biology and Life Sciences
                Neuroscience
                Learning and Memory
                Learning
                Human Learning
                Custom metadata
                As the data contain potentially identifying details, they are not available open access. The data are available upon request to the Mahidol-Oxford Tropical Medicine Research Unit Data Access Committee ( https://www.tropmedres.ac/units/moru-bangkok/bioethics-engagement/data-sharing) complying with the data access policy. The researchers have to follow the unit data access policy (The policy documents are available on the above link). Queries and applications for data should be directed to Rita Chanviriyavuth, Department of Bioethics & Public Engagement ( ca.sedemport@ 123456atir ).

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