Introduction
In the contemporary, highly globalized world, the spread of infections is higher than ever before in the history of humanity. Moreover, bacterial causes of diseases are often treated and prevented using antibiotics, which are commonly used in medicine, as well as in agriculture and other settings. In particular, when a medicine is used to cure a disease, bacteria mutate, becoming resistant to the cure. According to the Worlds Health Organization (2020), “antibiotic resistance occurs when bacteria change in response to the use of these medicines” (para. 6). The scope of antibiotic resistance has been recognized as a global public health concern due to the far-reaching and devastating mortality and morbidity implications (Hernando-Amado et al., 2019). Given the fast spread of antibiotic-resistant bacteria via infectious diseases in the global community, the most vulnerable populations are those residing in developing countries, especially children (Wall, 2019). Within the past decades, the global community of researchers, healthcare professionals, and decision-makers have tackled the rising problem of antibiotic resistance to find effective ways of preventing the problem.
However, the investigation of scholarly literature has indicated that the majority of studies are focused on global concerns related to antibiotic resistance or dwell on the biological underlying causes of the threat. Indeed, an example of a commonly conducted study on antibiotic resistance is the one by Hernando-Amado et al. (2019), who investigated the issue from the perspective of the One Health and Global Health framework. This framework addresses “the biological elements necessary for understanding the evolution of AMR, including the microorganisms or vectors involved in its emergence and dissemination, the host organisms (humans or animals) and the environments involved, and the cultural and socioeconomic features that may facilitate its spread” (p. 1432). Such an approach of setting the problem in a global context neglects the investigation of preventative measures available in developing countries, such as Kuwait. Furthermore, Wall (2019) provides a well-developed scoping review of the literature on the prevention of antibiotic resistance in children without specifically indicating the issues faced by separate countries. Thus, there is limited scholarly data on the particularities of Kuwait-specific measures and their effectiveness, which informs this research initiation.
Indeed, to prevent further exacerbation of the antibiotic resistance problem on a national and global scale, healthcare professionals and decision-makers should implement effective measures capable of instilling long-term and effective outcomes (Worlds Health Organization, WHO, 2020). In particular, the effectiveness and consistency of healthcare system-related preventative measures predetermine the overall success of the interventions aimed at eliminating antibiotic resistance. Thus, this study will investigate the effectiveness of Kuwait’s pediatric healthcare facilities’ effectiveness in addressing the problem of antibiotic resistance in their patients.
Aim of the Study
The aim of the study is to identify effective measures for preventing antibiotic resistance in children in Kuwait. The reason why this research aim is relevant to the current academic context is that there is a gap in the scholarly literature on preventative measures recognizing the threats to children’s health in developing countries under the impact of antibiotic resistance. According to the article, “more children die from a shortage of antibiotics in low-income countries than from drug-resistant infections; efforts, therefore, have to balance access and misuse” (Wall, 2019, p. 14). Furthermore, the selection of Kuwait as a site for the study is validated by the problematic addressing of the investigated public health issue in this country. Indeed, according to Torumkuney et al. (2022), “a lack of policies available for limiting inappropriate antibiotic use contributes to the increase in AMR in the region” (p. 78). Thus, the proposed study’s aim is to fill the identified gap and contextualize the developing country’s challenges in meeting the goals of reduced antibiotic resistance in children in Kuwait.
Hypothesis and Research Question
Given the reviewed literature on the investigated topic and the intended setting, the hypothesis for the research is as follows:
Hypothesis: The hospitals with balanced antibiotic shortage addressing and antibiotic resistance-preventing policies will demonstrate shorter hospitalization duration, lower levels of pediatric patient mortality, and lower costs per patient treatment.
The testing of this hypothesis will allow for evaluating the effectiveness of the policies and preventive protocols implemented in Kuwait pediatric hospitals. This consideration goes in accord with the research questions that the proposed study is designed to answer.
Research Question: How effective are the antibiotic resistance prevention policies and efforts of pediatric hospitals in Kuwait?
Study Design
To conduct the planned research study and answer the research question, the researcher will use a mixed-method study design involving the elements of both quantitative and qualitative inquiries. Since the proposed study will be focused on the investigation of protocols and policies of hospitals in terms of antibiotic resistance prevention, the source of data will be the documentation of the participating hospitals. In particular, the protocols and policies addressing antibiotic resistance, as well as the statistical annual hospital records of the pediatric patients’ outcomes, will be used to collect quantitative data. According to Dalglish, Khalid, and McMahon (2020), the methodology effective in policy investigations is the “systematic approach for document analysis in health policy research called the READ approach:
- ready materials,
- extract data,
- analyze data and
- distill findings” (p. 1424).
Thus, the method of systematic document analysis will be used to collect data, and statistical analysis will be used to analyze the retrieved data. The findings will be interpreted through the qualitative lens to narrate the implications of the overall effectiveness of ineffectiveness of particular hospital practices when preventing antibiotic resistance in children.
Research Process
The research process will start with a literature review on the topic to identify the context of the problem in Kuwait. Further, as the design of the proposed research study implies, the sample should include healthcare facilities ready to participate. For that purpose, pediatric healthcare facilities located in Kuwait will be contacted via e-mails to inform them about the aim and particularities of the study and inquiring their agreement to participate. Overall, it is anticipated to engage 10-12 hospitals to obtain a basis for the internal and external validity of the research outcomes. Once the hospitals are contacted, and agreements are established, the data collection process will begin. It will involve sending requests to obtain access to hospitals’ active policies and protocols addressing antibiotic availability and antibiotic resistance prevention. The data will be collected and systematically recorded for each hospital.
Another set of data required for the proposed research is the indicators of the effectiveness of the measures presented in the policies and protocols against which the outcomes will be evaluated. Indeed, it has been found that “antibiotic resistance leads to longer hospital stays, higher medical costs, and increased mortality” (WHO, 2020, para. 5). For that matter, to measure the effectiveness of pediatric hospitals’ antibiotic resistance prevention measures, their protocols and policies will be evaluated in correlation with the costs of hospitalization per patient, duration of hospital stay, and mortality rates. Thus, the annual reports on these indicators will be requested from the participating hospitals. At this point, the R and E elements of the earlier introduced READ framework will have been addressed.
Once all necessary data are collected, the statistical data analysis will be conducted using statistical analysis software. Each hospital’s effectiveness outcomes will be correlated with the presence and quality of the preventative measures in practice to identify the relationship between the policy and its outcomes. The results of the statistical analysis will then be interpreted via qualitative narration to answer the research question and establish the results of hypothesis testing. Thus, the A and D elements of the READ framework will be addressed at this stage of the research process.
Ethical Considerations
To address the ethical considerations inherent in the proposed research study, the researcher will ensure that the identities of all the patients will not be disclosed for reasons of privacy and confidentiality concerns. Furthermore, to obtain an ethical permit for the research, all proper documentation with the written voluntary agreement of the participating medical institutions will be provided. Indeed, since the research is aimed at collecting and analyzing data from Kuwait’s pediatric hospitals, only the information pertaining to the scope of the study, namely the protocols and interventions aimed at antibiotic resistance prevention, and the numerical statistical data indicating outcomes will be retrieved. Thus, the ethical considerations imply the opportunity of conducting the research without breaching any ethical principles.
Conclusion
The research is anticipated to contribute to the contemporary body of scholarly literature on the effectiveness of antibiotic resistance prevention measures and fill the gap in data indicating child-related efforts in Kuwait. It is anticipated that the hypothesis will be successfully tested, and the effectiveness of the hospitals’ policies will be properly evaluated to identify possible challenges and drawbacks. The detection of the issues in Kuwait’s healthcare system’s addressing of antibiotic resistance in children will serve as a basis for future research aimed at the improvement of healthcare practices.
Reference List
Dalglish, S.L., Khalid, H. and McMahon, S.A. (2020) ‘Document analysis in health policy research: the READ approach’, Health Policy and Planning, 35(10), pp.1424-1431.
Hernando-Amado, S., et al. (2019) ‘Defining and combating antibiotic resistance from One Health and Global Health perspectives.’, Nature Microbiology, 4(9), pp.1432-1442.
Torumkuney, D., et al. (2022) ‘Country data on AMR in Kuwait in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome’, Journal of Antimicrobial Chemotherapy, 77(Supplement_1), pp.77-83.
Wall, S. (2019) ‘Prevention of antibiotic resistance – an epidemiological scoping review to identify research categories and knowledge gaps’, Global Health Action, 12(sup1), pp.1-28.
World Health Organization (2020) Antibiotic resistance. Web.