Abstract
It is often difficult for the Editors of any journal to decide what, and occasionally what not, to publish. In this issue, we have decided to publish a paper by Dr Blomberg and colleagues from the Department of Dermatology at a University Hospital in Denmark. Two of the six authors, both from Denmark, visited a hospital in a rural and very deprived part of India and were struck by the amount of antibiotics that were prescribed by the physicians working there. They therefore arranged a second visit, lasting thirteen weeks, during which the two authors conducted an audit of antibiotic prescription among all the patients admitted to the hospital and noted that 83% were prescribed at least one and often more during their hospital stay. The authors draw two main conclusions from their work; one, that inappropriate antibiotic use is widespread in such a setting; and, two, that local or even national guidelines for antibiotic prescription would be very beneficial. There is nothing in the paper to suggest that the six authors have tried to produce such guidelines.
Tropical Doctor is only too aware of the ubiquitous problem of poly-pharmacy throughout the poorer parts of the world and that this practice extends not only to the prescription of antibiotics but to drugs of virtually every class and for every condition. The data collected by Dr Blomberg and colleagues are important and highlight these issues very well. In addition, their paper is clear and well-written and, for these reasons, the Editors have decided to publish this paper. However, the paper raises other important issues which are more difficult to resolve. It is relatively easy for health-care workers from affluent societies to visit institutions in poor parts of the world; it is much more difficult for health professionals from poor communities. Concepts such as postgraduate education, continuing medical education and clinical audit are virtually unknown in poorer societies; the number of patients seen and the patient to staff ratio in rural hospitals in poor parts of the world is extremely high and the pressures on health-care workers to prescribe drugs – any drugs – are immense. In addition, the diagnostic capacity to rule out an infection is virtually non-existent and it is hardly surprising under such circumstances that antibiotics are sometimes, perhaps often, unnecessarily given. Is it fair, then, for physicians trained and practicing in very affluent societies to visit institutions in much less well-resourced areas, audit the practice of the colleagues they are visiting and then write a paper which is overtly critical of their prescribing? Usually, the Editors of Tropical Doctor would immediately reject a paper on these grounds. On this occasion, we have decided to publish as the point of the paper is an important one and is very clearly made.
Unusually, the decision to publish this particular paper was taken jointly by the four of us who wrote this Editorial and during those discussions we had a wider debate about what in general Tropical Doctor should publish – and what we should reject. Our collective opinion is that we would be keen to publish papers that provide:
Evidence on the epidemiology, treatment and outcome of conditions that are common in the tropics; Reports that would affect practice in rural tropical hospitals; Data that help maximise the use of scarce resources (such as those provided by Dr Blomberg et al.); Things that may improve the practice of non-specialist health-care workers. Specialist papers that are irrelevant to most tropical clinicians; Articles that use ‘high tech’ investigations or involve ‘high tech’ treatment; Articles that concentrate on rare pathologies; Data that are only of relevance to one specific geographical location.
In contrast, we are unlikely to publish:
Finally, this is the last issue of Tropical Doctor for which Jill Donnelly has acted as the Associate Editor for Surgery. Jill is standing down after six years and we are all extremely appreciative of the work she has done for the journal. She will be replaced by Michael Cotton who has worked in sub-Saharan Africa for many years. In addition, we are delighted to welcome Leo Katzidzira, a physician in Zimbabwe, who has agreed to join as an Associate Editor – and we would welcome others working in any discipline in any area of the tropics, but particularly South Asia, to apply to join us.