MID TERM EXAMINATION 2

English for Public Health

Week 2: Reading Strategic Exercise

Brown (2001) has pointed out several reading strategies, one of which is identifying the purpose of
reading. Please elaborate on your strategy for determining the purpose when reading a public health
research article and create a flowchart to present it in a more systematic way.

Week 4: Making Inferences Simple Sentence

CONTEXT: Antimicrobial resistance

(Taken from WHO, https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance)

Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitic – are medicines used to
prevent and treat infectious diseases in humans, animals and plants.

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond
to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial
medicines become ineffective and infections become difficult or impossible to treat, increasing the
risk of disease spread, severe illness, disability and death.

AMR is a natural process that happens over time through genetic changes in pathogens. Its
emergence and spread are accelerated by human activity, mainly the misuse and overuse of
antimicrobials to treat, prevent or control infections in humans, animals and plants.

Antimicrobial medicines are the cornerstone of modern medicine. The emergence and spread of
drug-resistant pathogens threatens our ability to treat common infections and to perform life-saving
procedures including cancer chemotherapy and caesarean section, hip replacements, organ
transplantation and other surgeries.

In addition, drug-resistant infections impact the health of animals and plants, reduce productivity in
farms, and threaten food security.

AMR has significant costs for both health systems and national economies overall. For example, it
creates need for more expensive and intensive care, affects productivity of patients or their
caregivers through prolonged hospital stays, and harms agricultural productivity.

AMR is a problem for all countries at all income levels. Its spread does not recognize country borders.
Contributing factors include lack of access to clean water, sanitation and hygiene (WASH) for both
humans and animals; poor infection and disease prevention and control in homes, healthcare
facilities and farms; poor access to quality and affordable vaccines, diagnostics and medicines; lack of
awareness and knowledge; and lack of enforcement of relevant legislation. People living in low-
resource settings and vulnerable populations are especially impacted by both the drivers and
consequences of AMR.

The global rise in antibiotic resistance poses a significant threat, diminishing the efficacy of common
antibiotics against widespread bacterial infections. The 2022 Global Antimicrobial Resistance and Use
Surveillance System (GLASS) report highlights alarming resistance rates among prevalent bacterial
pathogens. Median reported rates in 76 countries of 42% for third-generation cephalosporin-
resistant E. coli and 35% for methicillin-resistant Staphylococcus aureus are a major concern. For
urinary tract infections caused by E. coli, 1 in 5 cases exhibited reduced susceptibility to standard
antibiotics like ampicillin, co-trimoxazole, and fluoroquinolones in 2020. This is making it harder to
effectively treat common infections.

Klebsiella pneumoniae, a common intestinal bacterium, also showed elevated resistance levels
against critical antibiotics. Increased levels of resistance potentially lead to heightened utilization of
last-resort drugs like carbapenems, for which resistance is in turn being observed across multiple
regions. As the effectiveness of these last-resort drugs is compromised, the risks increase of
infections that cannot be treated. Projections by the Organization for Economic Cooperation and
Development (OECD) indicate an anticipated twofold surge in resistance to last-resort antibiotics by
2035, compared to 2005 levels, underscoring the urgent need for robust antimicrobial stewardship
practices and enhanced surveillance coverage worldwide.

One Health refers to an integrated, unifying approach that aims to achieve optimal and sustainable
health outcomes for people, animals and ecosystems. It recognizes that the health of humans,
domestic and wild animals, plants and the wider environment are closely linked and inter-
dependent. The One Health approach to preventing and controlling AMR brings together
stakeholders from relevant sectors to communicate and work together in the design, implementation
and monitoring of programmes, policies, legislation and research to mitigate AMR and attain better
health and economic outcomes.

To address AMR globally, countries adopted the Global Action Plan (GAP) on AMR during the 2015
World Health Assembly and committed to the development and implementation of multisectoral
national action plans with a One Health approach to tackle AMR. The GAP was subsequently
endorsed by the Governing Bodies of the Food and Agriculture Organization of the United Nations
(FAO) and the World Organisation for Animal Health (WOAH, formerly known as OIE) and the United
Nations Environment Program.

INSTRUCTION

Please make 3 to 5 inferences sentences from the text given for each of these:

1. Analysing context
2. Describe implied information
3. Summarizing inferences