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Shempela DM, Mudenda S, Kasanga M, Daka V, Kangongwe MH, Kamayani M, Sikalima J, Yankonde B, Kasonde CB, Nakazwe R, Mwandila A, Cham F, Njuguna M, Simwaka B, Morrison L, Chizimu JY, Muma JB, Chilengi R, Sichinga K. A Situation Analysis of the Capacity of Laboratories in Faith-Based Hospitals in Zambia to Conduct Surveillance of Antimicrobial Resistance: Opportunities to Improve Diagnostic Stewardship. Microorganisms 2024; 12:1697. [PMID: 39203539 PMCID: PMC11357258 DOI: 10.3390/microorganisms12081697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024] Open
Abstract
Antimicrobial resistance (AMR) is a public health problem exacerbated by the overuse and misuse of antibiotics and the inadequate capacity of laboratories to conduct AMR surveillance. This study assessed the capacity of laboratories in seven faith-based hospitals to conduct AMR testing and surveillance in Zambia. This multi-facility, cross-sectional exploratory study was conducted from February 2024 to April 2024. We collected and analysed data using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. This study found an average score of 39%, indicating a low capacity of laboratories to conduct AMR surveillance. The highest capacity score was 47%, while the lowest was 25%. Only one hospital had a full capacity (100%) to utilise a laboratory information system (LIS). Three hospitals had a satisfactory capacity to perform data management with scores of 83%, 85%, and 95%. Only one hospital had a full capacity (100%) to process specimens, and only one hospital had good safety requirements for a microbiology laboratory, with a score of 89%. This study demonstrates that all the assessed hospitals had a low capacity to conduct AMR surveillance, which could affect diagnostic stewardship. Therefore, there is an urgent need to strengthen the microbiology capacity of laboratories to enhance AMR surveillance in Zambia.
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Affiliation(s)
- Doreen Mainza Shempela
- Churches Health Association of Zambia, Lusaka 10101, Zambia; (M.K.); (J.S.); (B.Y.); (C.B.K.); (A.M.); (K.S.)
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
| | - Maisa Kasanga
- Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka 10101, Zambia; (M.K.); (R.N.)
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Victor Daka
- Department of Public Health, School of Medicine, Copperbelt University, Ndola 10101, Zambia;
| | | | - Mapeesho Kamayani
- Churches Health Association of Zambia, Lusaka 10101, Zambia; (M.K.); (J.S.); (B.Y.); (C.B.K.); (A.M.); (K.S.)
| | - Jay Sikalima
- Churches Health Association of Zambia, Lusaka 10101, Zambia; (M.K.); (J.S.); (B.Y.); (C.B.K.); (A.M.); (K.S.)
| | - Baron Yankonde
- Churches Health Association of Zambia, Lusaka 10101, Zambia; (M.K.); (J.S.); (B.Y.); (C.B.K.); (A.M.); (K.S.)
| | - Cynthia Banda Kasonde
- Churches Health Association of Zambia, Lusaka 10101, Zambia; (M.K.); (J.S.); (B.Y.); (C.B.K.); (A.M.); (K.S.)
| | - Ruth Nakazwe
- Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka 10101, Zambia; (M.K.); (R.N.)
| | - Andrew Mwandila
- Churches Health Association of Zambia, Lusaka 10101, Zambia; (M.K.); (J.S.); (B.Y.); (C.B.K.); (A.M.); (K.S.)
| | - Fatim Cham
- Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), 1201 Geneva, Switzerland; (F.C.); (M.N.); (B.S.); (L.M.)
| | - Michael Njuguna
- Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), 1201 Geneva, Switzerland; (F.C.); (M.N.); (B.S.); (L.M.)
| | - Bertha Simwaka
- Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), 1201 Geneva, Switzerland; (F.C.); (M.N.); (B.S.); (L.M.)
| | - Linden Morrison
- Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), 1201 Geneva, Switzerland; (F.C.); (M.N.); (B.S.); (L.M.)
| | - Joseph Yamweka Chizimu
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia; (J.Y.C.); (R.C.)
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka 10101, Zambia;
| | - Roma Chilengi
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka 10101, Zambia; (J.Y.C.); (R.C.)
| | - Karen Sichinga
- Churches Health Association of Zambia, Lusaka 10101, Zambia; (M.K.); (J.S.); (B.Y.); (C.B.K.); (A.M.); (K.S.)
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Gahimbare L, Muvunyi CM, Guessennd NAK, Rutanga JP, Gashema P, Fuller W, Mwamelo AJ, Coulibaly SO, Mosha FS, Perovic O, Tali-Maamar H, Yahaya AA. Antimicrobial Resistance in the WHO African Region: A Systematic Literature Review 2016-2020. Antibiotics (Basel) 2024; 13:659. [PMID: 39061341 PMCID: PMC11273377 DOI: 10.3390/antibiotics13070659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance (AMR) is a significant global public health threat. This review presents the most recent in-depth review of the situation of the main AMR types in relation to the most commonly prescribed antibiotics in the World Health Organization (WHO) African Region. Underlying genes of resistance have been analyzed where possible. A search to capture published research data on AMR from articles published between 2016 and 2020 was done using PubMed and Google Scholar, with rigorous inclusion/exclusion criteria. Out of 48003 articles, only 167 were included. Among the tested gram-negative bacteria species, Klebsiella spp. remain the most tested, and generally the most resistant. The highest overall phenotypic resistance for imipenem was reported in E. coli, whereas for meropenem, E. coli and Haemophilus spp. showed an equal resistance proportion at 2.5%. For gram-positive bacteria, Streptococcus pneumoniae displayed high resistance percentages to trimethoprim/sulfamethoxazole (64.3%), oxacillin (32.2%), penicillin (23.2%), and tetracycline (28.3%), whereas Staphylococcus aureus contributed to 22.8% and 10% resistance to penicillin and oxacillin, respectively. This review shows that AMR remains a major public health threat. The present findings will help public health decision-makers in developing efficient preventive strategies and adequate policies for antibiotic stewardship and surveillance in line with the global action plan for AMR.
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Affiliation(s)
- Laetitia Gahimbare
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Claude Mambo Muvunyi
- AMR Consultants, Kigali P.O. Box 3286, Rwanda; (C.M.M.); (N.A.K.G.)
- Rwanda Biomedical Center, Kigali P.O. Box 7162, Rwanda
| | - Nathalie Aya Kouadio Guessennd
- AMR Consultants, Kigali P.O. Box 3286, Rwanda; (C.M.M.); (N.A.K.G.)
- UFR des Sciences Médicales, Université Félix Houphouet Boigny-Institut Pasteur de Côte d’Ivoire, Abidjan P.O. Box, 1563, Côte d’Ivoire
| | - Jean Pierre Rutanga
- CHU de Québec-Université Laval, L’ Hôtel-Dieu de Québec, Laboratoire de Microbiologie, Québec City, QC G1R 2J6, Canada;
| | - Pierre Gashema
- Repolicy Research Centre, Kigali P.O. Box 7584, Rwanda;
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Walter Fuller
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Ambele Judith Mwamelo
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Sheick Oumar Coulibaly
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Fausta Shakiwa Mosha
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
| | - Olga Perovic
- WHO Collaborating Centre for AMR, National Institute for Communicable Diseases (NICD), a Division of National Health Laboratory Service, Johannesburg 2192, South Africa;
| | | | - Ali Ahmed Yahaya
- World Health Organization Regional Office for Africa Cité du Djoué, Brazzaville P.O. Box 06, Congo; (W.F.); (A.J.M.); (S.O.C.); (F.S.M.); (A.A.Y.)
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Delpy L, Astbury CC, Aenishaenslin C, Ruckert A, Penney TL, Wiktorowicz M, Ciss M, Benko R, Bordier M. Integrated surveillance systems for antibiotic resistance in a One Health context: a scoping review. BMC Public Health 2024; 24:1717. [PMID: 38937706 PMCID: PMC11210117 DOI: 10.1186/s12889-024-19158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Antibiotic resistance (ABR) has emerged as a major threat to health. Properly informed decisions to mitigate this threat require surveillance systems that integrate information on resistant bacteria and antibiotic use in humans, animals, and the environment, in line with the One Health concept. Despite a strong call for the implementation of such integrated surveillance systems, we still lack a comprehensive overview of existing organizational models for integrated surveillance of ABR. To address this gap, we conducted a scoping review to characterize existing integrated surveillance systems for ABR. METHODS The literature review was conducted using the PRISMA guidelines. The selected integrated surveillance systems were assessed according to 39 variables related to their organization and functioning, the socio-economic and political characteristics of their implementation context, and the levels of integration reached, together with their related outcomes. We conducted two distinct, complementary analyses on the data extracted: a descriptive analysis to summarize the characteristics of the integrated surveillance systems, and a multiple-correspondence analysis (MCA) followed by a hierarchical cluster analysis (HCA) to identify potential typology for surveillance systems. RESULTS The literature search identified a total of 1330 records. After the screening phase, 59 references were kept from which 14 integrated surveillance systems were identified. They all operate in high-income countries and vary in terms of integration, both at informational and structural levels. The different systems combine information from a wide range of populations and commodities -in the human, animal and environmental domains, collection points, drug-bacterium pairs, and rely on various diagnostic and surveillance strategies. A variable level of collaboration was found for the governance and/or operation of the surveillance activities. The outcomes of integration are poorly described and evidenced. The 14 surveillance systems can be grouped into four distinct clusters, characterized by integration level in the two dimensions. The level of resources and regulatory framework in place appeared to play a major role in the establishment and organization of integrated surveillance. CONCLUSIONS This study suggests that operationalization of integrated surveillance for ABR is still not well established at a global scale, especially in low and middle-income countries and that the surveillance scope is not broad enough to obtain a comprehensive understanding of the complex dynamics of ABR to appropriately inform mitigation measures. Further studies are needed to better characterize the various integration models for surveillance with regard to their implementation context and evaluate the outcome of these models.
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Affiliation(s)
- Léo Delpy
- ASTRE, University of Montpellier, CIRAD, INRAE, Montpellier, France
- CIRAD, UMR ASTRE, Dakar, Senegal
- National Laboratory for Livestock and Veterinary Research, Senegalese Institute of Research in Agriculture, Dakar, Senegal
| | - Chloe Clifford Astbury
- Global Food Systems & Policy Research, School of Global Health, York University, Toronto, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
| | - Cécile Aenishaenslin
- Research Group On Epidemiology of Zoonoses and Public Health (GREZOSP), University of Montréal, Saint-Hyacinthe, Québec, Canada
- Centre de Recherche en Santé Publique de L'Université de Montréal Et du Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSS) du Centre-Sud-de-L'île-de-Montréal, Montréal, Québec, Canada
| | - Arne Ruckert
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Tarra L Penney
- Global Food Systems & Policy Research, School of Global Health, York University, Toronto, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
| | - Mary Wiktorowicz
- Dahdaleh Institute for Global Health Research, York University, Toronto, Canada
- School of Global Health, York University, Toronto, Canada
| | - Mamadou Ciss
- National Laboratory for Livestock and Veterinary Research, Senegalese Institute of Research in Agriculture, Dakar, Senegal
| | - Ria Benko
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Marion Bordier
- ASTRE, University of Montpellier, CIRAD, INRAE, Montpellier, France.
- CIRAD, UMR ASTRE, Dakar, Senegal.
- National Laboratory for Livestock and Veterinary Research, Senegalese Institute of Research in Agriculture, Dakar, Senegal.
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Mercy K, Pokhariyal G, Takah Fongwen N, Kivuti-Bitok L. Evaluation of cholera surveillance systems in Africa: a systematic review. FRONTIERS IN EPIDEMIOLOGY 2024; 4:1353826. [PMID: 38933896 PMCID: PMC11199716 DOI: 10.3389/fepid.2024.1353826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Introduction Despite several interventions on the control of cholera, it still remains a significant public health problem in Africa. According to the World Health Organization, 251,549 cases and 4,180 deaths (CFR: 2.9%) were reported from 19 African countries in 2023. Tools exist to enhance the surveillance of cholera but there is limited evidence on their deployment and application. There is limited evidence on the harmonization of the deployment of tools for the evaluation of cholera surveillance. We systematically reviewed available literature on the deployment of these tools in the evaluation of surveillance systems in Africa. Method Three electronic databases (PubMed, Medline and Embase) were used to search articles published in English between January 2012 to May 2023. Grey literature was also searched using Google and Google Scholar. Only articles that addressed a framework used in cholera surveillance in Africa were included. The quality of articles was assessed using the appropriate tools. Data on the use of surveillance tools and frameworks were extracted from articles for a coherent synthesis on their deployment. Result A total of 13 records (5 frameworks and 8 studies) were fit for use for this study. As per the time of the study, there were no surveillance frameworks specific for the evaluation of surveillance systems of cholera in Africa, however, five frameworks for communicable diseases and public health events could be adapted for cholera surveillance evaluation. None (0%) of the studies evaluated capacities on cross border surveillance, multisectoral one health approach and linkage of laboratory networks to surveillance systems. All (100%) studies assessed surveillance attributes even though there was no synergy in the attributes considered even among studies with similar objectives. There is therefore the need for stakeholders to harmoniously identify a spectrum of critical parameters and attributes to guide the assessment of cholera surveillance system performance.
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Affiliation(s)
- Kyeng Mercy
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
- Division of Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ganesh Pokhariyal
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Noah Takah Fongwen
- Division of Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Lucy Kivuti-Bitok
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
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Broom J, Broom A, Kenny K, Konecny P, Post JJ. Regulating antimicrobial use within hospitals: A qualitative study. Infect Dis Health 2024; 29:81-90. [PMID: 38216402 DOI: 10.1016/j.idh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES To examine how regulatory structures and processes focused on antimicrobial stewardship and antimicrobial resistance are experienced by hospital managers and clinicians. METHODS Forty-two hospital managers and clinicians working within accreditation and antimicrobial stewardship teams in three Australian hospitals participated in individual in-depth interviews. Thematic analysis was performed. RESULTS Thematic analysis revealed participants' experiences of hospital antimicrobial regulation and their perceptions of what would be required for meaningful antimicrobial optimisation. Theme 1: Experience of regulation of antimicrobials within hospitals: Participants described an increased profile of antimicrobial resistance with inclusion in regulatory requirements, but also the risks of bureaucratic manoeuvring to meet standards rather than governance-inducing systemic changes. Theme 2: Growth of accreditation processes and hospitals over time: Both regulatory requirements and hospitals were described as evolving over time, each manoeuvring in response to each other (e.g. development of short notice accreditation). Theme 3: Perceived requirements for change: Participants perceived a need for top-down buy-in, resource prioritisation, complex understanding of power and influence on clinician behaviour, and a critical need for medical engagement. CONCLUSIONS This study around antimicrobials shows the tension and dynamic relationship between regulatory processes and hospital responses, bringing to light the enduring balance of a system that positions itself to meet regulatory requirements and emerging "demands", without necessarily addressing the key underlying concerns. Antimicrobial resistance-related solutions are perceived as likely to require further resourcing and buy-in across multiple levels, engagement across professional streams and require strategies that consider complex systems change in order for regulatory structures to have potency.
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Affiliation(s)
- Jennifer Broom
- Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, 6 Doherty Street, Birtinya, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Camperdown, NSW, Australia.
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Camperdown, NSW, Australia.
| | - Pamela Konecny
- Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Kogarah, Sydney, Australia; School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Jeffrey J Post
- School of Clinical Medicine, University of New South Wales, Sydney, Australia; Department of Infectious Diseases, Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia.
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Kowalski M, Minka Obama B, Catho G, Dewez JE, Merglen A, Ruef M, Andrey DO, Hassoun-Kheir N, de Kraker ME, Combescure C, Emonet S, Galetto-Lacour A, Wagner N. Antimicrobial resistance in Enterobacterales infections among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 70:102512. [PMID: 38495519 PMCID: PMC10940950 DOI: 10.1016/j.eclinm.2024.102512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Background The burden of antimicrobial resistance (AMR) has been estimated to be the highest in sub-Saharan Africa (SSA). The current study estimated the proportion of drug-resistant Enterobacterales causing infections in SSA children. Methods We searched MEDLINE/PubMed, Embase and the Cochrane Library to identify retrospective and prospective studies published from 01/01/2005 to 01/06/2022 reporting AMR of Enterobacterales causing infections in sub-Saharan children (0-18 years old). Studies were excluded if they had unclear documentation of antimicrobial susceptibility testing methods or fewer than ten observations per bacteria. Data extraction and quality appraisal were conducted by two authors independently. The primary outcome was the proportion of Enterobacterales resistant to antibiotics commonly used in paediatrics. Proportions were combined across studies using mixed-effects logistic regression models per bacteria and per antibiotic. Between-study heterogeneity was assessed using the I2 statistic. The protocol was registered with PROSPERO (CRD42021260157). Findings After screening 1111 records, 122 relevant studies were included, providing data on more than 30,000 blood, urine and stool isolates. Escherichia coli and Klebsiella spp. were the predominant species, both presenting high proportions of resistance to third-generation cephalosporins, especially in blood cultures: 40.6% (95% CI: 27.7%-55%; I2: 85.7%, number of isolates (n): 1032) and 84.9% (72.8%-92.2%; I2: 94.1%, n: 2067), respectively. High proportions of resistance to other commonly used antibiotics were also observed. E. coli had high proportions of resistance, especially for ampicillin (92.5%; 95% CI: 76.4%-97.9%; I2: 89.8%, n: 888) and gentamicin (42.7%; 95% CI: 30%-56.5%; I2: 71.9%, n: 968). Gentamicin-resistant Klebsiella spp. were also frequently reported (77.6%; 95% CI: 65.5%-86.3%; I2: 91.6%, n: 1886). Interpretation High proportions of resistance to antibiotics commonly used for empirical treatment of infectious syndromes were found for Enterobacterales in sub-Saharan children. There is a critical need to better identify local patterns of AMR to inform and update clinical guidelines for better treatment outcomes. Funding No funding was received.
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Affiliation(s)
- Morgane Kowalski
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Basilice Minka Obama
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Regional Hospital Centre for Ebolowa, Ebolowa, Cameroon
| | - Gaud Catho
- Division of Infectious Diseases, Central Institute, Hospital of Valais, Switzerland
- Infection Control Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Juan Emmanuel Dewez
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
| | - Arnaud Merglen
- Division of General Paediatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Micaela Ruef
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Diego O. Andrey
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Nasreen Hassoun-Kheir
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre, Geneva, Switzerland
| | - Marlieke E.A. de Kraker
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre, Geneva, Switzerland
| | - Christophe Combescure
- Centre for Clinical Research, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephane Emonet
- Division of Infectious Diseases, Central Institute, Hospital of Valais, Switzerland
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Paediatric Emergency Medicine, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noémie Wagner
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
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7
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Otieku E, Kurtzhals JAL, Fenny AP, Ofori AO, Labi AK, Enemark U. Healthcare provider cost of antimicrobial resistance in two teaching hospitals in Ghana. Health Policy Plan 2024; 39:178-187. [PMID: 38048336 PMCID: PMC11020270 DOI: 10.1093/heapol/czad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023] Open
Abstract
Understanding the healthcare provider costs of antimicrobial resistance (AMR) in lower-middle-income countries would motivate healthcare facilities to prioritize reducing the AMR burden. This study evaluates the extra length of stay and the associated healthcare provider costs due to AMR to estimate the potential economic benefits of AMR prevention strategies. We combined data from a parallel cohort study with administrative data from the participating hospitals. The parallel cohort study prospectively matched a cohort of patients with bloodstream infections caused by third-generation cephalosporin-resistant enterobacteria and methicillin-resistant Staphylococcus aureus (AMR cohort) with two control arms: patients infected with similar susceptible bacteria and a cohort of uninfected controls. Data collection took place from June to December 2021. We calculated the cost using aggregated micro-costing and step-down costing approaches and converted costs into purchasing power parity in international US dollars, adjusting for surviving patients, bacterial species and cost centres. We found that the AMR cohort spent a mean of 4.2 extra days (95% CI: 3.7-4.7) at Hospital 1 and 5.5 extra days (95% CI: 5.1-5.9) at Hospital 2 compared with the susceptible cohort. This corresponds to an estimated mean extra cost of $823 (95% CI: 812-863) and $946 (95% CI: US$929-US$964) per admission, respectively. For both hospitals, the estimated mean annual extra cost attributable to AMR was approximately US$650 000. The cost varies by organism and type of resistance expressed. The result calls for prioritization of interventions to mitigate the spread of AMR in Ghana.
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Affiliation(s)
- Evans Otieku
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Accra 233, Ghana
- Department of Public Health, Aarhus University, Batholins Alle 1, Building No. 1261, Aarhus 8000, Denmark
| | - Joergen Anders Lindholm Kurtzhals
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen 1165, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 1165, Denmark
| | - Ama Pokuaa Fenny
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, P.O. Box LG 74, Accra 233, Ghana
| | - Alex Owusu Ofori
- Laboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi 233, Ghana
- Department of Clinical Microbiology, Korle-Bu Teaching Hospital, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi 233, Ghana
| | - Appiah-Korang Labi
- Department of Medical Microbiology, Korle-Bu Teaching Hospita, University of Ghana Medical School, Accra 233, Ghana
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Batholins Alle 1, Building No. 1261, Aarhus 8000, Denmark
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8
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Essack SY, Lenglet A. Bacterial antimicrobial resistance burden in Africa: accuracy, action, and alternatives. Lancet Glob Health 2024; 12:e171-e172. [PMID: 38134945 DOI: 10.1016/s2214-109x(23)00587-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Sabiha Y Essack
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark.
| | - Annick Lenglet
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark
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Poudyal N, Holm M, Joh HS, Gautam S, Sujan MJ, Kwon SY, Sahikh A, Shaw A, Gallagher P, Prifti K, Cho A, Chi KYK, Aboushady AT, MacWright WR, Stelling J, Marks F. Effective Stakeholder Engagement for Collation, Analysis and Expansion of Antimicrobial Resistance (AMR) Data: A CAPTURA Experience. Clin Infect Dis 2023; 77:S519-S527. [PMID: 38118005 PMCID: PMC10732561 DOI: 10.1093/cid/ciad585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND An effective implementation of antimicrobial resistance (AMR) surveillance projects requires sustainable and multidisciplinary engagement with stakeholders from various backgrounds, interests and aims. The "Capturing Data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) project, funded by the Fleming Fund, initially targeted 12 countries in South Asia (SA) and Southeast Asia (SEA) to "expand the volume of historical and current data on AMR and antimicrobial usage" and support local agencies through capacity building activities. METHODS In this article, we focus on early stakeholder engagement activities and present overall statistics on AMR data collated from 72 laboratories across seven countries. This included 2.3 million records of antimicrobial susceptibility testing (AST) data, which were curated, analyzed, and shared back to the facilities for informed decision making. RESULTS Approximately 98% of the data collated by CAPTURA originated from laboratories based in SA countries. Furthermore, country-wide data were analyzed to identify commonly reported pathogens in each country, followed by descriptions of AST practices and multidrug-resistant (MDR) pathogens. Overall, we found meager adherence to standard guidelines to perform and record AST results, and a significant number of MDR pathogens were reported. CONCLUSIONS We conclude that close collaboration with the existing national mechanisms for identifying AMR data sources was crucial for the project's success. Although we show a vast retrospective dataset on AMR is available for data sharing in Asia, there remain critical gaps in data generation/management practice and analysis capacity for AMR data at most facilities.
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Affiliation(s)
- Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Marianne Holm
- Research & Collaboration, Anka Analytica, Melbourne, Australia
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sanjay Gautam
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Affan Sahikh
- Public Health Surveillance Group LLC, Princeton, USA
| | - Alina Shaw
- Public Health Surveillance Group LLC, Princeton, USA
| | | | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | - Alyssa Cho
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Ahmed Taha Aboushady
- International Vaccine Institute, Seoul, Republic of Korea
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
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Musa K, Okoliegbe I, Abdalaziz T, Aboushady AT, Stelling J, Gould IM. Laboratory Surveillance, Quality Management, and Its Role in Addressing Antimicrobial Resistance in Africa: A Narrative Review. Antibiotics (Basel) 2023; 12:1313. [PMID: 37627733 PMCID: PMC10451735 DOI: 10.3390/antibiotics12081313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
AMR is a major public health concern that calls for extensive work and a multidisciplinary team approach. The high prevalence of infectious diseases in African nations leads to widespread antibiotic usage and eventual antimicrobial resistance, which has significant negative effects on people's health, the economy, and society. Additionally, inadequate or nonexistent antimicrobial drug regulations, inappropriate prescription practices, and restrictions on public health prevention initiatives such as immunization, water and sanitation, and sexual health may all contribute to the emergence of AMR. Despite the need for laboratory quality assurance, many African laboratories confront substantial difficulties in implementing efficient quality assurance programs. AMR surveillance in Africa is hampered by a lack of laboratory capacity, insufficient data collection and analysis, and poor stakeholder collaboration. Several initiatives and programs, including the World Health Organization's Global Antimicrobial Resistance and Use Surveillance System (GLASS), the Africa Centres for Disease Control and Prevention (Africa CDC) Antimicrobial Resistance Surveillance Network (AMRSNET), and the Fleming Fund, a UK government initiative aimed at tackling AMR in low- and middle-income countries, have been established to strengthen AMR surveillance in Africa and globally.
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Affiliation(s)
- Khalid Musa
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
- Department of Acute Medicine and Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Ijeoma Okoliegbe
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
| | - Tassabeeh Abdalaziz
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
- Department of Acute Medicine and Infectious Diseases, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
| | - Ahmed Taha Aboushady
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (A.T.A.); (J.S.)
| | - John Stelling
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; (A.T.A.); (J.S.)
| | - Ian M. Gould
- Department of Medical Microbiology and Virology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK; (I.O.); (T.A.); (I.M.G.)
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Ossebi W, Ndjoug Ndour AP, Dieng SD, Bedekelabou AP, Kalandi M, Diop FN, Bada Alambedji R, Kaboret YY, Faye A, Sambou B. One Health training needs for Senegalese professionals to manage emerging public health threats. SCIENCE IN ONE HEALTH 2022; 1:100005. [PMID: 39076607 PMCID: PMC11262269 DOI: 10.1016/j.soh.2022.100005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/22/2022] [Indexed: 07/31/2024]
Abstract
Global health trends, marked by increasing epidemics and pandemics, call for enhanced human resource preparedness to prevent and respond to emerging and future health problems. Indeed, according to the World Organization for Animal Health (WOAH), at least 75% of the pathogens responsible for emerging and re-emerging human infectious diseases originate from animals. These health problems involve environmental, economic and social factors. Because of their multidimensional nature, addressing these health problems requires the adoption of a One Health approach. To achieve this, training of human resources is a priority. This descriptive cross-sectional study was conducted from September 12 to 22, 2021 in 6 regions of Senegal, namely, Dakar, Thiès, Diourbel, Kaolack, Saint-Louis, and Ziguinchor. Questionnaires were administered online and in person to 217 professionals in human, environmental, animal health and agriculture. Data were statistically processed, and bivariate analyses enabled a better correlation between training needs for professionals according to their occupational group. The survey sample was 64% male and 36% female. More than half of the professionals surveyed (53.5%) had less than 10 years of experience. Human health workers were the most represented (46%), followed by animal health workers (34%) and environmental workers (16%). Agriculture, fisheries, and food security were weakly represented. Few had received training in the One Health approach and entry-level One Health skills predominated. The One Health competencies in which professionals want to build capacity differ by sector. Globally, public health and epidemiology, health risk management, basic of One Health concepts, animal health and biotechnology are the priorities. The development of training programs could then enable these expressed needs to be addressed.
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Affiliation(s)
- Walter Ossebi
- Inter-State School of Veterinary Sciences and Medicine, Cheikh Anta Diop University, Dakar-Fann BP, 5077, Senegal
| | - Andrée Prisca Ndjoug Ndour
- Inter-State School of Veterinary Sciences and Medicine, Cheikh Anta Diop University, Dakar-Fann BP, 5077, Senegal
| | - Sara Danièle Dieng
- Inter-State School of Veterinary Sciences and Medicine, Africa One Health University Network, Dakar-Fann BP, 5077, Senegal
- Institute of Environmental Sciences, Cheikh Anta Diop University, Dakar-Fann BP, 5005, Senegal
| | | | - Miguiri Kalandi
- Inter-State School of Veterinary Sciences and Medicine, Cheikh Anta Diop University, Dakar-Fann BP, 5077, Senegal
| | - Fatimata Niang Diop
- Institute of Environmental Sciences, Cheikh Anta Diop University, Dakar-Fann BP, 5005, Senegal
| | - Rianatou Bada Alambedji
- Inter-State School of Veterinary Sciences and Medicine, Cheikh Anta Diop University, Dakar-Fann BP, 5077, Senegal
| | - Yalacé Yamba Kaboret
- Inter-State School of Veterinary Sciences and Medicine, Cheikh Anta Diop University, Dakar-Fann BP, 5077, Senegal
| | - Adama Faye
- Institute of Health and Development, Cheikh Anta Diop University, Dakar-Fann BP, 5005, Senegal
| | - Bienvenu Sambou
- Institute of Environmental Sciences, Cheikh Anta Diop University, Dakar-Fann BP, 5005, Senegal
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