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Mudenda S, Chabalenge B, Daka V, Jere E, Sefah I, Wesangula E, Yamba K, Nyamupachitu J, Mugenyi N, Mustafa ZU, Mpundu M, Chizimu J, Chilengi R. Knowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study. JAC Antimicrob Resist 2024; 6:dlae076. [PMID: 38764535 PMCID: PMC11100357 DOI: 10.1093/jacamr/dlae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024] Open
Abstract
Background Antimicrobial resistance (AMR) poses a threat to public health globally. Despite its consequences, there is little information about the knowledge, awareness, and practices towards AMR among healthcare workers (HCWs). Therefore, this study assessed the knowledge, awareness and practices regarding antimicrobial use (AMU), AMR and antimicrobial stewardship (AMS) among HCWs who are involved in the implementation of AMS activities across eight hospitals in Zambia. Methods A cross-sectional study was conducted among 64 HCWs from October to December 2023 using a semi-structured questionnaire. Data were analysed using IBM SPSS version 25.0. Results Of the 64 HCWs, 59.4% were females, 60.9% were aged between 25 and 34 years, 37.5% were nurses, 18.7% were pharmacists, 17.2% were medical doctors and only one was a microbiologist. Overall, 75% of the HCWs had good knowledge, 84% were highly aware and 84% had good practices regarding AMU, AMR and AMS. Most of the HCWs (90.6%) responded that they had a multidisciplinary AMS team at their hospitals and were implementing the use of the WHO AWaRe classification of antibiotics. Conclusion This study found good knowledge levels, high awareness and good practices regarding AMU, AMR and AMS among HCWs who were involved in the implementation of AMS activities in hospitals in Zambia. Additionally, most hospitals have been conducting AMS training and implementing the use of the WHO AWaRe classification of antibiotics. However, there is still a need to address some identified gaps in AMU and AMR through the strengthening of AMS activities in hospitals.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Elimas Jere
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Isaac Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, PMB 31, Ho, Ghana
| | - Evelyn Wesangula
- Strengthening Pandemic Preparedness, Eastern, Central, and Southern Africa Health Community, Arusha, Tanzania
| | - Kaunda Yamba
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | | | - Nathan Mugenyi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, 11800, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, 57400, Pakistan
| | - Mirfin Mpundu
- Action on Antibiotic Resistance (ReAct) Africa, Lusaka, Zambia
| | - Joseph Chizimu
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
| | - Roma Chilengi
- Antimicrobial Resistance Coordinating Committee, Zambia National Public Health Institute, Lusaka, Zambia
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Ngoma MT, Sitali D, Mudenda S, Mukuma M, Bumbangi FN, Bunuma E, Skjerve E, Muma JB. Community antibiotic consumption and associated factors in Lusaka district of Zambia: findings and implications for antimicrobial resistance and stewardship. JAC Antimicrob Resist 2024; 6:dlae034. [PMID: 38449513 PMCID: PMC10914457 DOI: 10.1093/jacamr/dlae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/10/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a global public health crisis. This study assessed the general public's consumption of antibiotics and associated factors in the Lusaka district of Zambia. Methods This cross-sectional study was conducted among 2038 participants between December 2022 and January 2023. Data were analysed using Stata 13.0. Multivariable regression techniques were used to determine the factors that influenced antibiotic consumption. Results Of the 2038 participants, 53.4% were female, and 51.5% had attended at least secondary school. Antibiotic use was 99.2%, of which 40.9% were appropriately used. Overall, 79.1% of antibiotics were prescribed in hospitals, while 20.9% were used from leftovers and accessed without prescriptions. This study found that the appropriate use of antibiotics was associated with being female, being aged 35 years and above, attaining secondary school or tertiary education, having a monthly expenditure of 195 USD and above, being aware that antibiotics were not the same as painkillers, and being confident that when someone was hospitalized, they would get well. Conclusions This study found that the appropriate use of antibiotics was low, and this is an urgent public health issue requiring community engagement in tackling AMR and adherence to treatment guidelines in healthcare facilities. Additionally, there is a need to implement and strengthen antimicrobial stewardship programmes in healthcare facilities to promote the rational use of antibiotics in Zambia. There is also a need to heighten community awareness campaigns and educational activities on the appropriate use of antibiotics.
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Affiliation(s)
- Maty Tsumbu Ngoma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Doreen Sitali
- Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Mercy Mukuma
- Department of Food Science, School of Agricultural Sciences and Nutrition, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, Lusaka, Zambia
| | - Emmanuel Bunuma
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Eystein Skjerve
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Atalay YA, Abebe Gelaw K. Prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa: a systematic review and meta-analysis. Front Microbiol 2024; 15:1345145. [PMID: 38585703 PMCID: PMC10996921 DOI: 10.3389/fmicb.2024.1345145] [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: 12/01/2023] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background One of the main threats to public health today is antibiotic resistance. This resistance leads to the persistence of infections in the body. It poses an increased risk of transmission to humans and animals through various routes, such as food, water, and the environment. Objectives This study aimed to ascertain the overall prevalence of knowledge, attitudes, and practices regarding antimicrobial resistance in Africa. Methods A systematic review and meta-analysis of published and unpublished studies was conducted in Africa according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted using appropriate search terms in PubMed, Web of Science, Science Direct, Google Scholar, African Journals Online, and the Cochrane Library. Data were extracted using Microsoft Excel, and STATA version 14 was used for analysis. Publication bias was checked by funnel plot, Egger, and Begg regression tests. A p-value of 0.05 was regarded to indicate potential publication bias. Using I2 statistics, the heterogeneity of the studies was evaluated. Using forest plots, the random effect model was used to present the pooled prevalence with a 95% confidence interval (CI) of meta-analysis. Results This review included 39 studies, with 18,769 study participants. Among these 39 studies, 38 were on knowledge assessment, 28 on attitude assessment, and 25 on good practice assessment towards antimicrobial resistances. The overall pooled prevalence level of knowledge regarding antimicrobial resistance in Africa was 55.33% (95% CI: 47.48, 63.18). The overall pooled prevalence of positive attitudes toward antimicrobial resistance in Africa was 46.93% (95% CI: 35.10, 58.76), and the overall pooled prevalence of good practice of antimicrobial resistance in Africa was 51.05% (95% CI: 45.24, 56.87). In addition, sub-group statistical analysis was performed in this meta-analysis, stratified by population sub-region and study design types. Conclusion In Africa, the pooled prevalence of knowledge, attitudes, and practices regarding antimicrobial drug resistance among different groups, including the general population, patients, tertiary school students, healthcare workers, and animal owners was found to be low level. Therefore, it is imperative to enhance the education and training programs regarding antibiotic resistance for various groups including the general public, patients, students, healthcare workers, and individuals responsible for the well-being of animals.
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Affiliation(s)
- Yibeltal Assefa Atalay
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kelemu Abebe Gelaw
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Mudenda S, Chilimboyi R, Matafwali SK, Daka V, Mfune RL, Kemgne LAM, Bumbangi FN, Hangoma J, Chabalenge B, Mweetwa L, Godman B. Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications. JAC Antimicrob Resist 2024; 6:dlae023. [PMID: 38389802 PMCID: PMC10883698 DOI: 10.1093/jacamr/dlae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. Methods A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Results Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. Conclusions There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Robert Chilimboyi
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 50110, Lusaka, Zambia
- Department of Pharmacy, Saint Francis' Hospital, Private Bag 11, Katete, Zambia
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | - Ruth Lindizyani Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, P.O. Box 71191, Ndola, Zambia
| | | | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, P.O. Box 30226, Lusaka, Zambia
| | - Jimmy Hangoma
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, P.O. Box 31890, Lusaka, Zambia
| | - Larry Mweetwa
- Department of Science and Technology, Ministry of Technology and Science, Maxwell House, Los Angeles Boulevard, P. O. Box 50464, Lusaka, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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Dighriri IM, Alnomci BA, Aljahdali MM, Althagafi HS, Almatrafi RM, Altwairqi WG, Almagati AA, Shunaymir AM, Haidarah GA, Alanzi MH, Hadadi AA, Suwaydi HM, Aqdi MJ, Alharthi HN, Alshahrani AF. The Role of Clinical Pharmacists in Antimicrobial Stewardship Programs (ASPs): A Systematic Review. Cureus 2023; 15:e50151. [PMID: 38186441 PMCID: PMC10771624 DOI: 10.7759/cureus.50151] [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] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Antimicrobial resistance (AMR) is a major global health threat, increasing deaths and healthcare costs. Antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use and curb resistance. This systematic review aimed to summarize evidence on the role and impact of pharmacists in hospital ASPs. A comprehensive literature search was conducted across databases to identify relevant studies published from 2016 to 2023. Twenty-four studies met the inclusion criteria, comprising global observational and randomized clinical trials. Pharmacists performed various stewardship activities, including prospective audits, formulary management, de-escalation, guideline development, and education. Pharmacist-led interventions significantly improved antibiotic prescribing, reduced unnecessary antibiotic use, optimized therapy, and enhanced outcomes. Multiple studies found that pharmacist reviews decreased the time to optimal antibiotics and improved guideline compliance without affecting readmissions or revisits. De-escalation programs safely reduced antibiotic duration and length of stay. Acceptance rates for recommendations were high. Pharmacist stewardship curbed overall antibiotic use, costs, and duration across hospital departments, leading to savings. While most studies showed positive impacts, fewer detected significant changes in resistance or mortality over short periods. More research is needed, but current evidence demonstrates that pharmacists play critical roles in ASPs, leading to improved antibiotic use and patient outcomes. These findings support integrating pharmacists into stewardship activities, significantly extending programs to ambulatory settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mohmmad H Alanzi
- Department of Emergency Pharmacy, Dr. Sulaiman Al Habib Hospital, Riyadh, SAU
| | | | | | - Maha J Aqdi
- Faculty of Pharmacy, Jazan University, Jazan, SAU
| | - Hamed N Alharthi
- Department of Forensic Center, Forensic Medical Services Center, Al Baha, SAU
| | - Amaal F Alshahrani
- Department of Pharmacy, Armed Forces Hospital Southern Region, Abha, SAU
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Fuller W, Kapona O, Aboderin AO, Adeyemo AT, Olatunbosun OI, Gahimbare L, Ahmed YA. Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review. Antibiotics (Basel) 2023; 12:1613. [PMID: 37998815 PMCID: PMC10669252 DOI: 10.3390/antibiotics12111613] [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: 05/29/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023] Open
Abstract
This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.
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Affiliation(s)
- Walter Fuller
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
| | - Otridah Kapona
- Zambia National Public Health Institute, Lusaka 10101, Zambia;
| | - Aaron Oladipo Aboderin
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Adeyemi Temitayo Adeyemo
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Oluwadamilare Isaiah Olatunbosun
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Laetitia Gahimbare
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
| | - Yahaya Ali Ahmed
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
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Sefah IA, Chetty S, Yamoah P, Meyer JC, Chigome A, Godman B, Bangalee V. A Multicenter Cross-Sectional Survey of Knowledge, Attitude, and Practices of Healthcare Professionals towards Antimicrobial Stewardship in Ghana: Findings and Implications. Antibiotics (Basel) 2023; 12:1497. [PMID: 37887198 PMCID: PMC10604649 DOI: 10.3390/antibiotics12101497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Antimicrobial stewardship (AMS) programs are part of the key activities that contribute to reducing antimicrobial resistance (AMR). Good knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) are essential to improving future antimicrobial use and reducing AMR, which is a priority in Ghana. A multicenter cross-sectional survey was conducted in six public hospitals in Ghana among key HCPs to assess their level of KAP towards AMS using a validated self-administered electronic questionnaire. Data analyses included descriptive and inferential statistics using STATA version 14. Overall, 339 out of 355 HCPs responded to the questionnaire, giving a response rate of 95.5%. Most responders were nurses (n = 256, 78.2%), followed by medical doctors (n = 45, 13.3%). The study recorded both poor knowledge (8.9%) and practice levels (35.4%), as well as a good attitude (78.8%) towards AMS. Ongoing exposure to AMS structured training, exposure to continuous professional development training on AMS in the previous year, and the number of years of working experience were predictors of the HCPs' level of knowledge (aOR = 3.02 C.I = 1.12-8.11), attitude (aOR = 0.37 C.I = 0.20-0.69) and practice (aOR = 2.09 C.I =1.09-3.99), respectively. Consequently, concentrated efforts must be made to address current low levels of knowledge and poor practices regarding AMS among HCPs in Ghana as part of ongoing strategies in the National Action Plan to reduce AMR.
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Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho PMB 31, Ghana;
| | - Sarentha Chetty
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa;
| | - Peter Yamoah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho PMB 31, Ghana;
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa; (J.C.M.); (A.C.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa; (J.C.M.); (A.C.)
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa; (J.C.M.); (A.C.)
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow G4 0RE, UK
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa;
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Kasanga M, Kwenda G, Wu J, Kasanga M, Mwikisa MJ, Chanda R, Mupila Z, Yankonde B, Sikazwe M, Mwila E, Shempela DM, Solochi BB, Phiri C, Mudenda S, Chanda D. Antimicrobial Resistance Patterns and Risk Factors Associated with ESBL-Producing and MDR Escherichia coli in Hospital and Environmental Settings in Lusaka, Zambia: Implications for One Health, Antimicrobial Stewardship and Surveillance Systems. Microorganisms 2023; 11:1951. [PMID: 37630511 PMCID: PMC10459584 DOI: 10.3390/microorganisms11081951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Antimicrobial resistance (AMR) is a public health problem threatening human, animal, and environmental safety. This study assessed the AMR profiles and risk factors associated with Escherichia coli in hospital and environmental settings in Lusaka, Zambia. This cross-sectional study was conducted from April 2022 to August 2022 using 980 samples collected from clinical and environmental settings. Antimicrobial susceptibility testing was conducted using BD PhoenixTM 100. The data were analysed using SPSS version 26.0. Of the 980 samples, 51% were from environmental sources. Overall, 64.5% of the samples tested positive for E. coli, of which 52.5% were from clinical sources. Additionally, 31.8% were ESBL, of which 70.1% were clinical isolates. Of the 632 isolates, 48.3% were MDR. Most clinical isolates were resistant to ampicillin (83.4%), sulfamethoxazole/trimethoprim (73.8%), and ciprofloxacin (65.7%) while all environmental isolates were resistant to sulfamethoxazole/trimethoprim (100%) and some were resistant to levofloxacin (30.6%). The drivers of MDR in the tested isolates included pus (AOR = 4.6, CI: 1.9-11.3), male sex (AOR = 2.1, CI: 1.2-3.9), and water (AOR = 2.6, CI: 1.2-5.8). This study found that E. coli isolates were resistant to common antibiotics used in humans. The presence of MDR isolates is a public health concern and calls for vigorous infection prevention measures and surveillance to reduce AMR and its burdens.
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Affiliation(s)
- Maisa Kasanga
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China (J.W.)
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia;
| | - Jian Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China (J.W.)
| | - Maika Kasanga
- Department of Pharmacy, University Teaching Hospital, Lusaka 50110, Zambia;
| | - Mark J. Mwikisa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Raphael Chanda
- Adult Centre of Excellence, University Teaching Hospital, Lusaka 50110, Zambia
| | - Zachariah Mupila
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Baron Yankonde
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Mutemwa Sikazwe
- Department of Pathology, Lusaka Trust Hospital, Lusaka 35852, Zambia
| | - Enock Mwila
- Department of Pathology, Lusaka Trust Hospital, Lusaka 35852, Zambia
| | - Doreen M. Shempela
- Churches Health Association of Zambia, Lusaka 34511, Zambia
- Department of Laboratory and Research, Central University of Nicaragua, Managua 12104, Nicaragua
| | - Benjamin B. Solochi
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Christabel Phiri
- Department of Microbiology, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
- Research and Surveillance Technical Working Group, Zambia National Public Health Institute, Lusaka 10101, Zambia
| | - Duncan Chanda
- Adult Centre of Excellence, University Teaching Hospital, Lusaka 50110, Zambia
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9
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Kainga H, Phonera MC, Chikowe I, Chatanga E, Nyirongo H, Luwe M, Mponela J, Kachisi V, Kamanga N, Chulu J, Njunga G, Nabadda D, Fonchin A, Kallu SA, Mudenda S, Tembo R, Zulu M, Mwaba F, Mbewe N, Mpundu P, Samutela MT, Munyeme M, Muma JB, Simulundu E. Determinants of Knowledge, Attitude, and Practices of Veterinary Drug Dispensers toward Antimicrobial Use and Resistance in Main Cities of Malawi: A Concern on Antibiotic Stewardship. Antibiotics (Basel) 2023; 12:antibiotics12010149. [PMID: 36671349 PMCID: PMC9855151 DOI: 10.3390/antibiotics12010149] [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: 11/28/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Antimicrobial resistance (AMR) is an emerging challenge to global public health. The use of antibiotics in the veterinary field is one of the contributing factors to AMR mostly due to poor knowledge, attitudes, and practices (KAP) of dispensers. Veterinary drug dispensers are expected to guide clients on indications, contraindications, and withdrawal periods of veterinary drugs. This study assessed veterinary drug dispensers' KAP toward AMR and associated potential contributing factors. A cross-sectional study, using a structured questionnaire, was conducted in three main cities of Malawi, namely Mzuzu, Lilongwe, and Blantyre. A total of 68 agrovet shops were selected using a simple random sampling technique. The KAP level was presented descriptively. Bivariate and multivariable analyses were run to investigate the relationships between the independent and outcome variable. Overall, the KAP score for knowledge, attitude, and practices was 46.7%, 49.2%, and 41.6%, respectively. The significant determinants of the knowledge were the practice of asking for a written prescription (OR: 16.291, 95% CI: 11.6-24.2) (p = 0.024), female (OR: 0.609, 95% CI: 0.3-0.9) (p = 0.001), and old age (≥35) (OR: 0.227, 95% CI: 0.1-0.5) (p = 0.04). Poor knowledge, negative attitude, and poor practices were observed among most of the participants. Sensitization and training on AMR and antimicrobial stewardship are recommended to address the KAP score gaps and the observed determinants among veterinary drug dispensers.
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Affiliation(s)
- Henson Kainga
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
- Correspondence: or ; Tel.: +265-996-618-212
| | - Marvin Collen Phonera
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHES), Blantyre P.O. Box 360, Malawi
| | - Elisha Chatanga
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
| | - Hlupikire Nyirongo
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
| | - Mike Luwe
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - James Mponela
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | | | - Nathani Kamanga
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Julius Chulu
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Gilson Njunga
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Daisy Nabadda
- Department of Biosecurity, Ecosystems and Public Health, College of Veterinary Medicine, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Alyce Fonchin
- Community Initiative for Sustainable Development, Manko-Bamenda P.O. Box 356, Cameroon
| | - Simegnew Adugna Kallu
- College of Veterinary Medicine, Haramaya University, Dire Dawa P.O. Box 138, Ethiopia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Rabecca Tembo
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Mildred Zulu
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Florence Mwaba
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Natalia Mbewe
- Department of Basic and Clinical Nursing Sciences, School of Nursing Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Prudence Mpundu
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, Lusaka P.O. Box 33991, Zambia
| | - Mulemba Tillika Samutela
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - Edgar Simulundu
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
- Macha Research Trust, Choma P.O. Box 20100, Zambia
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