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Aboushady AT, Manigart O, Sow A, Fuller W, Ouedraogo AS, Ebruke C, Babin FX, Gahimbare L, Sombié I, Stelling J. Surveillance of Antimicrobial Resistance in the ECOWAS Region: Setting the Scene for Critical Interventions Needed. Antibiotics (Basel) 2024; 13:627. [PMID: 39061309 PMCID: PMC11273779 DOI: 10.3390/antibiotics13070627] [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: 06/11/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance poses a significant challenge to public health globally, leading to increased morbidity and mortality. AMR surveillance involves the systematic collection, analysis, and interpretation of data on the occurrence and distribution of AMR in humans, animals, and the environment for action. The West African Health Organization, part of the Economic Community of West African States (ECOWAS), is committed to addressing AMR in the region. This paper examines the status of AMR surveillance in ECOWAS countries using available WHO data from the TrACSS survey and GLASS enrollments. The analysis reveals that while progress has been made, significant challenges remain. Twelve of the fifteen ECOWAS countries are enrolled in GLASS, and ten have developed national action plans (NAPs) for AMR. However, there is a need to ensure all countries fully implement their NAPs, continue reporting to GLASS, and use the data for evidence-based actions and decision making. Surveillance systems for AMR and antimicrobial consumption/use vary across countries with some demonstrating limited capacity. All countries, except Cabo Verde, reported having a reference laboratory for AMR testing. Strengthening laboratory capabilities, data management and use, and multisectoral coordination are crucial for effective AMR surveillance and response. Based on the findings and the regional context, it is essential to prioritize capacity building, data utilization, and the adoption of standardized guidelines for AMR surveillance. Collaboration among ECOWAS countries, the WAHO, and international partners is essential to address AMR comprehensively. Ensuring a consistent supply of essential antimicrobial medications and reagents is vital.
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Affiliation(s)
| | - Olivier Manigart
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
- Ecole de Santé Publique, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Abdourahmane Sow
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- Institut Pasteur de Dakar, Dakar 220, Senegal
- Department de Santé Public, Faculté de Médecine, de Pharmacie et D’Odontostomatologie, Université Cheikh Anta Diop, Dakar 5005, Senegal
| | - Walter Fuller
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Abdoul-Salam Ouedraogo
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso 01 BP 390, Burkina Faso;
| | - Chinelo Ebruke
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
| | | | - Laetitia Gahimbare
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Issiaka Sombié
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
| | - John Stelling
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
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Abejew AA, Wubetu GY, Fenta TG. Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia. Heliyon 2024; 10:e32663. [PMID: 38912506 PMCID: PMC11193037 DOI: 10.1016/j.heliyon.2024.e32663] [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: 10/31/2023] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background Indiscriminate use of antibiotics leads to antibiotic resistance (AMR) and results in mortality, morbidity, and financial burden. Antibiotic stewardship programs (ASPs) with education can resolve a number of barriers recognized in the implementation of successful ASPs. The aim of this study was to assess health professionals' perceptions and status of ASPs in hospitals in 2022. Methods A cross-sectional study was conducted from September 1, 2022 to October 30, 2022. A total of 181 health professionals were included, and a self-administered questionnaire was used to collect data. The status of hospitals was assessed using a checklist. The data were analyzed using SPSS version 23, and descriptive statistics and Chi-square tests (X2) at a P-value of <0.05 were used. Results Of the 181 respondents, 163 (90.1 %), and 161 (89.0 %) believed that AMR is a significant problem in Ethiopia and globally, respectively. Easy access to antibiotics 155 (85.6 %), and inappropriate use 137 (75.7 %) were perceived as key contributors to AMR. Antibiotics were believed to be prescribed/dispensed without laboratory results 86 (47.5 %), and antibiotic susceptibility patterns were not considered to guide empiric therapy 81 (44.8 %). ASP was believed to reduce the duration of hospital stays and associated costs 137 (75.7 %), and improve the quality of patient care 133 (73.5 %), whereas 151 (83.4 %), 143 (79 %), and 142 (78.5 %) suggested education, institutional guidelines, and prospective audits with feedback interventions to combat AMR in their hospitals, respectively. There were significant differences in perception among professionals based on professional category and attempts by hospitals to implement ASPs. Although ASPs were not functioning according to standard, there have been attempts to implement it in three hospitals. The issue of ASP had never been heard in general hospitals. Currently, it is feasible to implement ASPs in four hospitals. Conclusion The status of ASP in hospitals was very poor. Despite a lack of prior knowledge on ASPs, most respondents do have a positive perception of AMR and the implementation of ASPs. Pharmacist-led prospective audits and feedback with education and institutional guidelines for empiric antibiotic use can be better implemented in hospitals. Involvement of representatives from infection prevention and control, and collaboration among hospitals in ASP implementation will help establish a strong ASP in the area.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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da Costa RC, Serrano I, Chambel L, Oliveira M. The importance of "one health approach" to the AMR study and surveillance in Angola and other African countries. One Health 2024; 18:100691. [PMID: 39010949 PMCID: PMC11247297 DOI: 10.1016/j.onehlt.2024.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/29/2024] [Indexed: 07/17/2024] Open
Abstract
The dissemination of multidrug-resistant (MDR) bacterial isolates in low- and middle-income countries, including several African countries, is a major concern. The poor sanitary conditions of rural and urban families observed in certain regions may favor the transmission of bacterial infections between animals and humans, including those promoted by strains resistant to practically all available antibiotics. In Angola, in particular, the presence of these strains in human hospitals has already been described. Nevertheless, the information on antimicrobial resistance (AMR) prevalence in Angola is still scarce, especially regarding veterinary isolates. This review aimed to synthesize data on antimicrobial resistance in African countries, with a special focus on Angola, from a One Health perspective. The main goals were to identify research gaps that may require further analysis, and to draw attention to the importance of the conscious use of antimicrobials and the establishment of preventive strategies, aiming to guarantee the safeguarding of public health. To understand these issues, the available literature on AMR in Africa was reviewed. We searched PubMed for articles pertinent to AMR in relevant pathogens in Angola and other African countries. In this review, we focused on AMR rates and surveillance capacity. The principal findings were that, in Africa, especially in sub-Saharan countries, AMR incidence is high due to the lack of legislation on antibiotics, to the close interaction of humans with animals and the environment, and to poverty. The information about current resistance patterns of common pathogenic bacteria is sparse, and the number of quality studies is limited in Angola and in some other Sub-Saharan African countries. Also, studies on the "One Health Approach" focusing on the environment, animals, and humans, are scarce in Africa. The surveillance capacity is minimal, and only a low number of AMR surveillance programs and national health programs are implemented. Most international and cooperative surveillance programs, when implemented, are not properly followed, concluded, nor reported. In Angola, the national health plan does not include AMR control, and there is a consistent omission of data submitted to international surveillance programs. By identifying One Health strengths of each country, AMR can be controlled with a multisectoral approach and governmental commitment.
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Affiliation(s)
- Romay Coragem da Costa
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
- Department of Animal Health, Faculty of Veterinary Medicine, University José Eduardo dos Santos, Huambo, Angola
| | - Isa Serrano
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Lélia Chambel
- BioISI-Biosystems and Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, 1749-016 Lisboa, Portugal
| | - Manuela Oliveira
- CIISA-Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
- cE3c - Centre for Ecology, Evolution and Environmental Changes & CHANGE - Global Change and Sustainability Institute, 1749-016 Lisboa, Portugal
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Ahaik I, Nunez-Rodríguez JC, Abrini J, Bouhdid S, Gabaldón T. Assessing Diagnosis of Candida Infections: A Study on Species Prevalence and Antifungal Resistance in Northern Morocco. J Fungi (Basel) 2024; 10:373. [PMID: 38921360 PMCID: PMC11204772 DOI: 10.3390/jof10060373] [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: 04/19/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 06/27/2024] Open
Abstract
The incidence of Candida infections has increased in the last decade, posing a serious threat to public health. Appropriately facing this challenge requires precise epidemiological data on species and antimicrobial resistance incidence, but many countries lack appropriate surveillance programs. This study aims to bridge this gap for Morocco by identifying and phenotyping a year-long collection of clinical isolates (n = 93) from four clinics in Tetouan. We compared the current standard in species identification with molecular methods and assessed susceptibility to fluconazole and anidulafungin. Our results identified limitations in currently used diagnostics approaches, and revealed that C. albicans ranks as the most prevalent species with 60 strains (64.52%), followed by C. glabrata with 14 (15.05%), C. parapsilosis with 6 (6.45%), and C. tropicalis with 4 (4.30%). In addition, we report the first identification of C. metapsilosis in Morocco. Susceptibility results for fluconazole revealed that some isolates were approaching MICs resistance breakpoints in C. albicans (2), and C. glabrata (1). Our study also identified anidulafungin resistant strains in C. albicans (1), C. tropicalis (1), and C. krusei (2), rendering the two strains from the latter species multidrug-resistant due to their innate resistance to fluconazole. These results raise concerns about species identification and antifungal resistance in Morocco and highlight the urgent need for more accurate methods and preventive strategies to combat fungal infections in the country.
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Affiliation(s)
- Islam Ahaik
- Laboratoire de Chimie et Microbiologie Appliquées et Biotechnologies, Faculté des Sciences, Université Abdelmalek Essaâdi, Tétouan 93000, Morocco; (I.A.); (S.B.)
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028 Barcelona, Spain
| | - Juan Carlos Nunez-Rodríguez
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028 Barcelona, Spain
- Barcelona Supercomputing Centre (BSC-CNS), Plaça Eusebi Güell, 1-3, 08034 Barcelona, Spain
| | - Jamal Abrini
- Laboratoire de Chimie et Microbiologie Appliquées et Biotechnologies, Faculté des Sciences, Université Abdelmalek Essaâdi, Tétouan 93000, Morocco; (I.A.); (S.B.)
| | - Samira Bouhdid
- Laboratoire de Chimie et Microbiologie Appliquées et Biotechnologies, Faculté des Sciences, Université Abdelmalek Essaâdi, Tétouan 93000, Morocco; (I.A.); (S.B.)
| | - Toni Gabaldón
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Baldiri Reixac, 10, 08028 Barcelona, Spain
- Barcelona Supercomputing Centre (BSC-CNS), Plaça Eusebi Güell, 1-3, 08034 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Vougat Ngom R, Jajere SM, Ayissi GJ, Tanyienow A, Moffo F, Watsop HM, Mimboe LM, Mouiche MM, Schüpbach-Regula G, Carmo LP. Unveiling the landscape of resistance against high priority critically important antimicrobials in food-producing animals across Africa: A scoping review. Prev Vet Med 2024; 226:106173. [PMID: 38503073 DOI: 10.1016/j.prevetmed.2024.106173] [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: 10/03/2023] [Revised: 02/10/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
The rapid population growth in Africa is associated with an increasing demand for livestock products which in turn can lead to antimicrobial use. Antimicrobial usage in animals contributes to the emergence and selection of resistant bacteria which constitutes a serious public health threat. This study aims to review and summarize the available information on highest priority critically important antimicrobials (HPCIAs) resistance in livestock production in Africa. This work will help to inform future policies for controlling antimicrobial resistance (AMR) in the food production chain. A scoping review was conducted according to the Cochrane handbook and following PRISMA 2020 guidelines for reporting. Primary research studies published after 1999 and reporting resistance of Escherichia coli, Enterococcus spp, Staphylococcus aureus, Salmonella spp, and Campylobacter spp to HPCIAs in poultry, cattle, pigs, goats, and sheep in Africa were searched in four databases. A total of 312 articles were included in the review. The majority of the studies (40.7) were conducted in North African countries. More than 49.0% of included studies involved poultry and 26.2% cattle. Cephalosporins and quinolones were the most studied antimicrobial classes. Of the bacteria investigated in the current review, E. coli (41.7%) and Salmonella spp (24.9%) represented the most commonly studied. High levels of resistance against erythromycin in E. coli were found in poultry (MR 96.1%, IQR 83.3-100.0%), cattle (MR 85.7%, IQR 69.2-100.0%), and pigs (MR 94.0%, IQR 86.2-94.0%). In sheep, a high level of resistance was observed in E. coli against nalidixic acid (MR 87.5%, IQR 81.3-93.8%). In goats, the low level of sensibility was noted in S. aureus against streptomycin (MR 86.8%, IQR 19.4-99.0%). The study provides valuable information on HPCIAs resistance in livestock production in Africa and highlights the need for further research and policies to address the public health risk of AMR. This will likely require an investment in diagnostic infrastructure across the continent. Awareness on the harmful impact of AMR in African countries is a requirement to produce more effective and sustainable measures to curb AMR.
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Affiliation(s)
- Ronald Vougat Ngom
- School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | - Saleh M Jajere
- Faculty of Veterinary Medicine, University of Maiduguri, Borno State, Nigeria
| | - Gaspard Ja Ayissi
- School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | - Akenghe Tanyienow
- School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | - Frédéric Moffo
- School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | - Hippolyte M Watsop
- School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | - Leina M Mimboe
- School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | - Mohamed Mm Mouiche
- School of Veterinary Medicine and Sciences, University of Ngaoundéré, Ngaoundéré, Cameroon
| | | | - Luís Pedro Carmo
- Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern, Bern, Switzerland; Norwegian Veterinary Institute, Elizabeth Stephansens vei 1, Ås 1433, Norway
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Lynch I, Fluks L, Manderson L, Isaacs N, Essop R, Praphasawat R, Middleton L, Naemiratch B. Gender and equity considerations in AMR research: a systematic scoping review. Monash Bioeth Rev 2024:10.1007/s40592-024-00194-2. [PMID: 38676854 DOI: 10.1007/s40592-024-00194-2] [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] [Accepted: 03/21/2024] [Indexed: 04/29/2024]
Abstract
Research on gender and antimicrobial resistance (AMR) beyond women's biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people's diverse identities and experiences, including their gender, socio-economic status, race, disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice.
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Affiliation(s)
- Ingrid Lynch
- Human Sciences Research Council, Cape Town, South Africa
| | - Lorenza Fluks
- Human Sciences Research Council, Cape Town, South Africa
| | | | - Nazeema Isaacs
- Human Sciences Research Council, Cape Town, South Africa
| | - Roshin Essop
- Human Sciences Research Council, Cape Town, South Africa
| | - Ravikanya Praphasawat
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Lyn Middleton
- University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Bhensri Naemiratch
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Mayito J, Kibombo D, Olaro C, Nabadda S, Guma C, Nabukenya I, Busuge A, Dhikusooka F, Andema A, Mukobi P, Onyachi N, Watmon B, Obbo S, Yayi A, Elima J, Barigye C, Nyeko FJ, Mugerwa I, Sekamatte M, Bazira J, Walwema R, Lamorde M, Kakooza F, Kajumbula H. Characterization of Antibiotic Resistance in Select Tertiary Hospitals in Uganda: An Evaluation of 2020 to 2023 Routine Surveillance Data. Trop Med Infect Dis 2024; 9:77. [PMID: 38668538 PMCID: PMC11053536 DOI: 10.3390/tropicalmed9040077] [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: 01/29/2024] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial resistance (AMR) is a public health concern in Uganda. We sought to conduct an extended profiling of AMR burden at selected Ugandan tertiary hospitals. We analyzed routine surveillance data collected between October 2020 and March 2023 from 10 tertiary hospitals. The analysis was stratified according to the hospital unit, age, gender, specimen type, and time. Up to 2754 isolates were recovered, primarily from pus: 1443 (52.4%); urine: 1035 (37.6%); and blood: 245 (8.9%). Most pathogens were Staphylococcus aureus, 1020 (37%), Escherichia coli, 808 (29.3%), and Klebsiella spp., 200 (7.3%). Only 28% of Escherichia coli and 42% of the other Enterobacterales were susceptible to ceftriaxone, while only 44% of Staphylococcus aureus were susceptible to methicillin (56% were MRSA). Enterococcus spp. susceptibility to vancomycin was 72%. The 5-24-year-old had 8% lower ampicillin susceptibility than the >65-year-old, while the 25-44-year-old had 8% lower ciprofloxacin susceptibility than the >65-year-old. The 0-4-year-old had 8% higher ciprofloxacin susceptibility. Only erythromycin susceptibility varied by sex, being higher in males. Escherichia coli ciprofloxacin susceptibility in blood (57%) was higher than in urine (39%) or pus (28%), as was ceftriaxone susceptibility in blood (44%) versus urine (34%) or pus (14%). Klebsiella spp. susceptibility to ciprofloxacin and meropenem decreased by 55% and 47%, respectively, during the evaluation period. During the same period, Escherichia coli ciprofloxacin susceptibility decreased by 40%, while Staphylococcus aureus gentamicin susceptibility decreased by 37%. Resistance was high across the Access and Watch antibiotic categories, varying with time, age, sex, specimen type, and hospital unit. Effective antimicrobial stewardship targeted at the critical AMR drivers is urgently needed.
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Affiliation(s)
- Jonathan Mayito
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Daniel Kibombo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | | | | | | | - Immaculate Nabukenya
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Andrew Busuge
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Flavia Dhikusooka
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Alex Andema
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Peter Mukobi
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Nathan Onyachi
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Ben Watmon
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Stephen Obbo
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Alfred Yayi
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - James Elima
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Celestine Barigye
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Filbert J. Nyeko
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | | | | | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Richard Walwema
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Francis Kakooza
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Henry Kajumbula
- Department of Microbiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda;
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Maveke SM, Aboge GO, Kanja LW, Mainga AO, Gachau N, Muchira BW, Moriasi GA. Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamase-Producing Clinical Isolates of Escherichia coli and Klebsiella pneumoniae in Two Kenyan Facilities: A National Referral and a Level Five Hospital. Int J Microbiol 2024; 2024:7463899. [PMID: 38384586 PMCID: PMC10881238 DOI: 10.1155/2024/7463899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/10/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Background The emergence of antimicrobial resistance (AMR) and multidrug resistance (MDR) among Escherichia coli and Klebsiella pneumoniae, especially through the production of extended spectrum β-lactamases (ESBLs), limits therapeutic options and poses a significant public health threat. Objective The aim of this study was to assess the phenotypic and genetic determinants of antimicrobial resistance of ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates from patient samples in two Kenyan Hospitals. Methods We collected 138 E. coli and 127 K. pneumoniae isolates from various clinical specimens at the two health facilities from January 2020 to February 2021. The isolates' ESBL production and antibiotic susceptibility were phenotypically confirmed using a standard procedure. Molecular analysis was done through conventional polymerase chain reaction (PCR) with appropriate primers for gadA, rpoB, blaTEM, blaSHV, blaOXA, blaCTX-M-group-1, blaCTX-M-group-2, blaCTX-M-group-9, and blaCTX-M-group-8/25 genes, sequencing and BLASTn analysis. Results Most E. coli (82.6%) and K. pneumoniae (92.9%) isolates were ESBL producers, with the highest resistance was against ceftriaxone (69.6% among E. coli and 91.3% among K. pneumoniae) and amoxicillin/clavulanic acid (70.9% among K. pneumoniae). The frequency of MDR was 39.9% among E. coli and 13.4% among K. pneumoniae isolates. The commonest MDR phenotypes among the E. coli isolates were CRO-FEP-AZM-LVX and CRO-AZM-LVX, while the FOX-CRO-AMC-MI-TGC-FM, FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI and CRO-AMC-TZP-AZM-MI were the most frequent among K. pneumoniae isolates. Notably, the FOX-CRO-FEP-AMC-TZP-AZM-LVX-MI phenotype was observed in ESBL-positive and ESBL-negative K. pneumoniae isolates. The most frequent ESBL genes were blaTEM (42%), blaSHV (40.6%), and blaOXA (36.2%) among E. coli, and blaTEM (89%), blaSHV (82.7%), blaOXA (76.4%), and blaCTX-M-group-1 (72.5%) were most frequent ESBL genes among K. pneumoniae isolates. The blaSHV and blaOXA and blaTEM genotypes were predominantly associated with FOX-CRO-FEP-MEM and CRO-FEP multidrug resistance (MDR) and CRO antimicrobial resistance (AMR) phenotypes, among E. coli isolates from Embu Level V (16.7%) and Kenyatta National Hospital (7.0%), respectively. Conclusions The high proportion of ESBL-producing E. coli and K. pneumoniae isolates increases the utilization of last-resort antibiotics, jeopardizing antimicrobial chemotherapy. Furthermore, the antimicrobial resistance patterns exhibited towards extended-spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, fluoroquinolones, and macrolides show the risk of co-resistance associated with ESBL-producing isolates responsible for MDR. Hence, there is a need for regular surveillance and implementation of infection prevention and control strategies and antimicrobial stewardship programs.
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Affiliation(s)
- Sylvia M. Maveke
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Gabriel O. Aboge
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Laetitia W. Kanja
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Alfred O. Mainga
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Naftaly Gachau
- Department of Laboratory Medicine, Microbiology, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Beatrice W. Muchira
- Department of Public Health, Pharmacology, and Toxicology, University of Nairobi, P.O. Box 29053-00625, Nairobi, Kenya
| | - Gervason A. Moriasi
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, P.O. Box 43844-00100-GPO, Nairobi, Kenya
- Department of Medical Biochemistry, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
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Sartorius B, Gray AP, Davis Weaver N, Robles Aguilar G, Swetschinski LR, Ikuta KS, Mestrovic T, Chung E, Wool EE, Han C, Gershberg Hayoon A, Araki DT, Abd-Elsalam S, Aboagye RG, Adamu LH, Adepoju AV, Ahmed A, Akalu GT, Akande-Sholabi W, Amuasi JH, Amusa GA, Argaw AM, Aruleba RT, Awoke T, Ayalew MK, Azzam AY, Babin FX, Banerjee I, Basiru A, Bayileyegn NS, Belete MA, Berkley JA, Bielicki JA, Dekker D, Demeke D, Demsie DG, Dessie AM, Dunachie SJ, Ed-Dra A, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Elsohaby I, Eyre D, Fagbamigbe AF, Feasey NA, Fekadu G, Fell F, Forrest KM, Gebrehiwot M, Gezae KE, Ghazy RM, Hailegiyorgis TT, Haines-Woodhouse G, Hasaballah AI, Haselbeck AH, Hsia Y, Iradukunda A, Iregbu KC, Iwu CCD, Iwu-Jaja CJ, Iyasu AN, Jaiteh F, Jeon H, Joshua CE, Kassa GG, Katoto PDMC, Krumkamp R, Kumaran EAP, Kyu HH, Manilal A, Marks F, May J, McLaughlin SA, McManigal B, Melese A, Misgina KH, Mohamed NS, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Moore CE, Mougin V, Mturi N, Mulugeta T, Musaigwa F, Musicha P, Musila LA, Muthupandian S, Naghavi P, Negash H, Nuckchady DC, Obiero CW, Odetokun IA, Ogundijo OA, Okidi L, Okonji OC, Olagunju AT, Olufadewa II, Pak GD, Perovic O, Pollard A, Raad M, Rafaï C, Ramadan H, Redwan EMM, Roca A, Rosenthal VD, Saleh MA, Samy AM, Sharland M, Shittu A, Siddig EE, Sisay EA, Stergachis A, Tesfamariam WB, Tigoi C, Tincho MB, Tiruye TY, Umeokonkwo CD, Walsh T, Walson JL, Yusuf H, Zeru NG, Hay SI, Dolecek C, Murray CJL, Naghavi M. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. Lancet Glob Health 2024; 12:e201-e216. [PMID: 38134946 PMCID: PMC10805005 DOI: 10.1016/s2214-109x(23)00539-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. METHODS We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO African region in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). We obtained data from research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. FINDINGS In the WHO African region in 2019, there were an estimated 1·05 million deaths (95% UI 829 000-1 316 000) associated with bacterial AMR and 250 000 deaths (192 000-325 000) attributable to bacterial AMR. The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119 000 deaths [92 000-151 000], or 48% of all estimated bacterial pathogen AMR deaths), bloodstream infections (56 000 deaths [37 000-82 000], or 22%), intra-abdominal infections (26 000 deaths [17 000-39 000], or 10%), and tuberculosis (18 000 deaths [3850-39 000], or 7%). Seven leading pathogens were collectively responsible for 821 000 deaths (636 000-1 051 000) associated with resistance in this region, with four pathogens exceeding 100 000 deaths each: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Third-generation cephalosporin-resistant K pneumoniae and meticillin-resistant S aureus were shown to be the leading pathogen-drug combinations in 25 and 16 countries, respectively (53% and 34% of the whole region, comprising 47 countries) for deaths attributable to AMR. INTERPRETATION This study reveals a high level of AMR burden for several bacterial pathogens and pathogen-drug combinations in the WHO African region. The high mortality rates associated with these pathogens demonstrate an urgent need to address the burden of AMR in Africa. These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen-drug combinations. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Luedtke S, Wood C, Olufemi O, Okonji P, Kpokiri EE, Musah A, Bammeke F, Mutiu B, Ojewola R, Bankole O, Ademuyiwa A, Ekumankama C, Theophilus A, Aworabhi-Oki N, Shallcross L, Molnar A, Wiseman S, Hayward A, Birjovanu G, Lefevre C, Petrou S, Ogunsola F, Kostkova P. Gamified antimicrobial decision support app (GADSA) changes antibiotics prescription behaviour in surgeons in Nigeria: a hospital-based pilot study. Antimicrob Resist Infect Control 2023; 12:141. [PMID: 38053212 PMCID: PMC10699010 DOI: 10.1186/s13756-023-01342-9] [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: 09/08/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
AIMS Surgical Antibiotic Prophylaxis (SAP) in Nigeria is often not evidence based. The aim of this study is to test if the GADSA application can change prescription behaviour of surgeons in Nigeria. In addition, the study aims to identify AMS strategies and policies for the future. METHODS The GADSA gamified decision support app uses WHO and Sanford prescribing guidelines to deliver real-time persuasive technology feedback to surgeons through an interactive mentor. The app can advise on whether clinician's decisions align with SAP recommendations and provides the opportunity for clinicians to make adjustments. Twenty surgeons actively participated in a 6-month pilot study in three hospitals in Nigeria. The surgeons determined the risk of infection of a surgical procedure, and the need, type and duration of SAP. The study used a longitudinal approach to test whether the GADSA app significantly changed prescribing behaviour of participating surgeons by analysing the reported prescription decisions within the app. RESULTS 321 SAP prescriptions were recorded. Concerning the surgical risk decision, 12% of surgeons changed their decision to be in line with guidelines after app feedback (p < 0.001) and 10% of surgeons changed their decision about the need for SAP (p = 0.0035) to align with guidelines. The change in decision making for SAP use in terms of "type" and "duration" to align with guidelines was similar with 6% and 5% respectively (both p-values < 0.001). CONCLUSION This study suggests that the GADSA app, with its game based and feedback feature, could significantly change prescribing behaviour at the point of care in an African setting, which could help tackle the global challenge of antibiotic resistance.
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Affiliation(s)
- Susanne Luedtke
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Caroline Wood
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Olajumoke Olufemi
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patrick Okonji
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Eneyi E Kpokiri
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Anwar Musah
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Funmi Bammeke
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Bamidele Mutiu
- Department of Medical Microbiology, Lagos State University College of Medicine/Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Rufus Ojewola
- Urology Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Neurosurgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adesoji Ademuyiwa
- Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chibuzo Ekumankama
- Department of Ophthalmology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ayibanoah Theophilus
- Department of Pharmacy, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Neni Aworabhi-Oki
- Department of Surgery, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria
| | - Laura Shallcross
- Institute of Infectious Diseases Informatics, University College London, London, UK
| | - Andreea Molnar
- School of Software and Electrical Engineering, Swinburne University of Technology, Melbourne, Australia
| | - Sue Wiseman
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew Hayward
- Institute of Epidemiology and Public Health, University College London, London, UK
| | - Georgiana Birjovanu
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Carmen Lefevre
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Stylianos Petrou
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patty Kostkova
- UCL IRDR Centre for Digital Public Health in Emergencies, University College London, Gower Street, London, WC1E 6BT, UK
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Gholizadeh A, Khiadani M, Foroughi M, Alizade Siuki H, Mehrfar H. Wastewater treatment plants: The missing link in global One-Health surveillance and management of antibiotic resistance. J Infect Public Health 2023; 16 Suppl 1:217-224. [PMID: 37865529 DOI: 10.1016/j.jiph.2023.09.017] [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: 05/16/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION As a global public health crisis, antibiotic resistance (AR) should be monitored and managed under the One-Health concept according to the World Health Organization (WHO), considering the interconnection between humans, animals, and the environment. But this approach often remains focused on human health and rarely on the environment and its compartments, especially wastewater as the main AR receptor. Wastewater treatment plants (WWTPs) not only are not designed for reliving AR but also provide appropriate conditions for enhancing AR through different mechanisms. METHODS By reviewing the research-based statistics on the inclusion of WWTPs in the One-Health/AR program crisis, this paper highlights the importance of paying attention to these hotspots, at first. Also, the importance and technical roadmap for the application of WWTPs in both surveillance and management of AR were provided. The current position of these facilities was also evaluated using strengths, weaknesses, opportunities, and threats (SWOT) analysis. In the end, the concluding knowledge gaps and research needs for future investigations were presented. RESULTS Despite the fact that wastewater matrices are the hotspot for AR dissemination, WWTPs appear under-represented in One-Health/AR literature. So, of the 414434 articles retrieved for One-Health only 1.5% (n = 6321) focused on AR and about 0.04% (n = 158) on WWTPs. The potential of WWTPs inclusion in AR surveillance has been confirmed by several studies, however, when it comes to its inclusion for management of AR, more evidence should be presented, which confirmed by SWOT results. DISCUSSION As such, WWTPs simultaneously provide opportunities for AR surveillance as it is assumed that this medium can reflect the reality of the corresponding society, and for managing unexpected crises which could impact the public. Nonetheless, there are still numerous considerations to change WWTPs role from Achilles' heel to Ajax' shield, including strengthening the research-based knowledge and conducting both surveillance and management strategies of AR under One-Health concept (One-Health/AR) in a clear straightforward framework.
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Affiliation(s)
- Abdolmajid Gholizadeh
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mehdi Khiadani
- School of Engineering, Edith Cowan University, Joondalup, Perth WA, Australia
| | - Maryam Foroughi
- Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Hadi Alizade Siuki
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Hadi Mehrfar
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
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GAHIMBARE LAETITIA, MWAMELO AMBELEJUDITH, YAHYA ALIAHMED, FULLER WALTER, PADIYARA PONNU, PRAKASH PRAVARSHA, BALACHANDRAN ANAND, MAKUBALO ELIZABETHLINDIWE. Monitoring progress on Antimicrobial Resistance (AMR) response in the World Health Organization African region: Insights from the Tracking AMR Country Self-Assessment Survey (TrACSS) 2021 results for the human health sector. J Public Health Afr 2023; 14:2392. [PMID: 38500695 PMCID: PMC10946299 DOI: 10.4081/jphia.2023.2392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
Antimicrobial resistance (AMR) is a major 21st century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan on AMR (GAP). The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. Fifteen 15(37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.
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Affiliation(s)
- LAETITIA GAHIMBARE
- World Health Organization Regional office for Africa, Brazzaville, Congo
| | | | - ALI AHMED YAHYA
- World Health Organization Regional office for Africa, Brazzaville, Congo
| | - WALTER FULLER
- World Health Organization Regional office for Africa, Brazzaville, Congo
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Mathevula H, Schellack N, Orubu S, Godman B, Matlala M. Off-Label and Unlicenced Medicine Use among Hospitalised Children in South Africa: Practice and Policy Implications. PHARMACY 2023; 11:174. [PMID: 37987384 PMCID: PMC10661306 DOI: 10.3390/pharmacy11060174] [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: 09/14/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event of adverse events. This potentially exposes physicians to legal penalties. Consequently, we sought to determine the prevalence of off-label and unlicensed medicine use among paediatric patients in South Africa to provide future direction. METHODS This study retrospectively examined the use of medicine in a point-prevalence survey study (PPS) involving paediatric patients aged (0-2 years) admitted to selected public hospitals in Gauteng Province, South Africa. Data were collected per hospital over two days between February 2022 and July 2022. Demographics, duration of treatment, diagnosis, and medicines prescribed were collected from patient medical records using a mobile application. Prescribed medicines were reviewed against the medicine formularies and other databases to assess their appropriateness. RESULTS From three academic hospitals, 184 patient records were reviewed. A total of 592 medicines were dispensed, of which 379 (64.0%) were licensed and 213 (36.0%) were used off-label/unlicensed for paediatric patients 0-2 years of age. The most prevalent off-label and unlicensed medicines were multivitamins (n = 32, 15.0%) and ampicillin injections (n = 15, 7.0%). CONCLUSION The frequency of unlicensed and off-label medicine prescribing shown in this study is consistent with the literature and can be considered high. This practice can pose a risk because it adversely affects patients if not properly regulated. Attention is needed to ensure future high-quality, safe, and effective use of medicines.
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Affiliation(s)
- Hlayiseka Mathevula
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
| | - Natalie Schellack
- Department of Pharmacology, University of Pretoria, Pretoria 0084, South Africa;
| | - Samuel Orubu
- Pharmacy Department, Niger Delta University, Yenagoa P.O. BOX 72, Nigeria;
- Global Strategy Lab, York University, Toronto, ON 4700, Canada
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
| | - Moliehi Matlala
- School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria 0204, South Africa; (B.G.); (M.M.)
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Rony MKK, Sharmi PD, Alamgir HM. Addressing antimicrobial resistance in low and middle-income countries: overcoming challenges and implementing effective strategies. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:101896-101902. [PMID: 37610548 DOI: 10.1007/s11356-023-29434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Antimicrobial resistance (AMR) has become a critical worldwide health crisis. It poses major challenges for healthcare systems across the globe, demanding immediate attention and action. Low and middle-income countries (LMICs), in particular, encounter unique obstacles in addressing AMR due to various factors. This article aims to examine specific challenges and propose effective strategies to combat this issue. Through a comprehensive review of existing literature, this article identifies common barriers and successful interventions in tackling AMR. The research highlights several challenges faced by LMICs in addressing AMR, including limited access to quality healthcare services, socioeconomic disparities, limited awareness, inadequate surveillance systems and data collection, limited regulatory frameworks and quality control, as well as weak healthcare infrastructure and infection prevention practices. The research suggests strategies like improving healthcare access, promoting responsible antimicrobial use, enhancing surveillance, ensuring quality antimicrobial drugs, and fostering global collaboration to address these challenges. By understanding the challenges encountered by LMICs, it is possible to mitigate the impact of AMR and contribute to global efforts in combating this growing threat.
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Affiliation(s)
- Moustaq Karim Khan Rony
- Masters of Public Health, Bangladesh Open University, Dhaka, Bangladesh.
- University of Dhaka, Dhaka, Bangladesh.
| | - Priyanka Das Sharmi
- College of Nursing, International University of Business Agriculture and Technology, Dhaka, Bangladesh
| | - Hasnat M Alamgir
- Department of Public Health, State University of Bangladesh, Dhaka, Bangladesh
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Sono TM, Yeika E, Cook A, Kalungia A, Opanga SA, Acolatse JEE, Sefah IA, Jelić AG, Campbell S, Lorenzetti G, Ul Mustafa Z, Marković-Peković V, Kurdi A, Anand Paramadhas BD, Rwegerera GM, Amu AA, Alabi ME, Wesangula E, Oluka M, Khuluza F, Chikowe I, Fadare JO, Ogunleye OO, Kibuule D, Hango E, Schellack N, Ramdas N, Massele A, Mudenda S, Hoxha I, Moore CE, Godman B, Meyer JC. Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Rev Anti Infect Ther 2023; 21:1025-1055. [PMID: 37740561 DOI: 10.1080/14787210.2023.2259106] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.
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Affiliation(s)
- Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Eugene Yeika
- Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Bene D Anand Paramadhas
- Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- DestinyMedical and Research Solutions Proprietary Limited, Gaborone, Botswana
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
| | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Margaret Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
| | - Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, School of Veterinary Meicine, University of Zambia, Lusaka, Zambia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho HealthSciences University, Garankuwa, Pretoria, South Africa
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Saleem Z, Haseeb A, Abuhussain SSA, Moore CE, Kamran SH, Qamar MU, Azmat A, Pichierri G, Raees F, Asghar S, Saeed A, Amir A, Hashmi FK, Meyer JC, Sefah IA, Rehman IU, Nadeem MU, Godman B. Antibiotic Susceptibility Surveillance in the Punjab Province of Pakistan: Findings and Implications. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1215. [PMID: 37512028 PMCID: PMC10383515 DOI: 10.3390/medicina59071215] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR.
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Affiliation(s)
- Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm AL-Qura University, Makkah 21955, Saudi Arabia
| | | | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK
| | - Sairah Hafeez Kamran
- Institute of Pharmacy, Lahore College for Women University, Lahore 54000, Pakistan
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan
| | - Aisha Azmat
- Department of Physiology, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Giuseppe Pichierri
- Microbiology Department, Torbay and South Devon Foundation Trust, Lowes Bridge Torbay Hospital, Torquay TQ2 7AA, UK
| | - Fahad Raees
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Shahzad Asghar
- Department of Pharmacy, University of South Asia, Lahore 54000, Pakistan
| | - Amna Saeed
- Department of Pharmaceutical Sciences, Pak-Austria Fachhochschule, Institute of Applied Sciences and Technology, Haripur 22620, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National University of Medical Sciences, Rawalpindi 46000, Pakistan
- National Institute of Health, Park Road, Islamabad 45501, Pakistan
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Ho PMB 31, Ghana
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
| | - Inaam Ur Rehman
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Muhammad Umer Nadeem
- Punjab University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore 54000, Pakistan
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
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Kamere N, Rutter V, Munkombwe D, Aywak DA, Muro EP, Kaminyoghe F, Rajab K, Lawal MO, Muriithi N, Kusu N, Karimu O, Barlatt SHA, Nambatya W, Ashiru-Oredope D. Supply-chain factors and antimicrobial stewardship. Bull World Health Organ 2023; 101:403-411. [PMID: 37265674 PMCID: PMC10225941 DOI: 10.2471/blt.22.288650] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 06/03/2023] Open
Abstract
Efficient and secure supply chains are vital for effective health services worldwide. In low- and middle-income countries, the accessibility, affordability and availability of essential medicines, including antimicrobials, remain challenging. Ineffective supply chains often cause antimicrobial shortages, leading to inappropriate use of alternative agents and increasing the risk of antimicrobial resistance. Shortages, coupled with insecure supply chains, also encourage the infiltration of substandard and falsified medicines, leading to suboptimal treatment and further promoting antimicrobial resistance. Addressing antimicrobial supply-chain issues should be considered a key component of antimicrobial stewardship programmes. We have explored the link between medicine supply chains and antimicrobial use in seven focus countries: Kenya, Malawi, Nigeria, Sierra Leone, Uganda, United Republic of Tanzania and Zambia. We explored country medicine supply-system structures, national medicine supply-chain policy documents and global study reports. Our aim was to develop evidence-based strategies to enhance the effectiveness and efficiency of the medicine supply chains in supporting antimicrobial stewardship efforts. Better management of medical supply chains involves rational selection, quantification, forecasting, procurement, storage, distribution, use and stock management of antimicrobials. Important supply-chain considerations include pooled procurement networks to ensure consistent pricing of quality-assured antimicrobials, and improved resource utilization and information exchange among relevant stakeholders. We propose adaptable recommendations for integrating medicine supply chains as an essential part of antimicrobial stewardship programmes, with a call for action at the local, regional and national levels in low- and middle-income countries.
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Affiliation(s)
- Nduta Kamere
- Commonwealth Pharmacists Association, London, England
| | | | | | | | - Eva Prosper Muro
- Kilimanjaro Christian Medical University College, Kilimanjaro, United Republic of Tanzania
| | | | - Kalidi Rajab
- Makerere University Pharmacy Department, Kampala, Uganda
| | | | | | - Ndinda Kusu
- Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Nairobi, Kenya
| | - Oluwatoyin Karimu
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
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Okedo-Alex IN, Akamike IC, Iyamu I, Umeokonkwo CD. Pattern of antimicrobial prescription in Africa: a systematic review of point prevalence surveys. Pan Afr Med J 2023; 45:67. [PMID: 37637407 PMCID: PMC10460099 DOI: 10.11604/pamj.2023.45.67.36191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 04/23/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction inappropriate use of antimicrobials is a cause for concern and contributes to the global antimicrobial resistance crises especially in Africa. This review aims to summarize the available evidence on the point prevalence and pattern of antimicrobial and/or antibiotic prescription in Africa. Methods this review was carried out between April and September 2021 and identified published studies up until March 2021 on the point prevalence of antibiotic and/or antimicrobial use in Africa. Sources searched were OVID, PubMed, EMBASE, CINAHL, Web of Science, Google Scholar, Google, and African Journal Online (AJOL). Observational studies that reported prevalence published in English language were included. Covidence systematic review software was used for this review. A form for data extraction using domains culled from the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) was developed on Covidence. Screening of studies for eligibility was done independently by two reviewers. Critical Appraisal tool for use in Joanna Briggs Institute (JBI) Systematic Reviews for prevalence studies was used for quality appraisal. Results a total of 17 studies that met the inclusion criteria were included in the review. The overall prevalence of antimicrobial/antibiotic use among inpatients in these studies ranged from 40.7% to 97.6%. The median antimicrobial/antibiotic use was 61.3 [IQR= 45.5-72.1]. The highest use of antimicrobials was reported among studies from Nigeria with a prevalence of 97.6%. The most prescribed antibiotics were the beta-lactam penicillin (Amoxicillin, clavulanic acid) (86.9%), and third generation cephalosporins (55.0%). There was general preference for parenteral route of administration of the antimicrobial agents (40-70%). Use for community acquired infections (28.0-79.5%) was the main reason for use. Majority of the prophylactic use of antimicrobial agents were for surgical prophylaxis. Conclusion: the high prevalence of antimicrobial use in Africa reinforces the need for continued surveillance and concerted efforts to institutionalize and support antimicrobial stewardship for prescribers in health institutions in the African region.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Abakaliki, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Abakaliki, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Ihoghosa Iyamu
- School of Population and Public Health (SPPH), University of British Columbia, Vancouver, Canada
- Pan-African Research Consortium, Federal Capital Territory (FCT), Abuja, Nigeria
| | - Chukwuma David Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki Ebonyi State, Abakaliki, Nigeria
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Darboe S, Mirasol R, Adejuyigbe B, Muhammad AK, Nadjm B, De St. Maurice A, Dogan TL, Ceesay B, Umukoro S, Okomo U, Nwakanma D, Roca A, Secka O, Forrest K, Garner OB. Using an Antibiogram Profile to Improve Infection Control and Rational Antimicrobial Therapy in an Urban Hospital in The Gambia, Strategies and Lessons for Low- and Middle-Income Countries. Antibiotics (Basel) 2023; 12:790. [PMID: 37107152 PMCID: PMC10135392 DOI: 10.3390/antibiotics12040790] [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: 02/22/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Antimicrobial resistance is a global health threat and efforts to mitigate it is warranted, thus the need for local antibiograms to improve stewardship. This study highlights the process that was used to develop an antibiogram to monitor resistance at a secondary-level health facility to aid empirical clinical decision making in a sub-Saharan African county. This retrospective cross-sectional descriptive study used 3 years of cumulative data from January 2016 to December 2018. Phenotypic data was manually imputed into WHONET and the cumulative antibiogram constructed using standardized methodologies according to CLSI M39-A4 guidelines. Pathogens were identified by standard manual microbiological methods and antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method according to CLSI M100 guidelines. A total of 14,776 non-duplicate samples were processed of which 1163 (7.9%) were positive for clinically significant pathogens. Among the 1163 pathogens, E. coli (n = 315) S. aureus (n = 232), and K. pneumoniae (n = 96) were the leading cause of disease. Overall, the susceptibility for E. coli and K. pneumoniae from all samples were: trimethoprim-sulfamethoxazole (17% and 28%), tetracycline (26% and 33%), gentamicin (72% and 46%), chloramphenicol (76 and 60%), and ciprofloxacin (69% and 59%), and amoxicillin/clavulanic (77% and 54%) respectively. Extended spectrum beta-lactamase (ESBL) resistance was present in 23% (71/315) vs. 35% (34/96) respectively. S. aureus susceptibility for methicillin was 99%. This antibiogram has shown that improvement in combination therapy is warranted in The Gambia.
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Affiliation(s)
- Saffiatou Darboe
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Ruel Mirasol
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Babapelumi Adejuyigbe
- David Geffen School of Medicine, University of California, UCLA, Los Angeles, CA 90095, USA
| | - Abdul Khalie Muhammad
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Behzad Nadjm
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
- University College London Hospital NHS Foundation Trust, London NW1 2BU, UK
| | - Annabelle De St. Maurice
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | - Tiffany L. Dogan
- Department of Clinical Epidemiology and Infection Prevention, University of California, UCLA Health, Los Angeles, CA 90095, USA
| | - Buntung Ceesay
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Solomon Umukoro
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Uduak Okomo
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Davis Nwakanma
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Anna Roca
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Ousman Secka
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Karen Forrest
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Joshi MP, Alombah F, Konduri N, Ndiaye A, Kusu N, Kiggundu R, Lusaya EP, Tuala Tuala R, Embrey M, Hafner T, Traore O, Mbaye M, Akinola B, Namburete D, Acho A, Hema Y, Getahun W, Sayem MA, Nfor E. Moving from assessments to implementation: promising practices for strengthening multisectoral antimicrobial resistance containment capacity. ONE HEALTH OUTLOOK 2023; 5:7. [PMID: 37055845 PMCID: PMC10101730 DOI: 10.1186/s42522-023-00081-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses a global threat to human, animal, and environmental health. AMR is a technical area in the Global Health Security Agenda initiative which uses the Joint External Evaluation tool to evaluate national AMR containment capacity. This paper describes four promising practices for strengthening national antimicrobial resistance containment capacity based on the experiences of the US Agency for International Development's Medicines, Technologies, and Pharmaceutical Services Program work with 13 countries to implement their national action plans on AMR in the areas of multisectoral coordination, infection prevention and control, and antimicrobial stewardship. METHODS We use the World Health Organization (WHO) Benchmarks on International Health Regulations Capacities (2019) to guide national, subnational, and facility actions that advance Joint External Evaluation capacity levels from 1 (no capacity) to 5 (sustainable capacity). Our technical approach is based on scoping visits, baseline Joint External Evaluation scores, benchmarks tool guidance, and country resources and priorities. RESULTS We gleaned four promising practices to achieve AMR containment objectives: (1) implement appropriate actions using the WHO benchmarks tool, which prioritizes actions, making it easier for countries to incrementally increase their Joint External Evaluation capacity from level 1 to 5; (2) integrate AMR into national and global agendas. Ongoing agendas and programs at international, regional, and national levels provide opportunities to mainstream and interlink AMR containment efforts; (3) improve governance through multisectoral coordination on AMR. Strengthening multisectoral bodies' and their technical working groups' governance improved functioning, which led to better engagement with animal/agricultural sectors and a more coordinated COVID-19 pandemic response; and (4) mobilize and diversify funding for AMR containment. Long-term funding from diversified funding streams is vital for advancing and sustaining countries' Joint External Evaluation capacities. CONCLUSIONS The Global Health Security Agenda work has provided practical support to countries to frame and conduct AMR containment actions in terms of pandemic preparedness and health security. The WHO benchmarks tool that Global Health Security Agenda uses serves as a standardized organizing framework to prioritize capacity-appropriate AMR containment actions and transfer skills to help operationalize national action plans on AMR.
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Affiliation(s)
- Mohan P. Joshi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Fozo Alombah
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Niranjan Konduri
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Antoine Ndiaye
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Abidjan, Côte d’Ivoire
| | - Ndinda Kusu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Nairobi, Kenya
| | - Reuben Kiggundu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Edgar Peter Lusaya
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dar Es Salaam, Tanzania
| | - Robert Tuala Tuala
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kinshasa, Democratic Republic of the Congo
| | | | - Tamara Hafner
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Ousmane Traore
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Bamako, Mali
| | - Mame Mbaye
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dakar, Senegal
| | - Babatunde Akinola
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Abuja, Nigeria
| | - Denylson Namburete
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Maputo, Mozambique
| | - Alphonse Acho
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Yaoundé, Cameroon
| | - Yacouba Hema
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Ouagadougou, Burkina Faso
| | - Workineh Getahun
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Addis Ababa, Ethiopia
| | - Md Abu Sayem
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dhaka, Bangladesh
| | - Emmanuel Nfor
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
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Richter L, Du Plessis EM, Duvenage S, Korsten L. Prevalence of extended-spectrum β-lactamase producing Enterobacterales in Africa's water-plant-food interface: A meta-analysis (2010–2022). FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2023. [DOI: 10.3389/fsufs.2023.1106082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BackgroundMultidrug-resistant extended-spectrum β-lactamase (ESBL)-producing Enterobacterales is regarded as a critical health issue, yet, surveillance in the water-plant-food interface remains low, especially in Africa.ObjectivesThe objective of the study was to elucidate the distribution and prevalence of antimicrobial resistance in clinically significant members of the Enterobacterales order isolated from the water-plant-food interface in Africa.MethodsA literature search was conducted using six online databases according to the PRISMA guidelines. All available published studies involving phenotypic and genotypic characterization of ESBL-producing Enterobacterales from water, fresh produce or soil in Africa were considered eligible. Identification and characterization methods used as well as a network analysis according to the isolation source and publication year were summarized. Analysis of Escherichia coli, Salmonella spp. and Klebsiella pneumoniae included the calculation of the multiple antibiotic resistance (MAR) index according to isolation sources and statistical analysis was performed using RStudio.ResultsOverall, 51 studies were included for further investigation. Twelve African countries were represented, with environmental AMR surveillance studies predominantly conducted in South Africa. In 76.47% of the studies, occurrence of antimicrobial resistant bacteria was investigated in irrigation water samples, while 50.98% of the studies included fresh produce samples. Analysis of bacterial phenotypic antimicrobial resistance profiles were reported in 94.12% of the studies, with the disk diffusion method predominantly used. When investigating the MAR indexes of the characterized Escherichia coli, Klebsiella pneumoniae and Salmonella spp., from different sources (water, fresh produce or soil), no significant differences were seen across the countries. The only genetic determinant identified using PCR detection in all the studies was the blaCTX − M resistance gene. Only four studies used whole genome sequence analysis for molecular isolate characterization.DiscussionGlobally, AMR surveillance programmes recognize ESBL- and carbapenemase-producing Enterobacterales as vectors of great importance in AMR gene dissemination. However, in low- and middle-income countries, such as those in Africa, challenges to implementing effective and sustainable AMR surveillance programmes remain. This review emphasizes the need for improved surveillance, standardized methods and documentation of resistance gene dissemination across the farm-to-fork continuum in Africa.
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Lingani M, Zango SH, Valéa I, Samadoulougou S, Somé G, Sanou M, Kaboré B, Rouamba T, Sorgho H, Tahita MC, Derra K, Dramaix M, Tinto H, Donnen P, Robert A. Effects of maternal antenatal treatment with two doses of azithromycin added to monthly sulfadoxine-pyrimethamine for the prevention of low birth weight in Burkina Faso: an open-label randomized controlled trial. Malar J 2023; 22:101. [PMID: 36932435 PMCID: PMC10024378 DOI: 10.1186/s12936-023-04530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Exposure during pregnancy to malaria and sexually-transmitted infections is associated with adverse birth outcomes including low birth weight (LBW). This study aimed at assessing if the adjunction of two doses of azithromycin to sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy can reduce LBW. METHODS A two parallel-groups, open-label randomized controlled trial involving pregnant women (16 to 35 years of age and 12 to 24 weeks of gestation as confirmed by last menstrual period or fundal height) was conducted in rural Burkina Faso. Women were assigned in a 1:1 ratio either to use azithromycin (1 g daily for 2 days) during the second and third trimesters of pregnancy plus monthly sulfadoxine-pyrimethamine (1500/75 mg) (SPAZ) (intervention) or to continue using a monthly sulfadoxine-pyrimethamine (1500/75 mg) (SP) (control). Primary outcome was a LBW (birth weight measured within 24 h after birth < 2500 g). Secondary outcomes including stillbirth, preterm birth or miscarriage are reported together with safety data. RESULTS A total of 992 pregnant women underwent randomization (496 per group) and 898 (90.5%) valid birth weights were available (450 in SPAZ and 448 in SP). LBW incidence was 8.7% (39/450) in SPAZ and 9.4% (42/448) in controls (p-value = 0.79). Compared with controls, pregnant women with SPAZ showed a risk ratio (RR) of 1.16 (95% confidence interval (CI 0.64-2.08]) for preterm births, 0.75 (95% CI 0.17-3.35) for miscarriage and 0.64 (95% CI 0.25-1.64) for stillbirths. No treatment-related serious adverse events (SAEs) have been observed, and there was no significant difference in the number of SAEs (13.5% [67/496] in SPAZ, 16.7% [83/496] in SP, p-value = 0.18) or AEs (17.1% [85/496] in SPAZ, 18.8% [93/496] in SP, p-value = 0.56). CONCLUSION Adequate prevention regimen with monthly sulfadoxine-pyrimethamine given to all pregnant women has been proved to reduce the risk of LBW in malaria endemic areas. Adding azithromycin to the regimen does not offer further benefits, as far as women receive a malaria prevention regimen early enough during pregnancy. Trial registration Pan African Clinical Trial Registry ( https://pactr.samrc.ac.za/Search.aspx ): PACTR201808177464681. Registered 21 August 2018.
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Affiliation(s)
- Moussa Lingani
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso.
- École de Santé Publique, Université Libre de Bruxelles. CP594, Route de Lennik 808, 1070, Brussels, Belgique.
| | - Serge H Zango
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Innocent Valéa
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Sékou Samadoulougou
- Evaluation Platform On Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec City, QC, G1V 4G5, Canada
| | - Georges Somé
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Maïmouna Sanou
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Berenger Kaboré
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Herman Sorgho
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Marc C Tahita
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Karim Derra
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Michèle Dramaix
- École de Santé Publique, Université Libre de Bruxelles. CP594, Route de Lennik 808, 1070, Brussels, Belgique
| | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé/Direction Régionale du Centre Ouest (IRSS/DRCO), BP 18, Nanoro, Burkina Faso
| | - Philippe Donnen
- École de Santé Publique, Université Libre de Bruxelles. CP594, Route de Lennik 808, 1070, Brussels, Belgique
| | - Annie Robert
- Epidemiology and Biostatistics Research Division, Institut de Recherche Expérimentale Et Clinique, Université Catholique de Louvain, Brussels B1.30.13, Clos Chapelle-Aux-Champs 30, B-1200, Brussels, Belgique
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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; 12:149. [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
| | - 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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Francis F, Robertson RC, Bwakura-Dangarembizi M, Prendergast AJ, Manges AR. Antibiotic use and resistance in children with severe acute malnutrition and human immunodeficiency virus infection. Int J Antimicrob Agents 2023; 61:106690. [PMID: 36372343 DOI: 10.1016/j.ijantimicag.2022.106690] [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: 04/07/2022] [Revised: 10/12/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
Severe acute malnutrition (SAM) and human immunodeficiency virus (HIV) infection underlie a major proportion of the childhood disease burden in low- and middle-income countries. These diseases commonly co-occur and lead to higher risk of other endemic infectious diseases, thereby compounding the risk of mortality and morbidity. The widespread use of antibiotics as treatment and prophylaxis in childhood SAM and HIV infections, respectively, has reduced mortality and morbidity but canlead to increasing antibiotic resistance. Development of antibiotic resistance could render future infections untreatable. This review summarises the endemic co-occurrence of undernutrition, particularly SAM, and HIV in children, and current treatment practices, specifically WHO-recommended antibiotic usage. The risks and benefits of antibiotic treatment, prophylaxis and resistance are reviewed in the context of patients with SAM and HIV and associated sub-populations. Finally, the review highlights possible research areas and populations where antibiotic resistance progression can be studied to best address concerns associated with the future impact of resistance. Current antibiotic usage is lifesaving in complicated SAM and HIV-infected populations; nevertheless, increasing baseline resistance and infection remain a significant concern. In conclusion, antibiotic usage currently addresses the immediate needs of children in SAM and HIV endemic regions; however, it is prudent to evaluate the impact of antibiotic use on resistance dynamics and long-term child health.
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Affiliation(s)
- Freddy Francis
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | | | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, U.K; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe..
| | - Amee R Manges
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.
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Samuel M, Fredrick Wabwire T, Tumwine G, Waiswa P. Antimicrobial Usage by Small-Scale Commercial Poultry Farmers in Mid-Western District of Masindi Uganda: Patterns, Public Health Implications, and Antimicrobial Resistance of E. coli. Vet Med Int 2023; 2023:6644271. [PMID: 37122610 PMCID: PMC10139818 DOI: 10.1155/2023/6644271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Poultry production in Uganda is growing at a fast rate due to increasing demand, notwithstanding, poor husbandry practices, and diseases, prompting farmers to rear healthy productive flocks with antimicrobials. The study evaluated the knowledge and practices as regards the use of antibiotics among poultry farmers in Masindi district and determined the antibiotic susceptibility profiles of E. coli strains from chickens. Methods A cross-sectional study using a closed-end questionnaire was conducted in 140 selected small-scale commercial poultry farms in Masindi district between June and December, 2020. Analyzed qualitative data were presented as frequencies, percentages, and their 95% confidence intervals (95% CI). Fecal swabs from chickens were inoculated onto a MacConkey agar, and E. coli was confirmed by standard biochemical tests. Antimicrobial susceptibility was determined by the disk diffusion method for 7 antibiotics. Results Most farmers (74%) used antibiotics, mainly tetracycline (51.4%) and sulfonamides (28.6%), given to the chicks (45%), for both curative and prophylaxis purposes (80%), and via drinking water (67%). Farmers mainly used antibiotics recommended by the veterinarian (76.4%), more than relying on experience (10.7%), while 45% were involved in self-medicating the birds. On choosing the correct dosage, 45.7% read the instruction, and 42.9% consulted a veterinarian. Only 10.7% observed the drug withdrawal period, while 53.6% consumed eggs at home or sold eggs (35.7%) from birds under treatment. Of the 200 E. coli strains, 90 (45.0%) were resistant to one drug, 74 (37.0%) to two, and multidrug resistance to three classes of antibiotics was 36 (18.0%). Overall, E. coli resistance to tetracycline was (69.0%), ampicillin (37.0%), sulfonamides (36.0%), and to kanamycin (1.5%). Conclusions The small-scale poultry farmers frequently use antimicrobial drugs, mainly tetracycline and sulfonamides for curative and prophylaxis. Thus, enforcing measures against antibiotic use supported by a strong veterinary service sector and farmers' training on judicious use of antimicrobials are needed.
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Affiliation(s)
- Majalija Samuel
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Tony Fredrick Wabwire
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Gabriel Tumwine
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Peter Waiswa
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
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Gulumbe BH, Haruna UA, Almazan J, Ibrahim IH, Faggo AA, Bazata AY. Combating the menace of antimicrobial resistance in Africa: a review on stewardship, surveillance and diagnostic strategies. Biol Proced Online 2022; 24:19. [PMID: 36424530 PMCID: PMC9685880 DOI: 10.1186/s12575-022-00182-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
The emergence of antibiotic-resistant pathogens has threatened not only our ability to deal with common infectious diseases but also the management of life-threatening complications. Antimicrobial resistance (AMR) remains a significant threat in both industrialized and developing countries alike. In Africa, though, poor clinical care, indiscriminate antibiotic use, lack of robust AMR surveillance programs, lack of proper regulations and the burden of communicable diseases are factors aggravating the problem of AMR. In order to effectively address the challenge of AMR, antimicrobial stewardship programs, solid AMR surveillance systems to monitor the trend of resistance, as well as robust, affordable and rapid diagnostic tools which generate data that informs decision-making, have been demonstrated to be effective. However, we have identified a significant knowledge gap in the area of the application of fast and affordable diagnostic tools, surveillance, and stewardship programs in Africa. Therefore, we set out to provide up-to-date information in these areas. We discussed available hospital-based stewardship initiatives in addition to the role of governmental and non-governmental organizations. Finally, we have reviewed the application of various phenotypic and molecular AMR detection tools in both research and routine laboratory settings in Africa, deployment challenges and the efficiency of these methods.
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Affiliation(s)
- Bashar Haruna Gulumbe
- Department of Microbiology, Federal University Birnin Kebbi, Kalgo, Kebbi State, Nigeria.
| | - Usman Abubakar Haruna
- Department of Medicine, Nazarbayev University School Medicine, Nursultan, Kazakhstan
- Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Joseph Almazan
- Department of Medicine, Nazarbayev University School Medicine, Nursultan, Kazakhstan
| | - Ibrahim Haruna Ibrahim
- Research Center for Cancer Biology, Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung City, 406040, Taiwan
| | | | - Abbas Yusuf Bazata
- Department of Microbiology, Federal University Birnin Kebbi, Kalgo, Kebbi State, Nigeria
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Antibiotic-Resistant Bacteria and Resistance Genes in Isolates from Ghanaian Drinking Water Sources. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:2850165. [PMID: 36246472 PMCID: PMC9560817 DOI: 10.1155/2022/2850165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/04/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022]
Abstract
The control of infectious diseases is seriously threatened by the increase in the number of microorganisms resistant to antimicrobial agents. Antibiotic-resistant bacteria have also been identified in the water environment. A field study was performed sampling drinking water sources in seven districts of southern Ghana targeting boreholes, dams, hand-dug wells, and streams during baseflow conditions. Bacteria were isolated (N = 110) from a total of 67 water samples to investigate their antimicrobial susceptibility and to determine their carriage of select antibiotic resistance genes. Bacterial identification was performed using conventional selective media methods and the analytical profile index (API) method. Antibiotic susceptibility tests were carried out using the Kirby–Bauer method. Results indicated that all water sources tested were of poor quality based on the presence of fecal indicator organisms. The most commonly occurring bacterium isolated from water was Klebsiella spp. (N = 24, 21.8%), followed by E. coli (N = 23, 20.9%). Gram-negative bacteria isolates were most commonly resistant to cefuroxime (24.5%), while the Gram-positives were most commonly resistant to meropenem (21.3%). The highest rates of bacterial resistances to more than one antibiotic were observed in Klebsiella spp. (30.0%) followed by E. coli (27.8%). PCR was used to detect the presence of a select antibiotic resistance genes in the Gram-negative isolates. The presence of blaNDM-1, sull, tet(O), and tet(W) were observed in isolates from all water sources. In contrast, ermF was not detected in any of the Gram-negative isolates from any water source. Most (28.7%) of the resistance genes were observed in E. coli isolates. Reducing microbial contamination of the various water sources is needed to protect public health and to ensure the sustainability of this resource. This further calls for education of the citizenry.
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Scoping Review of National Antimicrobial Stewardship Activities in Eight African Countries and Adaptable Recommendations. Antibiotics (Basel) 2022; 11:antibiotics11091149. [PMID: 36139929 PMCID: PMC9495160 DOI: 10.3390/antibiotics11091149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global health problem threatening safe, effective healthcare delivery in all countries and settings. The ability of microorganisms to become resistant to the effects of antimicrobials is an inevitable evolutionary process. The misuse and overuse of antimicrobial agents have increased the importance of a global focus on antimicrobial stewardship (AMS). This review provides insight into the current AMS landscape and identifies contemporary actors and initiatives related to AMS projects in eight African countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia), which form a network of countries participating in the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme. We focus on common themes across the eight countries, including the current status of AMR, infection prevention and control, AMR implementation strategies, AMS, antimicrobial surveillance, antimicrobial use, antimicrobial consumption surveillance, a one health approach, digital health, pre-service and in-service AMR and AMS training, access to and supply of medicines, and the impact of COVID-19. Recommendations suitable for adaptation are presented, including the development of a national AMS strategy and incorporation of AMS in pharmacists’ and other healthcare professionals’ curricula for pre-service and in-service training.
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Anning AS, Baah E, Buabeng SD, Baiden BG, Aboagye B, Opoku YK, Afutu LL, Ghartey-Kwansah G. Prevalence and antimicrobial resistance patterns of microbes isolated from individuals attending private diagnostic centre in Cape Coast Metropolis of Ghana. Sci Rep 2022; 12:14282. [PMID: 35995932 PMCID: PMC9395395 DOI: 10.1038/s41598-022-18595-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
The evidence of rising numbers of multidrug-resistant organisms requires the implementation of effective stewardship programs. However, this should be informed by evidence-based knowledge of local antimicrobial resistance patterns. The current study aims to establish the prevalence of common pathogenic microbes including their antimicrobial susceptibility patterns and distribution in the Cape Coast Metropolis. This was a retrospective study where microbial culture and antimicrobial susceptibility records for 331 patients were reviewed from January to December 2019, at a private health centre. All data were analysed using Excel (Microsoft Office, USA), SPSS and GraphPad Prism 8 software programs. Among the samples tested, 125 (37.76%) were positive for microbes with high vaginal swab (HVS) samples recording the highest number of pathogens (44%), followed by urine (40%) and both pleural and semen samples having the least (0.3% each). Again, gram-negative isolates were more prevalent than the gram-positive isolates. The prevalence of antimicrobial resistance was very significant with isolates resistant to more than one antibiotic (P < 0.05). Escherichia coli showed the highest level of resistance, followed by Citrobacter spp. These were followed by Klebsiella spp., Staphylococcus spp., Coliforms, Pseudomonas spp., Commensals and Candida spp. The high resistance pattern suggests an inevitable catastrophe requiring continuous monitoring and implementation of effective antibiotic stewardship.
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Affiliation(s)
- Alberta Serwah Anning
- Department of Biomedical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Emmanuel Baah
- Department of Biomedical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Suzzana Dickson Buabeng
- Department of Biomedical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Bernice Gloria Baiden
- Department of Biomedical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Benjamin Aboagye
- Department of Forensic Sciences, College of Agricultural and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Yeboah Kwaku Opoku
- Department of Biology Education, University of Education, Winneba, Ghana
| | | | - George Ghartey-Kwansah
- Department of Biomedical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
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Siachalinga L, Mufwambi W, Lee LH. Impact of Antimicrobial Stewardship Interventions to Improve Antibiotic Prescribing for Hospital Inpatients in Africa: A Systematic Review and Meta-analysis. J Hosp Infect 2022; 129:124-143. [PMID: 35970382 DOI: 10.1016/j.jhin.2022.07.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) interventions to improve antibiotic use are being implemented in Africa, but their impact is not fully known. AIM To estimate the effectiveness of interventions to improve antibiotic prescribing for hospital inpatients. METHODS Systematically searched for studies from PubMed, Embase, African Journals online and Google scholar from January 2010 to July 2022. Studies were included if they reported the impact of AMS interventions on outcomes of interest for hospital inpatients in Africa. Risk of bias was evaluated using the Cochrane Effective Practice and Organization of Care guidelines and the National Heart, Lung and Blood Institute tool. Findings were summarized in tables and meta-analyses were performed using random-effects models. FINDINGS Twenty-eight studies were included, 89% being uncontrolled before and after studies. Most interventions employed were multifaceted and found to be effective, evidenced by increased compliance, reduction in antibiotic utilization and cost, and slight reduction or no difference in mortality and length of hospital stay (LOS). Meta-analysis generated a relative risk of 0.82 (95% CI: 0.70∼0.97) for mortality, and a standard mean difference of -0.30 (95% CI: -0.41∼-0.19) for LOS. Generally, a decrease in resistance to most microorganisms was observed. Despite an increase in the number of AMS studies conducted in Africa, the studies lack in most quality design features for AMS studies. CONCLUSION Antimicrobial stewardship interventions are likely to be effective, however efforts are still required to align the study design with the quality design features required for validity and to inform practice.
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Affiliation(s)
- Linda Siachalinga
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, 50110, Zambia
| | - Lyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
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Godman B, Egwuenu A, Wesangula E, Schellack N, Kalungia AC, Tiroyakgosi C, Kgatlwane J, Mwita JC, Patrick O, Niba LL, Amu AA, Oguntade RT, Alabi ME, Ncube NBQ, Sefah IA, Acolatse J, Incoom R, Guantai AN, Oluka M, Opanga S, Chikowe I, Khuluza F, Chiumia FK, Jana CE, Kalemeera F, Hango E, Fadare J, Ogunleye OO, Ebruke BE, Meyer JC, Massele A, Malande OO, Kibuule D, Kapona O, Zaranyika T, Bwakura-Dangarembizi M, Kujinga T, Saleem Z, Kurdi A, Shahwan M, Jairoun AA, Wale J, Brink AJ. Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future. Expert Opin Drug Saf 2022; 21:1089-1111. [PMID: 35876080 DOI: 10.1080/14740338.2022.2106368] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a concern as this increases morbidity, mortality, and costs, with sub-Saharan Africa having the highest rates globally. Concerns with rising AMR have resulted in international, Pan-African, and country activities including the development of national action plans (NAPs). However, there is variable implementation across Africa with key challenges persisting. AREAS COVERED Consequently, there is an urgent need to document current NAP activities and challenges across sub-Saharan Africa to provide future guidance. This builds on a narrative review of the literature. EXPERT OPINION All surveyed sub-Saharan African countries have developed their NAPs; however, there is variable implementation. Countries including Botswana and Namibia are yet to officially launch their NAPs with Eswatini only recently launching its NAP. Cameroon is further ahead with its NAP than these countries; though there are concerns with implementation. South Africa appears to have made the greatest strides with implementing its NAP including regular monitoring of activities and instigation of antimicrobial stewardship programs. Key challenges remain across Africa. These include available personnel, expertise, capacity, and resources to undertake agreed NAP activities including active surveillance, lack of focal points to drive NAPs, and competing demands and priorities including among donors. These challenges are being addressed, with further co-ordinated efforts needed to reduce AMR.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Abiodun Egwuenu
- AMR Programme, Nigeria Centre for Disease Control, Jabi, Abuja, Nigeria
| | - Evelyn Wesangula
- Patient and Health Workers Safety Division, AMR Focal Point, Ministry of Health, Nairobi, Kenya
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | - Joyce Kgatlwane
- Department of Pharmacy, University of Botswana, Gaborone, Botswana
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Okwen Patrick
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon, Africa
- Department of Public Health, University of Bamenda, Bambili, Cameroon
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Eswatini
| | | | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Nondumiso B Q Ncube
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Israel Abebrese Sefah
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana
| | - Anastasia Nkatha Guantai
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis K Chiumia
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Collins Edward Jana
- Division of Biochemistry, Biomedical Sciences Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Ester Hango
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Bernard E Ebruke
- International Foundation Against Infectious Disease in Nigeria (IFAIN), Abuja, Nigeria
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Oliver Ombeva Malande
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Child Health and Paediatrics, Egerton University, Nakuru, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Tororo, Uganda
| | | | - Trust Zaranyika
- Department Of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Amanj Kurdi
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Iraq
| | - Moyad Shahwan
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- College of Pharmacy and Health Science, Ajman University, Ajman, United Arab Emirates
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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Closing the GAP in Antimicrobial Resistance Policy in Benin and Burkina Faso. mSystems 2022; 7:e0015022. [PMID: 35894597 PMCID: PMC9426606 DOI: 10.1128/msystems.00150-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global concern that is geographically unevenly distributed, with low- and middle-income countries and African countries suffering in particular. The World Health Organization (WHO) Global Action Plan (GAP) for antimicrobial resistance identified five key objectives that aim to ensure the continued treatment and prevention of infectious diseases with the use of antibiotics. Countries signatory to the WHO GAP are expected to develop their own national action plans (NAPs) based on the global model. How low-income countries are able to achieve the GAP objectives is not well understood. This paper analyzes the progress of two West African countries in achieving the GAP targets, Benin and Burkina Faso, countries among the lowest bracket in the World Development Index. We present qualitative data from interviews and focus group discussions with local policy-makers, nurses, doctors, animal breeders, veterinarians, and laboratory researchers, supported by participant observations and surveys within rural communities. The analysis is organized according to the five WHO GAP objectives to show the countries’ challenges in fulfilling them. The analysis shows that there are shortcomings in all of the WHO GAP areas in the two countries, making it a compounded and multifactorial problem—a stacking of lacks. In such contexts, calibrating a society toward AMR resilience/prevention requires overall development and attention to interdependencies. Active local research and policy communities with international, sustained financial support are essential for achieving the targets. IMPORTANCE The burden of antimicrobial resistance (AMR) is unequally distributed across the globe. Low-income countries face a more severe AMR situation and have fewer means to solve the problem. This paper brings out the voices of local experts, policy-makers, and members of the community in Benin and Burkina Faso across human health, animal health, and food production sectors, where the majority of antibiotic use is concentrated. We describe the difficulties that they face in implementing global action plans, targets set by the World Health Organization, for securing antibiotics and preventing the spread of antimicrobial resistance. This paper argues that the various deficits in implementation are stacked, multisectoral, and compounded. We highlight the role of active local scientists and policy-maker networks in setting priorities to address the AMR problem; however, their activities need technical and financial support from international partners.
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Kariuki S, Kering K, Wairimu C, Onsare R, Mbae C. Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now? Infect Drug Resist 2022; 15:3589-3609. [PMID: 35837538 PMCID: PMC9273632 DOI: 10.2147/idr.s342753] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/16/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction Although antimicrobials have traditionally been used to treat infections and improve health outcomes, resistance to commonly used antimicrobials has posed a major challenge. An estimated 700,000 deaths occur globally every year as a result of infections caused by antimicrobial-resistant pathogens. Antimicrobial resistance (AMR) also contributes directly to the decline in the global economy. In 2019, sub-Saharan Africa (SSA) had the highest mortality rate (23.5 deaths per 100,000) attributable to AMR compared to other regions. Methods We searched PubMed for articles relevant to AMR in pathogens in the WHO-GLASS list and in other infections of local importance in SSA. In this review, we focused on AMR rates and surveillance of AMR for these priority pathogens and some of the most encountered pathogens of public health significance. In addition, we reviewed the implementation of national action plans to mitigate against AMR in countries in SSA. Results and Discussion The SSA region is disproportionately affected by AMR, in part owing to the prevailing high levels of poverty, which result in a high burden of infectious diseases, poor regulation of antimicrobial use, and a lack of alternatives to ineffective antimicrobials. The global action plan as a strategy for prevention and combating AMR has been adopted by most countries, but fewer countries are able to fully implement country-specific action plans, and several challenges exist in many settings. Conclusion A concerted One Health approach will be required to ramp up implementation of action plans in the region. In addition to AMR surveillance, effective implementation of infection prevention and control, water, sanitation, and hygiene, and antimicrobial stewardship programs will be key cost-effective strategies in helping to tackle AMR.
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Affiliation(s)
- Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya,Correspondence: Samuel Kariuki, Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya, Email
| | - Kelvin Kering
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Celestine Wairimu
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Onsare
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cecilia Mbae
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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Rostamian M, Chegene Lorestani R, Jafari S, Mansouri R, Rezaeian S, Ghadiri K, Akya A. A systematic review and meta-analysis on the antibiotic resistance of Neisseria meningitidis in the last 20 years in the world. Indian J Med Microbiol 2022; 40:323-329. [PMID: 35654713 DOI: 10.1016/j.ijmmb.2022.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/30/2022] [Accepted: 05/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Neisseria meningitidis is one of the most important causes of meningitis and pathogens-associated deaths in developing and developed countries. Effective anti-microbial agents are pivotal to treat and control N. meningitidis infections. The aim of the present study was to systematically review published studies on the antibiotic resistance of N. meningitidis in the last 20 years (2000-2020) in the world. METHODS Published researches were identified through a literature search using reputable databases including PubMed, Scopus, and Web of Science. Finally, 24 studies were included for a random-effects model meta-analysis. RESULTS The overall resistance to most commonly used antibiotics such as ceftriaxone, cefotaxime, ciprofloxacin and rifampin was low, ranging from 1 to 3.4%. However, non-sensitivity to penicillin, as the first-line antibiotic against N. meningitidis, was higher (27.2%). Altogether, the resistance to the first-line antibiotics (except penicillin) is still low indicating these drugs are effective against meningococcal meningitis. We also found a significant gap between MIC and disk diffusion for evaluating resistance to antibiotics in which disk diffusion overestimate the resistance rate. CONCLUSIONS To properly management and prevent the spread of N. miningitidis isolates resistant antibiotics, it is necessary to monitor the pattern of antibiotic susceptibility regionally and globally using the MIC methods.
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Affiliation(s)
- Mosayeb Rostamian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Chegene Lorestani
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Somayeh Jafari
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rezvan Mansouri
- Student Research Committee and Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Keyghobad Ghadiri
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Alisha Akya
- Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Salamandane A, Malfeito-Ferreira M, Brito L. A high level of antibiotic resistance in Klebsiella and Aeromonas isolates from street water sold in Mozambique, associated with the prevalence of extended-spectrum and AmpC ß-lactamases. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART. B, PESTICIDES, FOOD CONTAMINANTS, AND AGRICULTURAL WASTES 2022; 57:561-567. [PMID: 35603723 DOI: 10.1080/03601234.2022.2078627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study aims to evaluate the resistance profile and the prevalence of antibiotic resistance genes in 30 isolates of Klebsiella spp. and Aeromonas spp. recovered from water sold in the streets of Maputo. Susceptibility profiles to 15 antibiotics were performed according to Clinical Laboratory Standard Institute guidelines with antibiotic disks on Mueller-Hinton agar plates. Multiplex PCRs were performed targeting 10 ß-lactamase genes, five ESBL (blaTEM-variants, blaOXA-variants, BlaSHV-variants, MCTX-M Group 1 and Group 9 variants) and five AmpC (ACC variants, FOX variants, MOX variants, CIT variants and DHA variants). The results showed a high prevalence of Klebsiella resistance to ß-lactam antibiotics, such as amoxicillin/clavulanic acid (62.5%), amoxicillin (56.3%), ampicillin (50%), cefoxitin (43.8%), and cefotaxime (43.8%). Aeromonas showed resistance to cefoxitin and ampicillin (71.4%), amoxicillin/clavulanic acid (57.1%) and imipenem (42.9%). ESBL blaOXA-variants, blaSVH-variants, MCTX-M Group 1 variants, and MCTX-M Group 9 variants were the most prevalent b-lactam genes, followed by the b-lactams AmpC, ACC variants and FOX variants. It is extremely important to improve waterborne disease control strategies, especially in terms of public awareness of the potential health implications of multidrug-resistant strains of Klebsiella and Aeromonas, which are often neglected.
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Affiliation(s)
- Acácio Salamandane
- LEAF - Linking Landscape, Environment, Agriculture and Food Research Centre, Associated Laboratory TERRA, Instituto Superior de Agronomia, Universidade de Lisboa, Lisboa, Portugal
- Faculdade de Ciências de Saúde, Universidade Lúrio, Nampula, Mozambique
| | - Manuel Malfeito-Ferreira
- LEAF - Linking Landscape, Environment, Agriculture and Food Research Centre, Associated Laboratory TERRA, Instituto Superior de Agronomia, Universidade de Lisboa, Lisboa, Portugal
| | - Luísa Brito
- Faculdade de Ciências de Saúde, Universidade Lúrio, Nampula, Mozambique
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Rodríguez-Molina D, Berglund F, Blaak H, Flach CF, Kemper M, Marutescu L, Pircalabioru Gradisteanu G, Popa M, Spießberger B, Wengenroth L, Chifiriuc MC, Larsson DGJ, Nowak D, Radon K, de Roda Husman AM, Wieser A, Schmitt H. International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals—The AWARE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084758. [PMID: 35457624 PMCID: PMC9029788 DOI: 10.3390/ijerph19084758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 02/06/2023]
Abstract
Antibiotic resistance (AR) is currently a major threat to global health, calling for a One Health approach to be properly understood, monitored, tackled, and managed. Potential risk factors for AR are often studied in specific high-risk populations, but are still poorly understood in the general population. Our aim was to explore, describe, and characterize potential risk factors for carriage of Extended-Spectrum Beta-Lactamase-resistant Escherichia coli (ESBL-EC) in a large sample of European individuals aged between 16 and 67 years recruited from the general population in Southern Germany, the Netherlands, and Romania. Questionnaire and stool sample collection for this cross-sectional study took place from September 2018 to March 2020. Selected cultures of participants’ stool samples were analyzed for detection of ESBL-EC. A total of 1183 participants were included in the analyses: 333 from Germany, 689 from the Netherlands, and 161 from Romania. Travels to Northern Africa (adjusted Odds Ratio, aOR 4.03, 95% Confidence Interval, CI 1.67–9.68), Sub-Saharan Africa (aOR 4.60, 95% CI 1.60–13.26), and Asia (aOR 4.08, 95% CI 1.97–8.43) were identified as independent risk factors for carriage of ESBL-EC. Therefore, travel to these regions should continue to be routinely asked about by clinical practitioners as possible risk factors when considering antibiotic therapy.
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Affiliation(s)
- Daloha Rodríguez-Molina
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (L.W.); (D.N.); (K.R.)
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, LMU Munich, 81377 Munich, Germany
- Pettenkofer School of Public Health, 81377 Munich, Germany
- Correspondence: ; Tel.: +49-(89)-4400-52358; Fax: +49-(89)-4400-54954
| | - Fanny Berglund
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (F.B.); (C.-F.F.); (D.G.J.L.)
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
| | - Hetty Blaak
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands; (H.B.); (M.K.); (A.M.d.R.H.); (H.S.)
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (F.B.); (C.-F.F.); (D.G.J.L.)
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
| | - Merel Kemper
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands; (H.B.); (M.K.); (A.M.d.R.H.); (H.S.)
| | - Luminita Marutescu
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, 050657 Bucharest, Romania; (L.M.); (G.P.G.); (M.P.); (M.C.C.)
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, 030018 Bucharest, Romania
| | - Gratiela Pircalabioru Gradisteanu
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, 050657 Bucharest, Romania; (L.M.); (G.P.G.); (M.P.); (M.C.C.)
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, 030018 Bucharest, Romania
| | - Marcela Popa
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, 050657 Bucharest, Romania; (L.M.); (G.P.G.); (M.P.); (M.C.C.)
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, 030018 Bucharest, Romania
| | - Beate Spießberger
- German Centre for Infection Research (DZIF), Partner Site Munich, 80336 Munich, Germany; (B.S.); (A.W.)
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, 81377 Munich, Germany
- Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, 80802 Munich, Germany
| | - Laura Wengenroth
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (L.W.); (D.N.); (K.R.)
| | - Mariana Carmen Chifiriuc
- Department of Microbiology and Immunology, Faculty of Biology, University of Bucharest and the Academy of Romanian Scientists, 050657 Bucharest, Romania; (L.M.); (G.P.G.); (M.P.); (M.C.C.)
- Earth, Environmental and Life Sciences Section, Research Institute of the University of Bucharest, University of Bucharest, 030018 Bucharest, Romania
| | - D. G. Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (F.B.); (C.-F.F.); (D.G.J.L.)
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, 40530 Gothenburg, Sweden
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (L.W.); (D.N.); (K.R.)
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), 80336 Munich, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (L.W.); (D.N.); (K.R.)
| | - Ana Maria de Roda Husman
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands; (H.B.); (M.K.); (A.M.d.R.H.); (H.S.)
| | - Andreas Wieser
- German Centre for Infection Research (DZIF), Partner Site Munich, 80336 Munich, Germany; (B.S.); (A.W.)
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, 81377 Munich, Germany
- Department of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, 80802 Munich, Germany
| | - Heike Schmitt
- Centre of Infectious Disease Control, National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands; (H.B.); (M.K.); (A.M.d.R.H.); (H.S.)
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Fujita AW, Werner K, Jacob JT, Tschopp R, Mamo G, Mihret A, Abdissa A, Kempker R, Rebolledo PA. Antimicrobial Resistance Through the Lens of One Health in Ethiopia: A Review of the Literature Among Humans, Animals, and the Environment. Int J Infect Dis 2022; 119:120-129. [PMID: 35358724 DOI: 10.1016/j.ijid.2022.03.041] [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: 01/01/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES We aimed to review and describe antimicrobial resistance (AMR) prevalence in humans, animals, and the environment in Ethiopia. METHODS We conducted a structured review of the literature on AMR in humans, animals, and the environment in Ethiopia from 2016 to 2020. We reported the pooled prevalence of AMR of bacterial pathogens in all three sectors. RESULTS We included 43 articles in our review. Only five studies evaluated AMR across multiple sectors. The most common bacteria in humans were Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. High prevalence of resistance to third-generation cephalosporins, fluoroquinolones, and sulfamethoxazole-trimethoprim were seen in gram-negative organisms, often with >50% prevalence of resistance. Highest resistance rates were seen in humans, followed by environmental isolates. Salmonella spp. exhibited higher rates of resistance than previously reported in the literature. We found methicillin-resistant S. aureus (MRSA) in approximately half of S. aureus from the environment and a third from human isolates. Few studies evaluated AMR across all three sectors. CONCLUSION Our review demonstrated high prevalence of AMR among bacteria in humans, animals, and the environment in Ethiopia. Integrating a One Health approach into AMR surveillance as part of Ethiopia's national surveillance program will inform future implementation of One Health interventions.
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Affiliation(s)
- Ayako Wendy Fujita
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States.
| | - Kaitlyn Werner
- Emory University, Rollins School of Public Health, Atlanta, GA, United States
| | - Jesse T Jacob
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States
| | - Rea Tschopp
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Gezahegne Mamo
- Addis Ababa University, College of Veterinary Medicine and Agriculture, Department of Microbiology, Immunology and Veterinary Public Health, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Russell Kempker
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States
| | - Paulina A Rebolledo
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States
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Adegbite BR, Edoa JR, Schaumburg F, Alabi AS, Adegnika AA, Grobusch MP. Knowledge and perception on antimicrobial resistance and antibiotics prescribing attitude among physicians and nurses in Lambaréné region, Gabon: a call for setting-up an antimicrobial stewardship program. Antimicrob Resist Infect Control 2022; 11:44. [PMID: 35241171 PMCID: PMC8892789 DOI: 10.1186/s13756-022-01079-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Africa is challenged by the emergence of antimicrobial resistance (AMR). In order to improve patient management and to optimise approaches to curb the spread of antimicrobial resistance, we examined knowledge and perceptions of AMR and antibiotics prescription practices of HCW (healthcare workers) in Lambaréné, Gabon. Methods We conducted a self-administered, questionnaire-based survey in HCW at the regional referral hospital, a medical research centre, and peripheral health care facilities. The proportions of correct responses to questions were determined and compared between physicians and nurses using Fisher’s Exact test. Results A total of 47 HCW took part in the survey. Of those, 64% (30/47) recognised antibiotic resistance as a major public health issue in Gabon, but only 14/47 (30%) recognised it as a problem in their health facility. Of note, 37/47 (79%) recognised excessive use of antibiotics without microbiological confirmation in case of infection, and buying antibiotics without a prescription, as possible cause of antimicrobial resistance. Some HCW (28%; 13/47) reported having prescribed antibiotics because the patients asked for them; and a total of 15/47 (32%) responded that antibiotics could help patients recover faster when added to malaria treatment. Compared to nurses, most of the physicians recognised that excessive use of antibiotics without microbiological confirmation of infection could contribute to AMR spread (18/19 (95%) vs 19/28 (68%); p = 0.028). Conclusion Most HCW recognised AMR as public health issue. However, a quarter of the participants did not know about the causes fostering the emergence of antimicrobial resistance. There is a need to perform regular HCW training in antimicrobial prescription, and to set up an antimicrobial stewardship program. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01079-x.
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Affiliation(s)
- Bayode Romeo Adegbite
- Centre de Recherches Médicales en Lambaréné and African Partner Institution, German Centre for Infection Research (CERMEL), Lambaréné, Gabon.,Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jean Ronald Edoa
- Centre de Recherches Médicales en Lambaréné and African Partner Institution, German Centre for Infection Research (CERMEL), Lambaréné, Gabon.,Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
| | - Abraham S Alabi
- Centre de Recherches Médicales en Lambaréné and African Partner Institution, German Centre for Infection Research (CERMEL), Lambaréné, Gabon
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales en Lambaréné and African Partner Institution, German Centre for Infection Research (CERMEL), Lambaréné, Gabon.,Institut Für Tropenmedizin, Universität Tübingen and German Centre for Infection Research, Tübingen, Germany.,Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martin P Grobusch
- Centre de Recherches Médicales en Lambaréné and African Partner Institution, German Centre for Infection Research (CERMEL), Lambaréné, Gabon. .,Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Institut Für Tropenmedizin, Universität Tübingen and German Centre for Infection Research, Tübingen, Germany. .,Masanga Medical Research Unit, Masanga, Sierra Leone. .,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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Harant A. Assessing transparency and accountability of national action plans on antimicrobial resistance in 15 African countries. Antimicrob Resist Infect Control 2022; 11:15. [PMID: 35073967 PMCID: PMC8785006 DOI: 10.1186/s13756-021-01040-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/06/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses an increasing public health threat to low- and lower-middle income countries. Recent studies found that in fact poor governance and transparency correlate more strongly with AMR than factors such as antibiotic use. While many African countries now have national action plans (NAPs) on AMR, it is unclear whether information is publicly available on their implementation, surveillance and financing. METHODS Here, the transparency of information related to AMR national action plans in 15 African countries is assessed, based on a governance framework for AMR action plans. Public availability is assessed for AMR documents, progress reports, AMR surveillance data, budget allocations, as well as bodies and persons responsible for implementation of NAPs. Government websites and search engines were perused using search terms related to the studied criteria and countries. RESULTS Results show that most countries have a national action plan publicly available. AMR surveillance data was available for a few countries, but systematic progress reports and funding allocations were absent in all but one country. Information on a body mandated to coordinate NAP implementation was available for most countries, but their functionality remain unclear. Most countries have nominated at least one person responsible for AMR nationally. In general, information was often fragmented and frequently available on external, non-government websites. It appears that commitments on AMR made in the often comprehensive NAPs are rarely met in a timely manner, exhibiting rather weak accountability for AMR results. The article provides concrete policy recommendations on how transparency and accountability may be improved with little effort. CONCLUSIONS Making information available can enable stakeholders such as civil society to demand accountability for results and lead to much needed specific actions on curbing AMR in countries.
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Affiliation(s)
- Anne Harant
- Faculty of Business, Economics and Social Sciences, University of Hamburg, Max-Brauer Allee 60, 22767, Hamburg, Germany.
- German Institute of Global and Area Studies (GIGA), Neuer Jungfernstieg 21, 20354, Hamburg, Germany.
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Craig J, Hiban K, Frost I, Kapoor G, Alimi Y, Varma JK. Comparison of national antimicrobial treatment guidelines, African Union. Bull World Health Organ 2022; 100:50-59. [PMID: 35017757 PMCID: PMC8722630 DOI: 10.2471/blt.21.286689] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To identify and compare antimicrobial treatment guidelines from African Union (AU) Member States. Methods We reviewed national government agency and public health institutes’ websites and communicated with country or regional focal points to identify existing treatment guidelines from AU Member States. We included guidelines if they contained disease-, syndrome- or pathogen-specific treatment recommendations and if those recommendations included antimicrobial name or class, dosage and therapy duration. The scope of the review was limited to infections and clinical syndromes that often have a bacterial cause. We assessed treatment guidelines for alignment with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We compared treatment recommendations for various common bacterial infections or clinical syndromes described across national guidelines and those described in three World Health Organization guidelines. Findings We identified 31 treatment guidelines from 20 of the 55 (36%) AU Member States; several countries had more than one treatment guideline that met our inclusion criteria. Fifteen (48%) guidelines from 10 countries have been published or updated since 2015. Methods used to develop the guidelines were not well described. No guidelines were developed according to the GRADE approach. Antimicrobial selection, dosage and duration of recommended therapies varied widely across guidelines for all infections and syndromes. Conclusion AU Member States lack antimicrobial treatment guidelines that meet internationally accepted methods and that draw from local evidence about disease burden and antimicrobial susceptibility.
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Affiliation(s)
- Jessica Craig
- Center for Disease Dynamics, Economics & Policy, 5636 Connecticut Ave NW, Washington, DC 20015, United States of America
| | - Kayli Hiban
- Center for Disease Dynamics, Economics & Policy, 5636 Connecticut Ave NW, Washington, DC 20015, United States of America
| | - Isabel Frost
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
| | | | - Yewande Alimi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Jay K Varma
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Koduah A, Gyansa-Lutterodt M, Hedidor GK, Sekyi-Brown R, Asiedu-Danso M, Asare BA, Ackon AA, Annan EA. Antimicrobial resistance national level dialogue and action in Ghana: setting and sustaining the agenda and outcomes. ONE HEALTH OUTLOOK 2021; 3:18. [PMID: 34663477 PMCID: PMC8524845 DOI: 10.1186/s42522-021-00051-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) has gained national and international attention. The design and launch of national policy on antimicrobial use and resistance and action plan marked a milestone in Ghana's commitment to control AMR. These strategies are some outcomes of getting and sustaining AMR issues prominence on government's agenda. Understanding the agenda setting processes, policy actors involved and policy change is important as this provides insights on how and why policy actors defined and framed AMR issues to sustain its prominence despite the changing priorities of government agenda. OBJECTIVE To examine the processes of setting and sustaining AMR issues on government agenda, the policy actors involved and resulting outcomes. METHODS A qualitative study was conducted and data collected through interviewing twenty-four respondents and reviewing technical working group meeting reports and health sector documents. Data was analysed drawing on Kingdon's agenda setting framework. RESULT Members of a multisectoral technical working group (AMR platform) formed in 2011 constantly built consensus on AMR problem definition, solutions and actively engaged decision makers to mobilise support and interest. The AMR platform members sustained AMR attention and prominence on government's agenda through the following multisectoral coordination mechanisms: (1) institutionalising AMR platform activities (2) gathering evidence, sharing findings, and supporting research (3) creating awareness and training (4) gaining and maintaining political support. The activities of the AMR platform contributed to three remarkable outcomes and these are (1) maintained network of AMR Champions, (2) design of a national policy on antimicrobial use and resistance in Ghana (1st edition) and national action plan (2017-2021), and (3) Ghana's hosting of the second Global call to action on AMR. CONCLUSION The AMR platform members as influencers concentrated their efforts to move and sustain AMR issues on government agenda. The identified multisectoral coordination mechanisms collectively contributed to agenda setting processes and policy change. The AMR platform engagements are ongoing and it is important the momentum is maintained. As multisectoral coordination and activities are vital especially for AMR 'One Health' approach, we hope this paper presents lessons for better understanding of how and why multisectoral groups influence national level agenda setting processes.
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Affiliation(s)
- Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy University of Ghana, P. O. Box LG43, Legon, Ghana
| | | | - George Kwesi Hedidor
- World Health Organization Country Office for Ghana, P.O Box MB 142, Accra, Ghana
| | - Reginald Sekyi-Brown
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy University of Ghana, P. O. Box LG43, Legon, Ghana
| | - Michelle Asiedu-Danso
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy University of Ghana, P. O. Box LG43, Legon, Ghana
| | - Brian Adu Asare
- Pharmacy Directorate, Ministry of Health, P. O. Box M44, Accra, Ghana
| | - Angela Ama Ackon
- World Health Organization Country Office for Ghana, P.O Box MB 142, Accra, Ghana
| | - Edith Andrews Annan
- World Health Organization African Region, P.O. Box CY 348, Causeway, Harare, Zimbabwe
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Wamai RG, Hirsch JL, Van Damme W, Alnwick D, Bailey RC, Hodgins S, Alam U, Anyona M. What Could Explain the Lower COVID-19 Burden in Africa despite Considerable Circulation of the SARS-CoV-2 Virus? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8638. [PMID: 34444386 PMCID: PMC8391172 DOI: 10.3390/ijerph18168638] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 01/12/2023]
Abstract
The differential spread and impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing Coronavirus Disease 2019 (COVID-19), across regions is a major focus for researchers and policy makers. Africa has attracted tremendous attention, due to predictions of catastrophic impacts that have not yet materialized. Early in the pandemic, the seemingly low African case count was largely attributed to low testing and case reporting. However, there is reason to consider that many African countries attenuated the spread and impacts early on. Factors explaining low spread include early government community-wide actions, population distribution, social contacts, and ecology of human habitation. While recent data from seroprevalence studies posit more extensive circulation of the virus, continuing low COVID-19 burden may be explained by the demographic pyramid, prevalence of pre-existing conditions, trained immunity, genetics, and broader sociocultural dynamics. Though all these prongs contribute to the observed profile of COVID-19 in Africa, some provide stronger evidence than others. This review is important to expand what is known about the differential impacts of pandemics, enhancing scientific understanding and gearing appropriate public health responses. Furthermore, it highlights potential lessons to draw from Africa for global health on assumptions regarding deadly viral pandemics, given its long experience with infectious diseases.
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Affiliation(s)
- Richard G. Wamai
- Department of Cultures, Societies, and Global Studies, Northeastern University, 201 Renaissance Park, 360 Huntington Ave., Boston, MA 02115, USA;
| | - Jason L. Hirsch
- Department of Cultures, Societies, and Global Studies, Northeastern University, 201 Renaissance Park, 360 Huntington Ave., Boston, MA 02115, USA;
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, B-2000 Antwerp, Belgium;
| | - David Alnwick
- DUNDEX (Deployable U.N.-Experienced Development Experts), FX68 Belturbet, Ireland;
| | - Robert C. Bailey
- School of Public Health, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Stephen Hodgins
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Uzma Alam
- Researcher Africa Institute for Health Policy Foundation, Nairobi 020, Kenya;
| | - Mamka Anyona
- T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
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Iwu CD, Patrick SM. An insight into the implementation of the global action plan on antimicrobial resistance in the WHO African region: A roadmap for action. Int J Antimicrob Agents 2021; 58:106411. [PMID: 34371112 DOI: 10.1016/j.ijantimicag.2021.106411] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/13/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Global Action Plan (GAP) on antimicrobial resistance (AMR) delivers a 'One Health' strategy for the development of the national action plan. It encourages the optimal use of antimicrobials and strengthens the evidence base through surveillance and research. METHODS This study evaluated the current status of implementation of the GAP on AMR in World Health Organization (WHO) African countries via a retrospective, cross-sectional analysis of routinely collected data on AMR. A SWOT analysis was used to identify the strengths, weaknesses, opportunities and threats involved in the GAP implementation. A roadmap for action was proposed. RESULTS The overall mean GAP performance score across all the countries that were assessed was 32% ± SD12 (95% CI 27-36%). The mean thematic scores were 59% ± 12 (53-65%) for multi-sector and One Health collaboration; 50% ± 22 (42-58%) for developing national AMR action plans; 38% ± 12 (33-42%) for awareness and training; 18% ± 13 (13-23%) for surveillance; 33% ± 13 (29-38%) for infection prevention and control; and 28% ± 23 (20-37%) for optimal use of antimicrobial medicines in human, animal and plant health. The difference in GAP performance scores between African sub-regions and between income categories was not statistically significant (P > 0.05). While seven countries exhibited strengths in two themes, 25 countries exhibited weaknesses across all themes. Six threats and six opportunities were identified to inform a practical roadmap for AMR action. CONCLUSION The findings from this study indicate that the overall GAP implementation on AMR in the WHO African region is inadequate. Some thematic GAP scores appeared to be relatively good, but on closer inspection, individual indicators revealed a lack of progress and implementation, requiring action.
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Affiliation(s)
- Chidozie Declan Iwu
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Sean Mark Patrick
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Environmental Chemical Pollution and Health (ECPH) Research Unit, University of Pretoria, Pretoria, South Africa
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Nyirenda T, Bockarie M, Machingaidze S, Nderu M, Singh M, Fakier N, Habarugira JM, Beattie P, Pandya L, Jajkowicz D, Yazdanpanah Y, Hankins C, Makanga M. Strengthening capacity for clinical research in sub-Saharan Africa: partnerships and networks. Int J Infect Dis 2021; 110:54-61. [PMID: 34216733 DOI: 10.1016/j.ijid.2021.06.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/19/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022] Open
Abstract
Global research collaboration, through partnerships and networks, is an effective way to deliver highly impactful and sustainable research that is collectively owned and promoted for the global good. Many models exist for effective North-South collaborations that are built on trust and balanced benefits. The European & Developing Countries Clinical Trials Partnership (EDCTP) model emphasises capacity development in clinical trials and product-focused implementation research. To ensure effectiveness and sustainability, capacity development requires a long-term perspective, an integrated system-wide approach, and local ownership and leadership from countries experiencing high disease burdens. Guided by these principles, the EDCTP2 programme, established in 2014, has developed and strengthened human capital and institutional capacities in 39 countries in sub-Saharan Africa to undertake high-quality clinical research guided by good clinical and regulatory practices. Projects in these countries have involved 238 African and 163 European institutions. To date, EDCTP has supported 171 Fellows and 232 postgraduate trainees. EDCTP-short-term training activities have equipped 9628 researchers and medical personnel. The EDCTP capacity-building described here includes its Regional Networks of Excellence and its Consortia for public health emergencies which provide the foundation for sustained efforts against emerging and re-emerging global health threats.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Catherine Hankins
- Amsterdam University Institute of Global Health, Amsterdam, Netherlands
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Antimicrobial resistance in Ethiopia: A systematic review and meta-analysis of prevalence in foods, food handlers, animals, and the environment. One Health 2021; 13:100286. [PMID: 34258373 PMCID: PMC8260865 DOI: 10.1016/j.onehlt.2021.100286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/01/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022] Open
Abstract
Antimicrobial resistance (AMR) has been recognized as one of the greatest global threats for human and animal health. The present review retrieved up to date information on the epidemiology of AMR in the animal-source food chain in Ethiopia focusing on AMR in bacterial species isolated from food handlers, live animals, foods (animal origin and non-animal origin), and in environmental samples. Accordingly, pooled prevalence of AMR in the different sources was estimated. For data analysis, we used random effect meta-analysis and in order to avoid exclusion of studies with zero prevalence of antimicrobial resistance, Freeman-Tukey double arcsine transformation was applied. We identified 152 eligible studies and retrieved 4097 data records (183 in food handlers, 2055 in foods, 1040 in live animals and 819 for environmental samples) which together reported a total of 86,813 AMR tests with 64 different antimicrobial disks for 81 bacteria species. We present the pooled prevalence of AMR for major bacterium-antibiotic combination in different sample types. The pooled prevalence of AMR in bacteria from food producing live animals was 20%. High estimates of AMR pooled prevalence were found in bacteria identified from milk, food handlers and the environmental samples with 29%, and 28% in meat. In foods of non-animal origin, the prevalence was lower with 13%. In milk, the highest AMR estimate was found for penicillin (69%) followed by amoxicillin (51%). Regarding multi-drug resistance (MDR), the overall pooled prevalence was 74% among AMR positive samples. Microbes reported having a higher MDR pattern were: Staphylococcus spp. (96%), Salmonella spp. (81%) and Escherichia coli (77%). The present review revealed a high resistance against commonly used drugs for animal and human treatments and/or prophylaxis. In conclusion, the high estimate of prevalence of AMR observed in bacteria recovered from different sample sources related to the animal-source food chain (food, live animal and environment) can highlight the possible linkage among them. The MDR levels in several bacteria species are a clear indication that the threat is directed to many antimicrobials. Our review demonstrated that the high overall AMR resistance levels call for effective policy and intervention measures, which best address the problem along the food chain through a One Health approach. Meta-analysis of antimicrobial resistance conducted from One Health perspectives. Pooled prevalence of AMR for bacterium-antibiotic combination in different sample was reported. Comparable high AMR prevalence estimates were found from milk, food handler and the environment. MDR prevalence was 74%, and higher estimate in E. coli, Staphylococcus, Salmonella and Shigella.
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Kasanga M, Mukosha R, Kasanga M, Siyanga M, Mudenda S, Solochi BB, Chileshe M, Mwiikisa MJ, Gondwe T, Kantenga T, Shibemba AL, Nakazwe R, Chitalu M, Wu J. Antimicrobial resistance patterns of bacterial pathogens their distribution in university teaching hospitals in Zambia. Future Microbiol 2021; 16:811-824. [PMID: 34184556 DOI: 10.2217/fmb-2021-0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aim: To determine the antimicrobial resistance patterns of bacterial pathogens from urine, blood and wound infections and their distribution by age, sex and location. Materials & methods: A total of 49,168 samples were collected, processed and analyzed. Results: Multidrug resistance was observed in almost all bacterial pathogens in blood urine and wound swabs. In urine and females odds ratio (OR) = 0.864, p = 0.023, OR = 0.909, p = 0.013 urine and neonates were susceptible to antibiotics OR = 0.859, p = 0.003, OR = 0.741, p < 0.001. Ampicillin resistance was above 90% against Escherichia coli in blood, urine and wound swabs. Conclusion: There was a spike in resistance to imipenem, ciprofloxacin and ampicillin against E. coli, Klebsiella pneumoniae, Proteus mirabilis and Proteus species from all three specimen sources.
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Affiliation(s)
- Maisa Kasanga
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China.,Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Raphael Mukosha
- Levy Mwanawasa University Teaching Hospital, Laboratory Department, Great East Road, Chainama Area, Lusaka, 3170151, Zambia
| | - Maika Kasanga
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Makomani Siyanga
- Zambia Medicines Regulatory Authority, Plot No. 2350/M, Off KK International Airport Road, Lusaka, 31890, Zambia
| | - Steward Mudenda
- Department of Pharmacy, The University of Zambia, School of Health Sciences, Lusaka, 50110, Zambia.,Department of Disease Control, The University of Zambia, School of Veterinary Medicine, Lusaka, 32379, Zambia
| | - Benjamin Bisesa Solochi
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Misheck Chileshe
- Department of Mary Begg Health Services Laboratory, 56 Chintu Avenue, Northrise, Ndola, 72221, Zambia
| | - Mark J Mwiikisa
- Department of Lusaka Trust Hospital Laboratory, Plot 2190, Nsumbu Rd, Woodlands, Lusaka Main, Lusaka, 35852, Zambia
| | - Theodore Gondwe
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
| | - Timothy Kantenga
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Aaron Lunda Shibemba
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia.,Directorate of Clinical Pathology & Laboratory Services, Ministry of Health, Lusaka, Zambia
| | - Ruth Nakazwe
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Mwansa Chitalu
- Department of Pathology & Microbiology, University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Jian Wu
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
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Nabaweesi I, Olum R, Sekite AB, Suubi WT, Nakiwunga P, Machali A, Kiyumba R, Kalyango P, Natamba A, Igumba Y, Kyeyune M, Mpairwe H, Katagirya E. Antibiotic Practices, Perceptions and Self-Medication Among Patients at a National Referral Hospital in Uganda. Infect Drug Resist 2021; 14:2155-2164. [PMID: 34140783 PMCID: PMC8203198 DOI: 10.2147/idr.s303075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a major global health concern with increasing reports of microorganisms resistant to most of the available antibiotics. There are limited data on antibiotic practices, perceptions and self-medication among Ugandans, necessitating this study. Methods A cross-sectional study was conducted among patients at Kiruddu National Referral Hospital, Kampala, Uganda. A pre-tested interviewer administered a questionnaire that was used to collect data after an informed consent. Chi-square tests and logistic regression were used to assess associations between outcome and exposure variables. A P<0.05 was statistically significant. Results A total of 279 patients (response rate=71%) with a median age of 32 years participated in the study. The majority were females (55.6%, n=155) and from the outpatient department (74.9%, n=209). Overall, 212 (76%) participants had taken an antibiotic in the past 6 months, and some 22.2% (n=47) of the participants had practiced self-medication. Male participants (adjusted odds ratio (aOR)=2.13, 95% confidence intervals (CI): 1.01 to 4.50, P=0.046) and Muslims (aOR=4.37, 96% CI:1.54 to 12.44, P=0.006) were more likely to self-medicate. Employees (aOR=0.06, 95% CI:0.01 to 0.51, P=0.010) and patients with tertiary education (aOR=0.14, 95% CI: 0.02 to 0.81, P=0.028) were less likely to practice self-medication. About 33% (n=70) of the participants had not completed treatment dosage during their last course of antibiotic treatment because of feeling better (60%, n=42), lack of money to purchase the medication (15.7%, n=11) and side effects (10%, n=7). Whereas 169 participants (79.7%) believed that not completing treatment would have an impact on their personal health, only 96 participants (45.3%) believed that this behaviour could affect the health of others. Conclusion Antibiotic misuse is significant among patients in Uganda. Continuous health education programs aimed at informing the public on antimicrobial resistance, and its dangers are recommended to curtail this challenge.
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Affiliation(s)
- Irene Nabaweesi
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Arthur Brian Sekite
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Prossy Nakiwunga
- School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aron Machali
- School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Richard Kiyumba
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Kalyango
- School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Allen Natamba
- School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yokosofati Igumba
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Martin Kyeyune
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Eric Katagirya
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
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Yeika EV, Ingelbeen B, Kemah BL, Wirsiy FS, Fomengia JN, van der Sande MAB. Comparative assessment of the prevalence, practices and factors associated with self-medication with antibiotics in Africa. Trop Med Int Health 2021; 26:862-881. [PMID: 33942448 DOI: 10.1111/tmi.13600] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate and compare the prevalence, reasons, sources and factors associated with self-medication with antibiotics (SMA) within Africa. METHODS Systematic review and meta-analysis. An electronic search of PubMed and Google Scholar databases was performed for observational studies conducted between January 2005 and February 2020. Two reviewers independently screened abstracts and full texts using the PRISMA flowchart and performed quality assessment of eligible studies. Both qualitative and quantitative syntheses were carried out. RESULTS Forty studies from 19 countries were eligible for qualitative synthesis. The prevalence of SMA in Africa ranged from 12.1% to 93.9% with a median prevalence of 55.7% (IQR 41-75%). Western Africa was the sub-region with the highest reported prevalence of 70.1% (IQR 48.3-82.1%), followed by Northern Africa with 48.1% (IQR 41.1-64.3%). We identified 27 antibiotics used for self-medication from 13 different antibiotic classes. Most frequently used antibiotics were penicillins (31 studies), tetracyclines (25 studies) and fluoroquinolones (23 studies). 41% of these antibiotics belong to the WHO Watch Group. The most frequent indications for SMA were upper respiratory tract infections (27 studies), gastrointestinal tract symptoms (25 studies) and febrile illnesses (18 studies). Common sources of antibiotics used for self-medication were community pharmacies (31 studies), family/friends (20 studies), leftover antibiotics (19 studies) and patent medicine stores (18 studies). The most frequently reported factor associated with SMA was no education/low educational status (nine studies). CONCLUSIONS The prevalence of SMA is high in Africa and varies across sub-regions with the highest prevalence reported in Western Africa. Drivers of SMA are complex, comprising of socio-economic factors and insufficient access to health care coupled with poorly implemented policies regulating antibiotic sales.
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Affiliation(s)
| | - Brecht Ingelbeen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ben-Lawrence Kemah
- University Hospitals North Midlands, Stoke-on-Trent, UK.,Health Education & Research Organization, Buea, Cameroon
| | | | - Joseph Nkeangu Fomengia
- École de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium.,Sintieh Research Academy, Yaoundé, Cameroon
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Global Health, Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
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49
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Frost I, Kapoor G, Craig J, Liu D, Laxminarayan R. Status, challenges and gaps in antimicrobial resistance surveillance around the world. J Glob Antimicrob Resist 2021; 25:222-226. [PMID: 33845163 DOI: 10.1016/j.jgar.2021.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/14/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Isabel Frost
- Center for Disease Dynamics, Economics & Policy, New Delhi, India; Imperial College London, London, UK
| | | | - Jessica Craig
- Center for Disease Dynamics, Economics & Policy, Washington DC
| | - Daniel Liu
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India; Center for Disease Dynamics, Economics & Policy, Washington DC; Princeton University, Princeton, NJ, USA
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50
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Elton L, Haider N, Kock R, Thomason MJ, Tembo J, Arruda LB, Ntoumi F, Zumla A, McHugh TD. Zoonotic disease preparedness in sub-Saharan African countries. ONE HEALTH OUTLOOK 2021; 3:5. [PMID: 33778376 PMCID: PMC7982296 DOI: 10.1186/s42522-021-00037-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The emergence of high consequence pathogens such as Ebola and SARS-CoV-2, along with the continued burden of neglected diseases such as rabies, has highlighted the need for preparedness for emerging and endemic infectious diseases of zoonotic origin in sub-Saharan Africa (SSA) using a One Health approach. To identify trends in SSA preparedness, the World Health Organization (WHO) Joint External Evaluation (JEE) reports were analysed. JEEs are voluntary, collaborative processes to assess country's capacities to prevent, detect and rapidly respond to public health risks. This report aimed to analyse the JEE zoonotic disease preparedness data as a whole and identify strengths and weaknesses. METHODS JEE zoonotic disease preparedness scores for 44 SSA countries who had completed JEEs were analysed. An overall zoonotic disease preparedness score was calculated as an average of the sum of all the SSA country zoonotic disease preparedness scores and compared to the overall mean JEE score. Zoonotic disease preparedness indicators were analysed and data were collated into regions to identify key areas of strength. RESULTS The mean 'Zoonotic disease' preparedness score (2.35, range 1.00-4.00) was 7% higher compared to the mean overall JEE preparedness score (2.19, range 1.55-3.30), putting 'Zoonotic Diseases' 5th out of 19 JEE sub-areas for preparedness. The average scores for each 'Zoonotic Disease' category were 2.45 for 'Surveillance Systems', 2.76 for 'Veterinary Workforce' and 1.84 for 'Response Mechanisms'. The Southern African region scored highest across the 'Zoonotic disease' categories (2.87).A multisectoral priority zoonotic pathogens list is in place for 43% of SSA countries and 70% reported undertaking national surveillance on 1-5 zoonotic diseases. 70% of SSA countries reported having public health training courses in place for veterinarians and 30% had veterinarians in all districts (reported as sufficient staffing). A multisectoral action plan for zoonotic outbreaks was in place for 14% countries and 32% reported having an established inter-agency response team for zoonotic outbreaks. The zoonotic diseases that appeared most in reported country priority lists were rabies and Highly Pathogenic Avian Influenza (HPAI) (both 89%), anthrax (83%), and brucellosis (78%). CONCLUSIONS With 'Zoonotic Diseases' ranking 5th in the JEE sub-areas and a mean SSA score 7% greater than the overall mean JEE score, zoonotic disease preparedness appears to have the attention of most SSA countries. However, the considerable range suggests that some countries have more measures in place than others, which may perhaps reflect the geography and types of pathogens that commonly occur. The category 'Response Mechanisms' had the lowest mean score across SSA, suggesting that implementing a multisectoral action plan and response team could provide the greatest gains.
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Affiliation(s)
- Linzy Elton
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
| | | | | | - Margaret J. Thomason
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
| | | | - Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
| | - Francine Ntoumi
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
- Congolese Foundation for Medical Research, Brazzaville, Republic of Congo
| | - Alimuddin Zumla
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
- National Institute for Health Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Timothy D. McHugh
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, UK
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