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Nayiga S, MacPherson EE, Mankhomwa J, Nasuwa F, Pongolani R, Kabuleta R, Kesby M, Dacombe R, Hilton S, Grace D, Feasey N, Chandler CI. "Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi. Glob Health Action 2024; 17:2322839. [PMID: 38441912 PMCID: PMC10916894 DOI: 10.1080/16549716.2024.2322839] [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: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not. OBJECTIVE We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi. METHODS Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting. RESULTS Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred. CONCLUSIONS Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.
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Affiliation(s)
- Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Eleanor E MacPherson
- Research and Innovation Services, University of Glasgow, Glasgow, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - John Mankhomwa
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | | | | | - Rita Kabuleta
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mike Kesby
- School of Geography & Sustainable Development, University of St Andrews, St Andrews, UK
| | - Russell Dacombe
- Research and Innovation Services, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Delia Grace
- Natural Resources Institute, University of Greenwich, Chatham, UK
- International Livestock Research Institute, Nairobi, Kenya
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- The School of Medicine, University of St Andrews, St Andrews, UK
| | - Clare I.R. Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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2
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Thongyuan S, Tansakul N. Antimicrobial use on pig farms in Thailand: Farmer perceptions of use and resistance. Prev Vet Med 2024; 230:106287. [PMID: 39059075 DOI: 10.1016/j.prevetmed.2024.106287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024]
Abstract
Limiting the use of antimicrobial agents in intensive livestock production is a challenge due to different perceptions between the short-term benefits of antimicrobial use (AMU) by livestock producers and the long-term social costs of antimicrobial resistance (AMR) and its impact on human, animal, and environmental health. Pig farmers are key stakeholders supporting Thailand's national strategic plan on AMR which aims to reduce antimicrobial consumption in the livestock sector. Consequently, this study explored the knowledge, perceptions, attitudes, and practices of pig farmers towards AMU and AMR, expecting to provide information that would help guide policymakers in the development of a proper interventional program for antimicrobial stewardship. The qualitative approach utilized individual, face-to-face, in-depth, semi-structured interviews with the 20 owners of middle- and large-scale pig farms in eastern Thailand. The major themes identified in this finding were: (1) the use of antimicrobials on farms and the knowledge of antimicrobials; (2) AMU on pig farms (the purpose of AMU, antimicrobial prescription practices, and performing antimicrobial susceptibility testing); (3) attitudes towards prescribing practices and record keeping; (4) farm animal husbandry practices and AMU; (5) factors influencing AMU; and (6) awareness regarding AMR. Most of the pig farm owners recognized that achieving Good Agricultural Practices certification required following the legislation and regulations for AMU. Other observations were that the respondents had positive attitudes towards prescribing practices, performing antimicrobial susceptibility testing before antimicrobial therapy, and recording drug use on farms; however, there was low awareness of AMR. In addition, alternative substances, such as medicinal plants, and proper biosecurity practices were mentioned. Factors influencing AMU on pig farms were intensive enforcement of legislation and regulations, the implementation of farm management practices, the provision of information and consultancy services by veterinary professionals, farmer experience, and consumer trends.
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Affiliation(s)
- Suporn Thongyuan
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Kasetsart University, Nakhon Pathom, Thailand
| | - Natthasit Tansakul
- Department of Pharmacology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok 10900, Thailand.
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3
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Ngunguni SM, Moodley A, Msefula C, Mkakosya R, Muloi DM. Patterns and drivers of antibiotic use in small-scale broiler production systems in Lilongwe District, Malawi. Prev Vet Med 2024; 230:106263. [PMID: 38964210 DOI: 10.1016/j.prevetmed.2024.106263] [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: 02/21/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
Reducing the inappropriate use of antibiotics in food animals is a global priority to address antimicrobial resistance (AMR). We investigated practices and factors associated with antibiotic use in small-scale commercial broiler farms in Lilongwe district, Malawi. We used structured questionnaires to collect data on recent antibiotic use practices among 128 broiler farmers, who kept between 50 and 1 000 birds, from December 2022 to March 2023. Logistic regression analysis was used to identify risk factors associated with antibiotic use. Over half (53.1 %, n=68) of the farms reported using antibiotics at least once in the previous production cycle. Overall, 11 different types of antibiotics were used either for treatment and/or preventive purposes, with oxytetracycline (88.2 %), erythromycin (29.4 %), and enrofloxacin (26.5 %) reported as the frequently used. One-third of all antibiotic formulations contained multiple active antibiotic ingredients, with 12 % containing four antibiotics. Covariates associated with an increased likelihood of antibiotic use include disease incidence (OR=13.8, 95 % CI 5.27-42.50, p<0.001) and entry of wild birds into poultry houses (OR=3.56, 95 % CI =1.44-9.61, p=0.008). Our study highlights inappropriate usage of antibiotics, largely associated with reduced biosecurity and disease incidence. These findings underscore the need to strengthen veterinary services, reinforce regulations on antibiotic access and use, and farmer education programs promoting proper husbandry, biosecurity, and responsible antibiotic use.
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Affiliation(s)
- Shareef Mtila Ngunguni
- Animal and Human Health Program, International Livestock Research Institute, P.O. Box 30709, Nairobi 00100, Kenya; Department of Pathology, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Arshnee Moodley
- Animal and Human Health Program, International Livestock Research Institute, P.O. Box 30709, Nairobi 00100, Kenya; Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, Frederiksberg C 1870, Denmark
| | - Chisomo Msefula
- Department of Pathology, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Rajab Mkakosya
- Department of Pathology, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
| | - Dishon M Muloi
- Animal and Human Health Program, International Livestock Research Institute, P.O. Box 30709, Nairobi 00100, Kenya; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK.
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4
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Sharma G, Dey TK, Hazarika RA, Shome BR, Shome R, Singh VP, Deka RP, Grace D, Lindahl JF. Knowledge and practices related to antibiotics among poultry producers and veterinarians in two Indian states. One Health 2024; 18:100700. [PMID: 38516289 PMCID: PMC10955645 DOI: 10.1016/j.onehlt.2024.100700] [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: 10/09/2023] [Revised: 01/21/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Background Antibiotics are frequently utilized in livestock, particularly poultry, for therapy and growth promotion, resulting in antimicrobial resistance. Multidrug-resistant bacteria are frequent in poultry samples from India. The purpose of this study was to better understand main antibiotic consumption patterns in poultry value chains, as well as antibiotic knowledge and practices among the stakeholders. Methods A cross-sectional survey was conducted in Assam and Karnataka, India. The poultry farmers were interviewed on antibiotic usage, antibiotic knowledge, feeding practices, and preventive measures on the farm. Poultry farmers reported their veterinarians, and we also interviewed them on knowledge and practices related to antimicrobial use in poultry and antimicrobial resistance. Item response theory (IRT) was used to assess the association between the answers and demographic factors. Results This survey interviewed 62 poultry farmers and 11 veterinarians. Small poultry farms with fewer than 4000 birds were owned by 51.6% of farmers. Most poultry farmers had heard about antibiotics, and 62.9% thought they cured all diseases. If one chicken is sick, 72.6% said others should be given antibiotics to prevent the disease. All veterinarians utilized tetracyclines, aminoglycosides, and cephalexin on the poultry farms. Over half (54.5%) stated antibiotics prevent diseases, and 72.7% said they treat and prevent diseases. Some (45.5%) said antibiotics boost growth. IRT analysis showed that 8 questions assessed a knowledge scale well. Univariable analysis showed that Assam farmers and women were likely to have have more knowledge. Conclusion The poultry farmers were mostly unaware of the relation between antibiotic use and antimicrobial resistance. Despite being aware, the veterinarians agreed with use antibiotics as a prophylactic measure. It is vital that these stakeholders understand the repercussions of such widespread antibiotic use. In order to increase knowledge, frequent trainings and antimicrobial stewardship programmes with effective communication and incentives for behaviour change should be conducted.
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Affiliation(s)
- Garima Sharma
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Deparment of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Tushar Kumar Dey
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Deparment of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Razibuddin Ahmed Hazarika
- Department of Veterinary Public Health and Epidemiology, Assam Agricultural University, Jorahat, India
| | - Bibek Ranjan Shome
- National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Rajeshwari Shome
- National Institute of Veterinary Epidemiology and Disease Informatics, Bangalore, India
| | - Vijay Pal Singh
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, Delhi, India
| | - Ram Pratim Deka
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
| | - Delia Grace
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Food and Markets Department, Natural Resources Institute, Chatham, United Kingdom
| | - Johanna F. Lindahl
- Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Deparment of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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5
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Heinz E, Pearse O, Zuza A, Bilima S, Msefula C, Musicha P, Siyabu P, Tewesa E, Graf FE, Lester R, Lissauer S, Cornick J, Lewis JM, Kawaza K, Thomson NR, Feasey NA. Longitudinal analysis within one hospital in sub-Saharan Africa over 20 years reveals repeated replacements of dominant clones of Klebsiella pneumoniae and stresses the importance to include temporal patterns for vaccine design considerations. Genome Med 2024; 16:67. [PMID: 38711148 PMCID: PMC11073982 DOI: 10.1186/s13073-024-01342-3] [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: 10/10/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Infections caused by multidrug-resistant gram-negative bacteria present a severe threat to global public health. The WHO defines drug-resistant Klebsiella pneumoniae as a priority pathogen for which alternative treatments are needed given the limited treatment options and the rapid acquisition of novel resistance mechanisms by this species. Longitudinal descriptions of genomic epidemiology of Klebsiella pneumoniae can inform management strategies but data from sub-Saharan Africa are lacking. METHODS We present a longitudinal analysis of all invasive K. pneumoniae isolates from a single hospital in Blantyre, Malawi, southern Africa, from 1998 to 2020, combining clinical data with genome sequence analysis of the isolates. RESULTS We show that after a dramatic increase in the number of infections from 2016 K. pneumoniae becomes hyperendemic, driven by an increase in neonatal infections. Genomic data show repeated waves of clonal expansion of different, often ward-restricted, lineages, suggestive of hospital-associated transmission. We describe temporal trends in resistance and surface antigens, of relevance for vaccine development. CONCLUSIONS Our data highlight a clear need for new interventions to prevent rather than treat K. pneumoniae infections in our setting. Whilst one option may be a vaccine, the majority of cases could be avoided by an increased focus on and investment in infection prevention and control measures, which would reduce all healthcare-associated infections and not just one.
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Affiliation(s)
- Eva Heinz
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke PlaceLiverpool, L3 5QA, UK.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke PlaceLiverpool, L3 5QA, UK.
| | - Oliver Pearse
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke PlaceLiverpool, L3 5QA, UK
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Allan Zuza
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Sithembile Bilima
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Patrick Musicha
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke PlaceLiverpool, L3 5QA, UK
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Edith Tewesa
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Fabrice E Graf
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke PlaceLiverpool, L3 5QA, UK
| | - Rebecca Lester
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Division of Infection & Immunity, University College London, London, UK
| | - Samantha Lissauer
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Jennifer Cornick
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Joseph M Lewis
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke PlaceLiverpool, L3 5QA, UK
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Kondwani Kawaza
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nicholas R Thomson
- Parasites and Microbes Program, Wellcome Sanger Institute, Hinxton, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicholas A Feasey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke PlaceLiverpool, L3 5QA, UK.
- Malawi Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
- School of Medicine, St Andrews University, St Andrews, UK.
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6
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Portal EAR, Sands K, Farley C, Boostrom I, Jones E, Barrell M, Carvalho MJ, Milton R, Iregbu K, Modibbo F, Uwaezuoke S, Akpulu C, Audu L, Edwin C, Yusuf AH, Adeleye A, Mukkadas AS, Maduekwe D, Gambo S, Sani J, Walsh TR, Spiller OB. Characterisation of colistin resistance in Gram-negative microbiota of pregnant women and neonates in Nigeria. Nat Commun 2024; 15:2302. [PMID: 38485761 PMCID: PMC10940312 DOI: 10.1038/s41467-024-45673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/30/2024] [Indexed: 03/18/2024] Open
Abstract
A mobile colistin resistance gene mcr was first reported in 2016 in China and has since been found with increasing prevalence across South-East Asia. Here we survey the presence of mcr genes in 4907 rectal swabs from mothers and neonates from three hospital sites across Nigeria; a country with limited availability or history of colistin use clinically. Forty mother and seven neonatal swabs carried mcr genes in a range of bacterial species: 46 Enterobacter spp. and single isolates of; Shigella, E. coli and Klebsiella quasipneumoniae. Ninety percent of the genes were mcr-10 (n = 45) we also found mcr-1 (n = 3) and mcr-9 (n = 1). While the prevalence during this collection (2015-2016) was low, the widespread diversity of mcr-gene type and range of bacterial species in this sentinel population sampling is concerning. It suggests that agricultural colistin use was likely encouraging sustainment of mcr-positive isolates in the community and implementation of medical colistin use will rapidly select and expand resistant isolates.
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Affiliation(s)
- E A R Portal
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK.
- Ineos Oxford Institute for Antimicrobial Research, Department of Biology, University of Oxford, Oxford, UK.
| | - K Sands
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK.
- Ineos Oxford Institute for Antimicrobial Research, Department of Biology, University of Oxford, Oxford, UK.
| | - C Farley
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - I Boostrom
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - E Jones
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - M Barrell
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - M J Carvalho
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - R Milton
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - K Iregbu
- National Hospital Abuja, Abuja, Nigeria
| | - F Modibbo
- Murtala Muhammad Specialist Hospital, Kano, Nigeria
| | - S Uwaezuoke
- Federal Medical Centre -Jabi, Abuja, Nigeria
| | - C Akpulu
- Ineos Oxford Institute for Antimicrobial Research, Department of Biology, University of Oxford, Oxford, UK
- National Hospital Abuja, Abuja, Nigeria
- Interdisciplinary Biosciences DTP, University of Oxford, Oxford, UK
| | - L Audu
- National Hospital Abuja, Abuja, Nigeria
| | - C Edwin
- Department of Medical Microbiology Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A H Yusuf
- Department of Medical Microbiology Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A Adeleye
- Department of Medical Microbiology Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A S Mukkadas
- Department of Medical Microbiology Aminu Kano Teaching Hospital, Kano, Nigeria
| | - D Maduekwe
- Wuse General Hospital Abuja, Abuja, Nigeria
| | - S Gambo
- Department of Paediatrics, Murtala Muhammed Specialist Hospital, Kano, Nigeria
| | - J Sani
- Department of Paediatrics Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - T R Walsh
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Ineos Oxford Institute for Antimicrobial Research, Department of Biology, University of Oxford, Oxford, UK
| | - O B Spiller
- Department of Medical Microbiology, Division of Infection and Immunity, Cardiff University, Cardiff, UK
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7
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Odey TOJ, Tanimowo WO, Afolabi KO, Jahid IK, Reuben RC. Antimicrobial use and resistance in food animal production: food safety and associated concerns in Sub-Saharan Africa. Int Microbiol 2024; 27:1-23. [PMID: 38055165 PMCID: PMC10830768 DOI: 10.1007/s10123-023-00462-x] [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: 08/30/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
The use of antimicrobials in food animal (FA) production is a common practice all over the world, with even greater usage and dependence in the developing world, including Sub-Saharan Africa (SSA). However, this practice which serves obvious economic benefits to producers has raised public health concerns over the last decades, thus driving the selection and dissemination of antimicrobial resistance and adversely impacting food safety and environmental health. This review presents the current and comprehensive antimicrobial usage practices in food animal production across SSA. We further highlighted the overall regional drivers as well as the public health, environmental, and economic impact of antimicrobial use in the production of food animals. Antimicrobial use is likely to increase with even exacerbated outcomes unless cost-effective, safe, and sustainable alternatives to antibiotics, especially probiotics, prebiotics, bacteriocins, antimicrobial peptides, bacteriophages, vaccines, etc. are urgently advocated for and used in food animal production in SSA. These, in addition to the implementation of strong legislation on antimicrobial use, and improved hygiene will help mitigate the public health concerns associated with antimicrobial use in food animals and improve the well-being and safety of food animals and their products.
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Affiliation(s)
- Timothy Obiebe Jason Odey
- Department of Biological Sciences, Faculty of Natural, Applied, and Health Sciences, Anchor University, Lagos, Nigeria
| | - Williams Omotola Tanimowo
- Department of Biological Sciences, Faculty of Natural, Applied, and Health Sciences, Anchor University, Lagos, Nigeria
| | - Kayode Olayinka Afolabi
- Department of Biological Sciences, Faculty of Natural, Applied, and Health Sciences, Anchor University, Lagos, Nigeria
- Pathogenic Yeasts Research Group, Department of Microbiology and Biochemistry, University of The Free State, Bloemfontein, South Africa
| | - Iqbal Kabir Jahid
- Department of Microbiology, Jashore University of Science and Technology, Jashore, 7408, Bangladesh
| | - Rine Christopher Reuben
- Department of Biological Sciences, Faculty of Natural, Applied, and Health Sciences, Anchor University, Lagos, Nigeria.
- Area of Biochemistry and Molecular Biology, OneHealth-UR Research Group, University of La Rioja, 26006, Logroño, Spain.
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8
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Aboah J, Ngom B, Emes E, Fall AG, Seydi M, Faye A, Dione M. Mapping the effect of antimicrobial resistance in poultry production in Senegal: an integrated system dynamics and network analysis approach. Front Vet Sci 2023; 10:1189109. [PMID: 37519996 PMCID: PMC10374361 DOI: 10.3389/fvets.2023.1189109] [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: 03/18/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
The impact of antimicrobial resistance (AMR) extends beyond the farm-level to other stakeholders warranting the need for a collaborative approach to combat AMR while optimising production objectives and safeguarding human health. This study maps out the effect of AMR originating from poultry production in Senegal and highlights the entry points for interventions from stakeholders' perspectives. A causal loop diagram (CLD) was developed following a group model building procedure with 20 stakeholders and integrated with network analysis by translating the CLD into an unweighted directed network. Results indicate that with an eigenvector centrality of 1, 0.85, and 0.74, the production cost, on-farm profit, and on-farm productivity, respectively are the most ranked influential variables driving the complexity of AMR in the poultry production system. Two reinforcing feedback loops highlight the dual benefits of improving on-farm productivity and increasing on-farm profit. However, one balancing feedback loop that revolves around the causal link between producers' investment in qualified human resource personnel to ensure good farm management practices underline the financial implication of producers' investment decisions. The findings provide precursory groundings for the development of a quantitative SD model, the formulation of intervention scenarios and ex-ante impact assessment of the cost-effectiveness of the interventions.
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Affiliation(s)
- Joshua Aboah
- International Livestock Research Institute (Senegal), Saint-Louis, Senegal
- Commonwealth Scientific and Industrial Research Organisation, St Lucia, QLD, Australia
| | - Babacar Ngom
- Directorate of Veterinary Services, Ministry of Livestock and Animal Productions, Dakar, Senegal
| | - Eves Emes
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Awa Gueye Fall
- Directorate of Veterinary Services, Ministry of Livestock and Animal Productions, Dakar, Senegal
| | - Moutar Seydi
- Directorate of Veterinary Services, Ministry of Livestock and Animal Productions, Dakar, Senegal
| | - Ardiouma Faye
- Université Cheikh Anta Diop de Dakar, Département de Sociologie, Dakar, Senegal
| | - Michel Dione
- International Livestock Research Institute (Senegal), Saint-Louis, Senegal
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9
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Cocker D, Chidziwisano K, Mphasa M, Mwapasa T, Lewis JM, Rowlingson B, Sammarro M, Bakali W, Salifu C, Zuza A, Charles M, Mandula T, Maiden V, Amos S, Jacob ST, Kajumbula H, Mugisha L, Musoke D, Byrne R, Edwards T, Lester R, Elviss N, Roberts AP, Singer AC, Jewell C, Morse T, Feasey NA. Investigating One Health risks for human colonisation with extended spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Malawian households: a longitudinal cohort study. THE LANCET. MICROBE 2023; 4:e534-e543. [PMID: 37207684 PMCID: PMC10319635 DOI: 10.1016/s2666-5247(23)00062-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Low-income countries have high morbidity and mortality from drug-resistant infections, especially from enteric bacteria such as Escherichia coli. In these settings, sanitation infrastructure is of variable and often inadequate quality, creating risks of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales transmission. We aimed to describe the prevalence, distribution, and risks of ESBL-producing Enterobacterales colonisation in sub-Saharan Africa using a One Health approach. METHODS Between April 29, 2019, and Dec 3, 2020, we recruited 300 households in Malawi for this longitudinal cohort study: 100 each in urban, peri-urban, and rural settings. All households underwent a baseline visit and 195 were selected for longitudinal follow-up, comprising up to three additional visits over a 6 month period. Data on human health, antibiotic usage, health-seeking behaviours, structural and behavioural environmental health practices, and animal husbandry were captured alongside human, animal, and environmental samples. Microbiological processing determined the presence of ESBL-producing E coli and Klebsiella pneumoniae, and hierarchical logistic regression was performed to evaluate the risks of human ESBL-producing Enterobacterales colonisation. FINDINGS A paucity of environmental health infrastructure and materials for safe sanitation was identified across all sites. A total of 11 975 samples were cultured, and ESBL-producing Enterobacterales were isolated from 1190 (41·8%) of 2845 samples of human stool, 290 (29·8%) of 973 samples of animal stool, 339 (66·2%) of 512 samples of river water, and 138 (46·0%) of 300 samples of drain water. Multivariable models illustrated that human ESBL-producing E coli colonisation was associated with the wet season (adjusted odds ratio 1·66, 95% credible interval 1·38-2·00), living in urban areas (2·01, 1·26-3·24), advanced age (1·14, 1·05-1·25), and living in households where animals were observed interacting with food (1·62, 1·17-2·28) or kept inside (1·58, 1·00-2·43). Human ESBL-producing K pneumoniae colonisation was associated with the wet season (2·12, 1·63-2·76). INTERPRETATION There are extremely high levels of ESBL-producing Enterobacterales colonisation in humans and animals and extensive contamination of the wider environment in southern Malawi. Urbanisation and seasonality are key risks for ESBL-producing Enterobacterales colonisation, probably reflecting environmental drivers. Without adequate efforts to improve environmental health, ESBL-producing Enterobacterales transmission is likely to persist in this setting. FUNDING Medical Research Council, National Institute for Health and Care Research, and Wellcome Trust. TRANSLATION For the Chichewa translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Derek Cocker
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Kondwani Chidziwisano
- Centre for Water, Sanitation, Health and Appropriate Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi; Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
| | - Madalitso Mphasa
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Taonga Mwapasa
- Centre for Water, Sanitation, Health and Appropriate Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Joseph M Lewis
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Barry Rowlingson
- Centre for Health Informatics Computing and Statistics, Lancaster University, Lancaster, UK
| | - Melodie Sammarro
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Centre for Health Informatics Computing and Statistics, Lancaster University, Lancaster, UK
| | - Winnie Bakali
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Chifundo Salifu
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Allan Zuza
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mary Charles
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Tamandani Mandula
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victor Maiden
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Stevie Amos
- Centre for Water, Sanitation, Health and Appropriate Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Shevin T Jacob
- Global Health Security Department, Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Lawrence Mugisha
- College of Health Sciences, and College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda; Conservation and Ecosystem Health Alliance, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, Makerere University, Kampala, Uganda
| | - Rachel Byrne
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas Edwards
- Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rebecca Lester
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicola Elviss
- Science Group, United Kingdom Health Security Agency, London, UK
| | - Adam P Roberts
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Christopher Jewell
- Centre for Health Informatics Computing and Statistics, Lancaster University, Lancaster, UK
| | - Tracy Morse
- Centre for Water, Sanitation, Health and Appropriate Technology Development, Malawi University of Business and Applied Sciences, Blantyre, Malawi; Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, UK
| | - Nicholas A Feasey
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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10
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Kainga H, Phonera MC, Chikowe I, Chatanga E, Nyirongo H, Luwe M, Mponela J, Kachisi V, Kamanga N, Chulu J, Njunga G, Nabadda D, Fonchin A, Kallu SA, Mudenda S, Tembo R, Zulu M, Mwaba F, Mbewe N, Mpundu P, Samutela MT, Munyeme M, Muma JB, Simulundu E. Determinants of Knowledge, Attitude, and Practices of Veterinary Drug Dispensers toward Antimicrobial Use and Resistance in Main Cities of Malawi: A Concern on Antibiotic Stewardship. Antibiotics (Basel) 2023; 12:antibiotics12010149. [PMID: 36671349 PMCID: PMC9855151 DOI: 10.3390/antibiotics12010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
Antimicrobial resistance (AMR) is an emerging challenge to global public health. The use of antibiotics in the veterinary field is one of the contributing factors to AMR mostly due to poor knowledge, attitudes, and practices (KAP) of dispensers. Veterinary drug dispensers are expected to guide clients on indications, contraindications, and withdrawal periods of veterinary drugs. This study assessed veterinary drug dispensers' KAP toward AMR and associated potential contributing factors. A cross-sectional study, using a structured questionnaire, was conducted in three main cities of Malawi, namely Mzuzu, Lilongwe, and Blantyre. A total of 68 agrovet shops were selected using a simple random sampling technique. The KAP level was presented descriptively. Bivariate and multivariable analyses were run to investigate the relationships between the independent and outcome variable. Overall, the KAP score for knowledge, attitude, and practices was 46.7%, 49.2%, and 41.6%, respectively. The significant determinants of the knowledge were the practice of asking for a written prescription (OR: 16.291, 95% CI: 11.6-24.2) (p = 0.024), female (OR: 0.609, 95% CI: 0.3-0.9) (p = 0.001), and old age (≥35) (OR: 0.227, 95% CI: 0.1-0.5) (p = 0.04). Poor knowledge, negative attitude, and poor practices were observed among most of the participants. Sensitization and training on AMR and antimicrobial stewardship are recommended to address the KAP score gaps and the observed determinants among veterinary drug dispensers.
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Affiliation(s)
- Henson Kainga
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
- Correspondence: or ; Tel.: +265-996-618-212
| | - Marvin Collen Phonera
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHES), Blantyre P.O. Box 360, Malawi
| | - Elisha Chatanga
- Department of Veterinary Pathobiology, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
| | - Hlupikire Nyirongo
- Department of Veterinary Epidemiology and Public Health, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
| | - Mike Luwe
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - James Mponela
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | | | - Nathani Kamanga
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Julius Chulu
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Gilson Njunga
- Department of Animal Health and Livestock Development, Ministry of Agriculture, Lilongwe 207203, Malawi
| | - Daisy Nabadda
- Department of Biosecurity, Ecosystems and Public Health, College of Veterinary Medicine, Makerere University, Kampala P.O. Box 7062, Uganda
| | - Alyce Fonchin
- Community Initiative for Sustainable Development, Manko-Bamenda P.O. Box 356, Cameroon
| | - Simegnew Adugna Kallu
- College of Veterinary Medicine, Haramaya University, Dire Dawa P.O. Box 138, Ethiopia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Rabecca Tembo
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Mildred Zulu
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Florence Mwaba
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Natalia Mbewe
- Department of Basic and Clinical Nursing Sciences, School of Nursing Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Prudence Mpundu
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, Lusaka P.O. Box 33991, Zambia
| | - Mulemba Tillika Samutela
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
| | - Edgar Simulundu
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 10101, Zambia
- Macha Research Trust, Choma P.O. Box 20100, Zambia
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