Background. The world prevalence of community and hospital-acquired extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing tremendously. Bacteria harboring ESBLs are currently the number one critical pathogens posing a major threat to human health. Objective. To provide a summary of molecular evidence on the prevalence of ESBL-producing Enterobacteriaceae (ESBL-E) and associated genes at community and hospital settings in East, Central, and Southern African countries. Methods. We conducted a systematic literature search on PubMed and Google Scholar databases for the available molecular studies on ESBL-E in hospitals and community settings in East, Central, and Sothern Africa (ECSA). Published studies in English language involving gene characterization of ESBLs from human samples in hospital and community settings were included in the review, inception to November 2019. A random effect meta-analysis was performed to estimate the prevalence of ESBL-E. Results. A total of 27 studies involving molecular characterization of resistance genes from 20,225 ESBL-E isolates were included in the analysis. Seventy-four percent of all studies were hospital based, 15% were based in community settings, and others were done in both hospital and community settings. Of all the studies, 63% reported E. coli as the dominant isolate among ESBL-E recovered from clinical samples and Klebsiella pneumoniae was reported dominant isolates in 33% of all studies. A random pooled prevalence of ESBL-E was 38% (95% CI = 24–53%), highest in Congo, 92% (95% CI = 90–94%), and lowest in Zimbabwe, 14% (95% CI = 9–20%). Prevalence was higher in hospital settings 41% (95% CI = 23–58%) compared to community settings 34% (95% CI = 8–60%). ESBL genes detected from clinical isolates with ESBL-E phenotypes in ECSA were those of Ambler molecular class A [1] that belongs to both functional groups 2be and 2d of Bush and Jacob classification of 2010 [2]. Majority of studies (n = 22, 81.5%) reported predominance of blaCTX-M gene among isolates, particularly CTX-M-15. Predictors of ESBL-E included increased age, hospital admissions, previous use of antibiotics, and paramedical use of herbs. Conclusion. Few studies have been conducted at a molecular level to understand the genetic basis of increased resistance among members of ESBL-E in ECSA. Limited molecular studies in the ECSA region leave a gap in estimating the burden and risk posed by the carriage of ESBL genes in these countries. We found a high prevalence of ESBL-E most carrying CTX-M enzyme in ECSA with a greater variation between countries. This could be an important call for combined (regional or global) efforts to combat the problem of antimicrobial resistance (AMR) in the region. Antibiotic use and hospital admission increased the carriage of ESBL-E, while poor people contributed little to the increase of AMR due to lack of access and failure to meet the cost of healthcare compared to high income individuals.

Background: Toxoplasmosis caused by the obligate intracellular coccidian protozoan Toxoplasma gondii (T. gondii) infects all warm-blooded animals including humans. This parasite may develop in both immune-compromised and immunocompetent hosts but usually the disease manifestations strongly differ according to immune status. Immunocompromised hosts develop more severe disease than immunocompetent hosts. Infections in pregnancy carry the risk of foetal involvement and can lead to serious clinical outcomes including psychomotor and ocular disorders in congenitally infected foetuses and children.Objective: To assess the level of awareness and practices towards congenital toxoplasmosis among health workers and pregnant women in Tanzania’s Temeke municipality.Methods: This was a cross-sectional study involving 371 pregnant women and 22 health workers from six healthcare facilities in Temeke municipality of Dar es Salaam, Tanzania. A structured questionnaire and review of prenatal screening forms were used to collect information. The questionnaire focused on knowledge of disease aetiology, signs and symptoms, modes of transmission, treatment and management.Results: Of the pregnant women, 96% (95% CI: 0. 94-0.98) were unaware of the disease, had never heard, read or seen any information regarding toxoplasmosis. The majority of respondents including those who had heard, read or seen information concerning toxoplasmosis were unaware of the disease aetiology, signs and symptoms. However, 90% (95% CI: 0.86–0.93) of respondents unknowingly observed preventive practices towards the disease including avoiding eating raw, cured or rare meat. There was a significant statistical relationship between practices towards toxoplasmosis and age of pregnant women, such that for every increase in age by ten years the risk practices towards toxoplasmosis increased by 41% (OR=1.41, 95%, C.I. 1.05-1.90). Preventive practices towards toxoplasmosis decreased significantly by 74% and 78% for the age of 19-25 and 26-35 years old pregnant women respectively, as compared to those < 19 years. No significant difference was observed for those aged > 35 years. Multigravidae was associated with at-risk practices towards toxoplasmosis (OR=2.65, CI: 1.38-5.08). Of the 22 health workers who participated in the study, 36% (95% CI: 0.15–0.58) were aware of the congenital toxoplasmosis and its clinical outcomes. None of them had diagnosed the disease before.Conclusion: Due to general lack of awareness towards toxoplasmosis observed among both health workers and pregnant women in Temeke Municipality, we recommend health policy on maternal and child healthcare to address prenatal screening that is aimed at providing early diagnosis for any possible congenital toxoplasmosis as well as diseases that are currently screened in Tanzania such as HIV, syphilis and malaria. Integrating a One Health approach in educating medical professionals and the vulnerable population of pregnant women on the importance of congenital zoonoses will promote awareness and preventive practices towards the disease.Keywords: Toxoplasmosis awareness, pregnant women, health workers, Dar es Salaam, Tanzania.

Antimicrobial resistance due to extended-spectrum β-lactamase (ESBL) production by Enterobacterales is a global health problem contributing to increased morbidity and mortality, particularly in resource-constrained countries. We aimed to determine the prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in community patients in Blantyre, Malawi. Clinical samples were collected from 300 patients and screened for ESBL-E using a CHROMagarTM ESBL medium. Confirmation of ESBL production was done by a combination disk test (CDT). The prevalence of community-acquired ESBL-E was 16.67% (50/300, 95% CI = 12.43–20.91%). The most common ESBL-E species isolated was Escherichia coli (66%). All ESBL-E isolates were resistant to Trimethoprim-Sulfamethoxazole except for 2% of E. coli. Besides this, all ESBL-E were susceptible to Imipenem and only 4% were resistant to Meropenem. No patients with a positive ESBL-E phenotype had a history of hospital admission in the last three months, and the carriage of ESBL-E was neither associated with the demographic nor the clinical characteristics of participants. Our findings reveal a low presence of ESBL-E phenotypes in community patients. The low prevalence of ESBL-E in the community settings of Blantyre can be maintained if strong infection and antimicrobial use-control strategies are implemented.

No abstract

No abstract