A systematic review and meta-analysis of antimicrobial resistance knowledge, attitudes, and practices: Current evidence to build a strong national antimicrobial drug resistance narrative in Ethiopia

Abstract

Antimicrobial resistance (AMR) is a silent pandemic that has claimed millions of lives, and resulted in long-term disabilities, limited treatment options, and high economic costs associated with the healthcare burden. Given the rising prevalence of AMR, which is expected to pose a challenge to current empirical antibiotic treatment strategies, we sought to summarize the available data on knowledge, attitudes, and practices regarding AMR in Ethiopia. Articles were searched in international electronic databases. Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 checklist was followed. The methodological quality of the studies included was assessed by the Joana Briggs Institute critical appraisal checklists. The random-effect meta-analysis model was used to estimate Der Simonian-Laird’s pooled effect. Statistical heterogeneity of the meta-analysis was checked through Higgins and Thompson’s I2 statistics and Cochran’s Q test. Publication bias was investigated by funnel plots, and the regression-based test of Egger for small study effects with a P value < 0.05 was considered to indicate potential reporting bias. In addition, sensitivity and subgroup meta-analyses were performed. Fourteen studies with a total of 4476 participants met the inclusion criteria. Overall, the pooled prevalence of good AMR knowledge was 51.53% [(95% confidence interval (CI): 37.85, 65.21), I2 = 99.0%, P <0.001]. The pooled prevalence of favorable attitudes and good practices were 63.43% [(95% CI: 42.66, 84.20), I2 = 99.6, P <0.001], and 48.85% [(95% CI: 38.68, 59.01), I2 = 93.1, P <0.001] respectively. In conclusion, there is a significant knowledge and practice gap on AMR among the general public, patients, and livestock producers. As a result, we call for greater educational interventions to raise awareness and build a strong national AMR narrative.

Risk Factors Associated with Opportunistic Infections among People Living with HIV/AIDS and Receiving an Antiretroviral Therapy in Gabon, Central Africa

“…CD4 T-cell counts of [200–499] and <200 cells/mm 3 were reported in our study, and similar counts are most likely reported in cases of development of OIs. This result is reasonable as CD4 T-cells play critical roles in the induction of both humoral and cellular immunity to combat OIs [ 1 ]. Comparatively, other authors found that PLWHA with a CD4 T-cell count of 200 cells/mm 3 were at higher risk of developing advanced forms of OIs such as pulmonary TB [ 51 ].…”

“…There is regularly a shortage of ARVs experienced in Gabon, and that might assuredly constitute a significant contributor and possible explanation for the high rates of OIs. Furthermore, starting ART at later stages of HIV infection, on the one hand, and the disparity observed in the level of engagement in HIV care facilities in poor countries or/and resource-limited areas, on the other hand, limit the effectiveness of the administered therapy [ 1 , 23 ]. Additionally, the emerging or increasing levels of HIV drug resistance to NNRTIs in resource-limited countries could also be considered as restraining factors [ 15 ].…”

“…Despite receiving ART, OIs were reported in the current study. The fact that men are more likely to develop OIs could be explained by the decision to adhere to and receive ART at the latter stages or/and the poor adherence and subsequent side effects [ 1 ]. It is recognised that, unlike women who often attend healthcare facilities as quickly as possible when they get ill/diagnosed, their male counterparts are prompt to seek medical advice when facing health-related complications or severe cases [ 50 ].…”

“…The vulgarization of antiretroviral therapy (ART) has improved the living conditions of people living with HIV/AIDS (PLWHA) and has led to a significant decrease in morbidity and mortality [ 1 , 2 , 3 ]. Factors related to ART—late initiation, discontinuation, poor adherence, low CD4 T lymphocyte count, inadequate virological monitoring, isoniazid preventive therapy, gender, age, place of residence, and functional or disclosure or nutritional status—have been associated with the emergence of opportunistic infections (OIs) among adults (PLWHA) post-ART [ 4 , 5 , 6 , 7 ].…”

“…The prevalence of OIs among ART-treated adults varies and depends on the specificity of each country; for example, it was estimated at 22.4% in the south-east of Nigeria, from 33.6 to 88.44% in Ethiopia, and at 33.51% in seven provinces of Indonesia [ 10 , 11 ]. Some of the commonly described OIs in PLWHA are salmonella infection, chronic diarrhoea, candidiasis, toxoplasmosis, tuberculosis, dermatitis, and pneumonia [ 1 ].…”