Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future

Godman, Brian; Egwuenu, Abiodun; Wesangula, Evelyn; Schellack, Natalie; Kalungia, Aubrey; Tiroyakgosi, Celda; Kgatlwane, Joyce; Mwita, Julius Chacha; Okwen, Patrick; Niba, Loveline Lum; Amu, Adefolarin A; Oguntade, Racheal Tomilola; Alabi, Mobolaji Eniola; Ncube, Nondumiso B. Q.; Sefah, Israel Abebrese; Acolatse, Joseph; Incoom, Robert; Guantai, Anastasia Nkatha; Oluka, Margaret; Opanga, Sylvia; Chikowe, Ibrahim; Khuluza, Felix; Chiumia, Francis Kachidza; Jana, Collins E.; Kalemeera, Francis; Hango, Ester; Fadare, Joseph; Ogunleye, Olayinka O; Ebruke, Bernard E.; Meyer, Johanna C.; Massele, Amos; Malande, Oliver Ombeva; Kibuule, Dan; Kapona, Otridah; Zaranyika, Trust; Bwakura‐Dangarembizi, Mutsa; Kujinga, Tapiwanashe; Saleem, Zikria; Kurdi, Amanj; Shahwan, Moyad; Jairoun, Ammar Abdulrahman; Wale, Janney; Brink, Adrian

doi:10.1080/14740338.2022.2106368

Cited by 63 publications

(107 citation statements)

References 256 publications

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“…High and unnecessary use of antimicrobials enhances antimicrobial resistance (AMR) with its associated impact on morbidity, mortality and costs [9][10][11]. Growing rates of AMR across countries, and the consequences, led to the development of national action plans (NAPs) to reduce AMR, building on the World Health Organization's initiative [12,13]. South Africa is no exception [14].…”

Section: Introductionmentioning

confidence: 99%

A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications

et al. 2022

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Objective: Up to 90% of antimicrobials globally are prescribed and dispensed in ambulatory care. However, there are considerable gaps regarding the extent and rationale for their use especially in lowand middle-income countries such as South Africa. Point prevalent surveys (PPS) are useful to determine current prescribing patterns, identify targets for quality improvement and evaluate the effectiveness of antimicrobial stewardship programmes (ASPs) within institutions. Consequently, the objective of this study was to undertake a PPS within community healthcare centers (CHCs) in South Africa given their importance to the public healthcare system. The findings will be used to provide guidance on future interventions to improve antimicrobial use in South Africa and wider. Methods: A PPS of antimicrobial consumption was undertaken among patients attending 18 CHCs in South Africa. A web-based application was used to record the utilization data, with utilization assessed against World Health Organization (WHO) and South African guidelines. Results:The overall prevalence of antimicrobial use amongst patients attending the CHCs was 21.5% (420 of 1958 patients). This included one or more antimicrobials per patient. The most frequently prescribed antimicrobials were amoxicillin (32.9%), isoniazide (11.3%) and a combination of rifampicin, isoniazid, pyrazinamide and ethambutol (Rifafour ® ) (10.5%), with the majority from the WHO Access list of antibiotics. There was high adherence to guidelines (93.4%). The most common indication for antibiotics were ear, nose and throat infections (22.8%), with no culture results recorded in patients' files. Conclusions: It's encouraging to see high adherence to South African guidelines when antimicrobials were prescribed, with the majority taken from the WHO Access list. However, there were concerns with appreciable prescribing of antimicrobials for upper respiratory tract infections that are essentially viral in origin, and a lack of microbiological testing. The establishment of ASPs can help address identified concerns through designing and implementing appropriate interventions.

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Section: Introductionmentioning

confidence: 99%

A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications

et al. 2022

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“…Key issues and concerns regarding the rising rates of AMR globally, and the subsequent consequences, have resulted in the World Health Organisation urging countries, including African countries, to develop their national action plans (NAPs) to tackle AMR [ 25 , 26 , 27 ]. South Africa is no exception [ 28 ], building on the South African Antimicrobial Resistance National Strategy Frameworks as well as ongoing activities to encourage antimicrobial stewardship programmes (ASPs) starting in hospitals [ 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

“…A key element of South African and other NAPs is the documentation of current antimicrobial usage and resistance patterns across all sectors of care [ 27 , 28 , 34 ]. We are aware that there have been a number of studies undertaken in South Africa to monitor prescribing and resistance patterns in ambulatory care; however, these have shown variable findings alongside requests for additional data to guide future strategies [ 14 , 24 , 35 , 36 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

Determinants of the Empiric Use of Antibiotics by General Practitioners in South Africa: Observational, Analytic, Cross-Sectional Study

et al. 2022

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The overuse of antibiotics is the main driver of antimicrobial resistance (AMR). However, there has been limited surveillance data on AMR and antibiotic prescribing at a primary healthcare level in South Africa. An observational, analytic, cross-sectional study was undertaken to assess key factors associated with empiric antibiotic prescribing among private sector general practitioners (GPs) in the eThekwini district in South Africa, particularly for patients with acute respiratory infections (ARIs). A semi-structured web-based questionnaire was used between November 2020–March 2021. One hundred and sixteen (55.5%) responding GPs prescribed antibiotics empirically for patients with ARIs more than 70% of the time, primarily for symptom relief and the prevention of complications. GPs between the ages of 35–44 years (OR: 3.38; 95%CI: 1.15–9.88), >55 years (OR: 4.75; 95% CI 1.08–21) and in practice < 15 years (OR: 2.20; 95%CI: 1.08–4.51) were significantly more likely to prescribe antibiotics empirically. Three factors—workload/time pressures; diagnostic uncertainty, and the use of a formulary, were significantly associated with empiric prescribing. GPs with more experience and working alone were slightly less likely to prescribe antibiotics empirically. These findings indicate that a combination of environmental factors are important underlying contributors to the development of AMR. As a result, guide appropriate interventions using a health system approach, which includes pertinent prescribing indicators and targets.

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“… 37 , 38 This, however, is beginning to change with ASPs successfully being instigated across Africa 29 , 39–41 in line with the goals of National Action Plans (NAP) across Africa to reduce AMR. 42 …”

Section: Introductionmentioning

confidence: 99%

“… 44 These are part of general quality improvement measures designed to improve on antimicrobial use in this teaching hospital, which is in line with the Ghana NAP for AMR. 42 …”

Section: Introductionmentioning

confidence: 99%

Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: findings and implications

Sefah

Denoo

Bangalee

et al. 2022

JAC-Antimicrobial Resistance

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Background Surgical site infections (SSIs) are among the most common infections seen in hospitalized patients in low- and middle-income countries (LMICs), accounting for up to 60% of hospital-acquired infections. Surgical antimicrobial prophylaxis (SAP) has shown to be an effective intervention for reducing SSIs and their impact. There are concerns of inappropriate use of SAP in Ghana and therefore our audit in this teaching hospital. Methods A retrospective cross sectional clinical audit of medical records of patients undergoing surgery over a 5 month duration from January to May 2021 in Ho Teaching Hospital. A data collection form was designed to collect key information including the age and gender of patients, type and duration of surgery, choice and duration of SAP. The collected data was assessed for the proportion of SAP compliance with Ghana Standard Treatment Guidelines (STGs) and any association with various patient, surgical wound and drug characteristics. Results Of the 597 medical records assessed, the mean age of patients was 35.6 ± 12.2 years with 86.8% (n = 518) female. Overall SAP compliance with the STG was 2.5% (n = 15). SAP compliance due to appropriate choice of antimicrobials was 67.0% (n = 400) and duration at 8.7% (n = 52). SAP compliance was predicted by duration of SAP (P < 0.000) and postoperative hospitalization duration (P = 0.005). Conclusions SAP compliance rate was suboptimal, principally due to a longer duration of prescription. Quality improvement measures such as education of front-line staff on guideline compliance, coupled with clinical audit and regular updates, are urgently needed to combat inappropriate prescribing and rising resistance rates.

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Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future

Cited by 63 publications

References 256 publications

A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications

A national, multicentre web-based point prevalence survey of antimicrobial use in community healthcare centres across South Africa and the implications

Determinants of the Empiric Use of Antibiotics by General Practitioners in South Africa: Observational, Analytic, Cross-Sectional Study

Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana: findings and implications

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