Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on Ogunleye et al. COVID-19 in Africa NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction.Method: Principally a structured review of current and planned activities.Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities.Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research.

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.

2020) Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future, Current Medical Research and Opinion, 36:2, 301-327,

Objectives: The problem of antimicrobial resistance (AMR) is increasing worldwide with health-related and economic consequences. This is a concern in Africa, including Nigeria the most populous country in Africa, with its high rates of infectious diseases. Approaches to reducing AMR include instigating antimicrobial stewardship programs (ASPs) in hospitals. Currently, no information is available regarding the extent of ASPs in Nigerian hospitals. Consequently, the objective was to address this starting in tertiary hospitals. METHODS: Cross-sectional, questionnaire-based study among tertiary healthcare facilities. Tertiary hospitals were chosen initially since if there are concerns in these training hospitals, such concerns will likely to be exacerbated in others. RESULTS: Completed questionnaires were received from 17 out of 25 tertiary healthcare facilities across five of the six geo-political regions of Nigeria. 10 (58.8%), four (23.6%), two (11.8%) and one (5.8%) respondents were in internal medicine, infectious diseases, medical microbiology and clinical pharmacology respectively. Only six (35.3%) healthcare facilities had a formal organizational structure and a team responsible for ASP. Facility-specific treatment recommendations, based on local AMR patterns, were available in only four (23.5%) facilities. Policies on approval for prescribing specified antimicrobial agents and formal procedures for reviewing their appropriateness after 48 hours was present in only 2 (11.8%) facilities. The cumulative antimicrobial susceptibility report for the previous year was available in only three (17.6%) facilities and only one facility routinely monitored antimicrobial use. CONCLUSION: Significant inadequacies in the availability of ASPs programmes were seen. This needs to be urgently addressed to reduce AMR rates in Nigeria.

Background: Antimicrobial stewardship is currently not mandatory as part of the undergraduate training of pharmacists. Identifying gaps in knowledge and a better understanding of pharmacy students' perceptions about antimicrobial stewardship could assist in recommendations for appropriate changes to the pharmacy degree curricula that may lead to more appropriate use of antimicrobials, within the multidisciplinary team. Methods: A descriptive quantitative study with a survey design was conducted at the eight universities offering the pharmacy degree in South Africa. An electronic questionnaire with four main categories on antimicrobial stewardship was administered to final (fourth) year pharmacy students (June-August 2015). Results: An overall response rate of 26.6% (n = 260) was obtained from 978 students, despite a weekly reminder. Most of the respondents were familiar with antimicrobial stewardship programmes in South Africa (71.9%), and claimed to know what antimicrobial stewardship is (83.5%) with significant differences between the universities (p < 0.001). Only 37.7% of the respondents recalled having had formal training on antimicrobial stewardship, with responses from the eight universities differing significantly (p < 0.001). However, almost all respondents (98.5%) felt that a strong knowledge of antimicrobials was important for their future career, with 90.0% indicating that they would like more training on antimicrobial stewardship at undergraduate level. Conclusion: There were significant differences between the eight universities with regards to undergraduate education on antimicrobial stewardship. In order to help prevent antimicrobial resistance, efforts should be made to introduce concepts of antimicrobial stewardship into the undergraduate pharmacy curricula to promote better use of antimicrobials and prevent antimicrobial resistance.

Background: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction. Method: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with. Results: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed. Conclusions: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments.

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