Antifungal resistance and stewardship: a call to action in Zambia

Mudenda, Steward; Chabalenge, Billy; Kasanga, Maisa; Mufwambi, Webrod; Mfune, Ruth Lindizyani; Daka, Victor; Matafwali, Scott Kaba

doi:10.11604/pamj.2023.45.152.41232

Cited by 4 publications

(4 citation statements)

References 9 publications

(13 reference statements)

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“…Antifungal resistance (AFR) remains a problem that has been neglected compared to antibacterial and antiviral resistance [58] [73] [76] [88] [89]. This study was conducted to comprehensively provide information on the global and regional studies published on AFR and AFS and provide recommendations to address this problem.…”

Section: Resultsmentioning

confidence: 99%

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Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Mudenda

2024

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Background: Antifungal resistance (AFR) is a global public health problem with devastating effects, especially among immunocompromised individuals. Addressing AFR requires a One Health approach including Antifungal Stewardship (AFS). This study aimed to comprehensively review global studies published on fungal infections and AFR and to recommend solutions to address this growing problem. Materials and Methods: This was a narrative review that was conducted using published papers on fungal infections, AFR, and AFS between January 1961 and March 2024. The literature was searched using PubMed, Google Scholar, Web of Science, and EMBASE. Results: This found that there has been an increase in fungal infections globally, especially among immunocompromised patients. Due to this increase in fungal infections, there has been a proportionate increase in the use of antifungal agents to prevent and treat fungal infections. This increased use of antifungal agents has worsened the problem of AFR contributing to increased morbidity and mortality. Globally, fungal infections have contributed to 150 million infections annually and 1.7 million deaths per year. By the year 2023, over 3.8 million people died from fungal infections. Addressing AFR remains a challenge because the treatment of antifungal-resistant infections is difficult. Finally, the treatment of fungal infections is a global challenge exacerbated by the limited number of antifungal agents to treat invasive fungal infections. Conclusion: The results of this study indicated that fungal infections and AFR are prevalent across humans, animals, agriculture, and the environment. Addressing this problem requires the provision of solutions such as improving the awareness of AFR, conducting further research on the discovery of new antifungal agents, and implementing AFS programs. If this global problem is not addressed, the morbidity and mortality associated with AFR will continue to rise in the future.How to cite this paper: Mudenda, S.

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Section: Resultsmentioning

confidence: 99%

“…Strategies to address AFR have been documented and require urgent attention just like those implemented to address AMR [14] [66] [75]. Antifungal stewardship (AFS) programs have been reported to be effective in addressing AFR [76].…”

Section: Introductionmentioning

confidence: 99%

Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Mudenda

2024

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“…The Ministry of Health and the Zambia National Public Health Institute (ZNPHI) should also champion the promotion of research and awareness campaigns on AFR and support AFSPs. 22 …”

Section: Discussionmentioning

confidence: 99%

“… 11 , 21 This skew has had unintended consequences of leaving AFR relatively neglected compared with antibiotic resistance (ABR), which is despite increasing concerns with AFR. 9 , 13 , 22 This oversight has serious implications for the overall management of fungal infections, although this is starting to change with, for instance, the call for more research on AFR and the introduction of stewardship programmes to improve the utilization of antifungals. 23 For instance, in Zambia, Nowbuth et al ., 24 in their recent systematic review on published studies regarding the prevalence of AMR in Zambia, did not find any studies on AFR meeting their inclusion criteria.…”

Section: Introductionmentioning

confidence: 99%

Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications

Mudenda,

Matafwali,

Mukosha

et al. 2023

JAC-Antimicrobial Resistance

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Introduction Antifungal resistance (AFR) is a growing global public health concern. Little is currently known about knowledge, attitudes and practices regarding AFR and antifungal stewardship (AFS) in Zambia, and across the globe. To address this evidence gap, we conducted a study through a questionnaire design starting with pharmacy students as they include the next generation of healthcare professionals. Methods A cross-sectional study among 412 pharmacy students from June 2023 to July 2023 using a structured questionnaire. Multivariable analysis was used to determine key factors of influence. Results Of the 412 participants, 55.8% were female, with 81.6% aged between 18 and 25 years. Most students had good knowledge (85.9%) and positive attitudes (86.7%) but sub-optimal practices (65.8%) towards AFR and AFS. Overall, 30.2% of students accessed antifungals without a prescription. Male students were less likely to report a good knowledge of AFR (adjusted OR, AOR = 0.55, 95% CI: 0.31–0.98). Similarly, students residing in urban areas were less likely to report a positive attitude (AOR = 0.35, 95% CI: 0.13–0.91). Fourth-year students were also less likely to report good practices compared with second-year students (AOR = 0.48, 95% CI: 0.27–0.85). Conclusions Good knowledge and positive attitudes must translate into good practices toward AFR and AFS going forward. Consequently, there is a need to provide educational interventions where students have low scores regarding AFR and AFS. In addition, there is a need to implement strategies to reduce inappropriate dispensing of antifungals, especially without a prescription, to reduce AFR in Zambia.

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Antimicrobial stewardship: knowledge, attitudes and practices regarding antimicrobial use and resistance among non-healthcare students at the University of Zambia

Mudenda,

Chisha,

Chabalenge

et al. 2023

JAC-Antimicrobial Resistance

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Background Antimicrobial resistance (AMR) poses a significant threat to the world and could become humanity's next major challenge. This study assessed non-healthcare students’ knowledge, attitude and practices (KAP) towards antimicrobial use (AMU) and AMR at the University of Zambia. Methods This cross-sectional study was conducted among 443 non-healthcare students from August to October 2022 using a structured questionnaire. Data analysis was done using IBM SPSS version 24.0. Results Of the 433 participants, 55.2%, 63.5% and 45% had moderate KAP scores regarding AMU and AMR. The prevalence of self-medication with antibiotics was 76.7%. Male participants were less likely to have good knowledge (OR = 0.524, 95% CI: 0.347–0.792) and positive attitudes (OR = 0.585, 95% CI: 0.364–0.940) towards AMU and AMR compared with females. Students who were studying Engineering and Mining were more likely to have good knowledge of AMR (OR = 1.891, 95% CI: 1.197–2.987) compared with those in Social Sciences. Those who were in their fourth and fifth years were more likely to have positive attitudes towards AMU and AMR (OR = 1.851, 95% CI: 1.147–2.986) compared with those who were in the first, second and third years. Finally, students who practised self-medication were less likely to have good self-reported practice towards AMR (OR = 0.442, 95% CI: 0.278–0.702) compared with those who did not. Conclusions This study demonstrated that non-healthcare students had moderate KAP regarding AMU and AMR. All university students should be provided with education about AMU and AMR through free short courses, seminars, workshops, and AMR and antimicrobial stewardship awareness campaigns.

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Antifungal resistance and stewardship: a call to action in Zambia

Cited by 4 publications

References 9 publications

Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Antifungal resistance and stewardship: a knowledge, attitudes and practices survey among pharmacy students at the University of Zambia; findings and implications

Antimicrobial stewardship: knowledge, attitudes and practices regarding antimicrobial use and resistance among non-healthcare students at the University of Zambia

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