Antimicrobial resistance surveillance in Ethiopia: Implementation experiences and lessons learned

Abstract

IntroductionAntimicrobial resistance (AMR) poses a global threat. High levels of AMR to commonly used antibiotics have been reported in East Africa. A situation analysis of AMR in Ethiopia also indicated high resistance levels. To prevent and contain AMR, Ethiopia established a national surveillance network.ObjectivesThis article describes the steps taken to prioritise AMR and establish the National Antimicrobial Resistance Surveillance System in Ethiopia, as well as present the challenges and lessons learned through implementation.MethodsIn April 2017, Ethiopia had developed and approved the National AMR Surveillance Plan for laboratory-based AMR surveillance. The World Health Organization recommendations and Ethiopias’s current microbiology capacity were used to prioritise organisms for reporting. The surveillance system is comprised of a network linking the national reference laboratory with surveillance sentinel sites. Roll-out of the AMR surveillance network occurred in three phases in order to ensure successful implementation.ResultsElectronic capture and transmission of data, supply chain for the microbiology laboratory and communication problems were challenges observed after implementation started. Support from Ethiopian Public Health Institute focal persons for data entry, regular scheduled communication establishment and procurement of supplies by the American Society for Microbiology were some of the measures taken to address the challenges.ConclusionEthiopia has demonstrated that setting up AMR surveillance in lower resource settings is possible with strong leadership and stakeholder engagement.

Assessment of knowledge, practice, and status of food handlers toward Salmonella, Shigella, and intestinal parasites: A cross-sectional study in Tigrai prison centers, Ethiopia

“…These findings suggested that the issue of antimicrobial resistance has not yet been resolved in Ethiopia. Antibiotic resistance has become a major public health threat throughout the globe, which requires collaborative intervention [ 33 ]. The main factors that contribute to antimicrobial resistances include mutations in bacterial genomes, inappropriate use of antibiotics, poor drug regulation policies, improper drug prescription, and disobedience to prescription [ 34 ].…”

Guideline Recommendations for Empirical Antimicrobial Therapy: An Appraisal of Research Evidence for Clinical Decision-Making in Ethiopia

“…Six of the reviewed SRs and MAs (three moderate [20,25,26] and three critically low quality [21,22,24]) revealed significantly high resistance of erythromycin (30-97.6%). According to the FMHACA national baseline, AMR surveillance reported that the resistance of Streptococcus pneumonia, the most common cause of CAP, to erythromycin increased from 0% in 1996 to 19.2% in 2000 [9]. In Ethiopia, where clinicians are not supported by basic bacteriology services to ensure that treatment is tailored to the specific condition, information deduced from such pooled data is crucial in principle.…”

“…Bacterial infections are the major cause of death in Ethiopia, and antibacterial resistance threatens the management of bacterial infection in the health care setting [8]. The first national AMR baseline survey (2009) revealed that most bacteria causing common infections in humans showed considerable resistance to commonly used first-line antibacterial agents [9]. The country's Medicine and Health Care Administration and Control Authority (FMHACA), currently called the EFDA (Ethiopia Food and Drug Administration), has established STGs for the three levels of the health care system (health centers, primary and general hospitals) since 2004 and has an updated third edition [10].…”

The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania

“…Institutions that have successfully implemented programs to curb inappropriate antimicrobial prescribing have done so through interdisciplinary clinician education, protocol development, and ongoing reviews of guideline adherence [4,5]. Establishment of these antimicrobial stewardship (AMS) interventions has been developed in multiple LMICs [6][7][8][9][10]. Specifically in African nations, AMS implementation has been limited but successful in several published reports, although these programs have additional challenges [11][12][13][14][15][16][17][18][19][20].…”