Identifying and addressing challenges to antimicrobial use surveillance in the human health sector in low- and middle-income countries: experiences and lessons learned from Tanzania and Uganda

Abstract

Background Antimicrobial resistance (AMR) is a global health security threat and is associated with increased morbidity and mortality. One of the key drivers of AMR is the inappropriate use of antibiotics. A key component of improving antibiotic use is conducting antimicrobial use (AMU) surveillance. Methods USAID Medicines Technologies and Pharmaceutical Services Program has supported the implementation of antimicrobial stewardship activities, including setting up systems for AMU surveillance in Tanzania and Uganda. Results from both countries have been previously published. However, additional implementation experience and lessons learned from addressing challenges to AMU surveillance have not been previously published and are the subject of this narrative article. Results The team identified challenges including poor quality data, low digitalization of tools, and inadequate resources including both financial and human resources. To address these gaps, the Program has supported the use of continuous quality improvement approaches addressing gaps in skills, providing tools, and developing guidelines to fill policy gaps in AMU surveillance. Recommendations to fill these gaps, based on the Potter and Brough systematic capacity building model have been proposed. Conclusions Strengthening AMU surveillance through using a capacity-building approach will fill gaps and strengthen efforts for AMR control in both countries.

The epidemiology of antibiotic-resistant clinical pathogens in Uganda

“…The emergence of ABR is strongly associated with the level of antibiotic exposure and worryingly, the use of antibiotics in both humans and animals has increased by 46% over the past two decades (8), with a projected 67% increase in animal antibiotic usage by 2030 due to rapid climate-driven environmental changes (9). This level of use will inevitably come with an increase in ABR and extra-burden to already struggling health care systems especially in the developing world, which is why robust antibiotic stewardship strategies are urgently required to preserve the effectiveness of currently available antibiotics and safeguard public health (10,11). Global efforts to address antimicrobial resistance (AMR) as a whole have been gaining momentum since the launch of an action plan in 2015, which is implemented through national action plans (12).…”

“…Here, AMR surveillance active or passive surveillance strategies can serve as critical sources of evidence for NAPs implementation and outcome realization. In our earlier country situation report, we presented Uganda’s efforts towards developing a sentinel surveillance system (27) which is a non-trivial endeavor, especially in Low- and Middle-Income countries (LMIC) where data quality is affected by manual data capture methods, inadequate diagnostic capacity, inadequate resources including both financial and human resources (11).…”

Quality of Data Recording and Antimicrobial Use in a Municipal Veterinary Clinic in Ghana

“…The quality of prescription data recorded by veterinary healthcare providers is critical in the development of the national standards and policies required to contain the development of antimicrobial resistance (AMR) [3]. These data contribute to the understanding of the factors that contributes to antimicrobial stewardship, which is essential for monitoring and tracking the use of antimicrobials in veterinary facilities [4].…”

“…The data used for antimicrobial stewardship programs implemented in Africa for continuous quality improvement is largely obtained from global AMR control initiatives [7]. These may vary from one country to another as a result of the different methodologies and tools used [3,7].…”

“…Many LMICs, including Ghana, either lack or have inadequate uptake of contextspecific policy frameworks [8,9]. These frameworks may include National Action Plans (NAPs) that clearly outline objectives and strategies for addressing the issues related to antimicrobial resistance specific to a country's veterinary medicine sector, antimicrobial prescription guidelines on how antimicrobials should be prescribed for the management of diseases in animals, and education and training for veterinary prescribers on the best practices for prescribing and dispensing antimicrobials [3,8]. In 2017, 44 out the 54 African countries submitted reports on antimicrobial use to the World Organization for Animal Health (WOAH, previously OiE).…”