Introduction
Methods
Initial search terms
|
Refining terms
|
---|---|
“Antibiotic resistan*” | “east* Africa*” |
“Antimicrobial* resistan*” | “east* Africa*countr*” |
“Drug* resistan*” | “Kenya*” |
“Multi-drug resistan*” | “Uganda*” |
“Multidrug resistan*” | “Tanzania*” |
“Multiple-drug resistan*” | “Ethiopia*” |
“Multiple drug* resistan*” | “Rwanda*” |
“Antibiotic* susceptib*” | “Burundi” |
“Antimicrobial* susceptib*” | “enterobacteria*” |
“Drug* susceptib*” | “enter* pathogen*” |
“Multi-drug susceptib*” | “diarrh* pathogen*” |
“Multidrug susceptib*” | “Salmonella* resistan*” |
“Multiple-drug susceptib*” | “Shigella* resistan*” |
“Multiple drug* susceptib*” | “Vibrio resistan*” |
“Escherichia* resistance*” |
Data extraction for analysis
Results
Study selection
Study characteristics
Population
Bur
|
Eth
|
Ken
|
Rwa
|
Tan
|
Uga
| ||||
---|---|---|---|---|---|---|---|---|---|
A. Human studies
|
Total
|
Citation
| |||||||
E. coli
| Adults | - | - | 1 | - | - | - | 1 | [15] |
Children | - | - | 5 | - | - | 1 | 6 | ||
All ages | - | 1 | 2 | - | - | 1 | 4 | ||
(n)
|
0
|
2
|
8
|
0
|
0
|
2
|
11
| ||
Salmonella
sp.
| Adults | - | 4 | 5 | - | - | - | 9 | |
Children | - | 2 | 5 | - | 1 | 1 | 9 | ||
All ages | - | 4 | 10 | 1 | 1 | 16 | |||
(n)
|
0
|
10
|
20
|
1
|
1
|
2
|
34
| ||
Shigella
sp.
| Adults | - | 2 | - | - | - | - | 2 | |
Children | - | 2 | - | - | 1 | - | 3 | ||
All ages | 4 | 9 | 6 | 8 | 1 | 1 | 29 | ||
(n)
|
4
|
13
|
6
|
8
|
2
|
1
|
34
| ||
Vibrio
sp.
| All ages | 1 | 1 | - | 4 | 3 | 1 | 10 | |
N
|
5
|
25
|
34
|
13
|
6
|
6
|
89
| ||
B. Animal studies
| |||||||||
E. coli
| - | 1 | 11 | - | - | - | 12 | ||
Salmonella
sp.
| - | 14 | 1 | - | 1 | - | 16 | ||
N
|
0
|
15
|
12
|
0
|
1
|
0
|
28
|
Laboratory methods
Pathogens and resistances tested
I. Factors that favor the emergence, dissemination and/or persistence of AMR
| |
a) Factors common to human and animal studies
| |
• Ease of access (cheap, widely available) to antibiotics | |
• Antibiotic use practices, including self-medication, high frequency of antibiotic use, sub-therapeutic use or indiscriminate use | |
b) Human studies
| |
• Over-prescription at health facilities due to limited diagnostics resources | |
• Severe infections requiring different antibiotics | Rwanda [79] |
• Human importation of antibiotic resistant bacteria | Burundi [75] |
• Nosocomial or community transmission of resistant bacteria | |
c) Animal studies
| |
• Resistant bacteria imported via contaminated food | |
• Antibiotic use in humans | |
• Animal-animal contact | Ethiopia [119] |
• Animal-human close co-existence increasing contact | Kenya [103] |
• High antibiotic use in animals in small production systems, poor farm management practices disseminating resistant bacteria | |
• Housing contamination | Ethiopia [124] |
• Contamination during handling animal products. | |
II. Factors that contribute to the reduction of AMR
| |
• High cost of antibiotic | |
• Limiting antibiotic availability | |
• Periodic withdrawal of antibiotics from public use | |
• Parenteral administration of antibiotics | Ethiopia [47] |
• Infrequent or prudent use of antibiotics |