scholarly journals Antimicrobial Resistance of Sterile Site Infections in Sub-Saharan Africa: A Systematic Review

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Meklit Workneh ◽  
Morgan J Katz ◽  
Mohammed Lamorde ◽  
Sara E Cosgrove ◽  
Yukari C Manabe
Keyword(s):  
Antimicrobial Resistance ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
World Health ◽  
Fluoroquinolone Resistance ◽  
Mechanisms Of Resistance ◽  
Salmonella Spp ◽  
Sterile Site ◽  
Sub Saharan ◽  
Tract Infections

Abstract Sparse data exist from sub-Saharan Africa (SSA) on the prevalence of antimicrobial resistance (AMR). A prior review of antimicrobial resistance in SSA from 1990 to 2013 showed a high prevalence of AMR to commonly used antibiotics in this setting. We reviewed the literature published since 2013. Four databases (PubMed, EMBASE, Cochrane, and African Journals Online) were searched for articles between February 2013 and March 2016 with a focus on sterile site infections (bacteremia, urinary tract infections [UTIs], and meningitis). We focused on the original World Health Organization–identified priority pathogens and antibiotics, prior to the release of the most recently updated and expanded list in 2017. There were 19 eligible studies: bacteremia (12), UTI (6), and meningitis (1). Eight studies were from Western and Central Africa, 8 from Eastern Africa, and 4 from Southern Africa. Prevalence of Escherichia coli resistance to third-generation cephalosporins ranged from 0% to 75%. No studies reported resistance to carbapenems among Klebsiella spp. Prevalence of fluoroquinolone resistance ranged from 8.3% to 100% among E. coli and 0% to 15% among Salmonella spp. Prevalence of resistance to penicillin among Streptococcus pneumoniae isolates ranged from 25% to 100%. Testing for extended-spectrum beta-lactamase was reported in 7 studies (range, 1.3–60% among tested isolates). Methods for evaluating AMR varied across studies; standardized approaches are needed in the region. Testing for mechanisms of resistance is low even in research settings, but important mechanisms of resistance such as ESBL production are present.

scholarly journals Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens: a study of prevalence, risk factors and molecular mechanisms of resistance (ARGUS) in Zimbabwe – a study protocol

2020 ◽  
Vol 5 ◽  
pp. 140
Author(s):  
Ioana D. Olaru ◽  
Shunmay Yeung ◽  
Rashida A. Ferrand ◽  
Richard Stabler ◽  
Prosper Chonzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Molecular Mechanisms ◽  
Outpatient Setting ◽  
Sub Saharan Africa ◽  
Gram Negative ◽  
Sub Saharan ◽  
Few Data ◽  
Tract Infections

Antimicrobial resistance (AMR) is compromising our ability to successfully treat infections. There are few data on gram-negative AMR prevalence in sub-Saharan Africa especially from the outpatient setting. This study aims to investigate the prevalence of and underlying molecular mechanisms for AMR in gram-negative bacilli causing urinary tract infections (UTIs) in Zimbabwe. Risk factors for AMR and how AMR impacts on clinical outcomes will also be investigated. Adults presenting with UTI symptoms at primary health clinics in Harare will be included. A questionnaire will be administered, and urine samples will be collected for culture. Participants with positive urine cultures will be followed up at 7-14 days post-enrolment. All participants will also be followed by telephone at 28 days to determine clinical outcomes. Bacterial identification and antibiotic susceptibility testing will be performed on positive cultures. The results from this study will be used to inform policy and development of treatment recommendations. Whole genome sequencing results will provide a better understanding of the prevalent resistance genes in Zimbabwe, of the spread of successful clones, and potentially will contribute to developing strategies to tackle AMR.

scholarly journals The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia

2020 ◽  
Vol 41 (04) ◽  
pp. 592-604
Author(s):  
Keertan Dheda ◽  
Edson Makambwa ◽  
Aliasgar Esmail
Keyword(s):  
Community Acquired Pneumonia ◽  
Sub Saharan Africa ◽  
World Health ◽  
Limited Data ◽  
Common Cause ◽  
The World ◽  
Diagnostic Approaches ◽  
Sub Saharan ◽  
Health Organization ◽  
Tract Infections

AbstractAccording to World Health Organization estimates, tuberculosis (TB) and lower respiratory tract infections (LRTIs) are both among the top 10 global causes of death. TB and community-acquired pneumonia (CAP), if mortality estimates are combined, would rank as the third most common cause of death globally. It is estimated that each year there are approximately 10 million new cases of TB that are associated with approximately 1.2 million deaths, and almost 450 million new episodes of LRTI (synonymous with CAP) with approximately 4 million associated deaths. Globally, Streptococcus pneumoniae remains the most common cause of CAP. However, although well documented, it is not widely appreciated that in several parts of the world, including sub-Saharan Africa, Asia, and South America, Mycobacterium tuberculosis is an important cause of CAP, if not the most common organism isolated in such settings. Thus, CAP due to M. tuberculosis is not uncommon in some parts of the world with up to a third of cases being attributable to M. tuberculosis. Consequently, TB remains an important clinical entity in the intensive care unit in these settings. Despite its frequency and importance, there are very limited data about TB CAP. In this review we discussed the epidemiology, immunopathogenesis, clinical presentation, diagnosis, management, prognosis, and prevention of TB CAP. The utility of newer diagnostic approaches is highlighted.

scholarly journals Drivers of antimicrobial resistance amongst intestinalEscherichia coliisolated from children in South Asia and sub-Saharan Africa

2017 ◽  
Author(s):  
Danielle J. Ingle ◽  
Myron M. Levine ◽  
Karen L. Kotloff ◽  
Kathryn E. Holt ◽  
Roy M. Robins-Browne
Keyword(s):  
Developing Countries ◽  
Antimicrobial Resistance ◽  
South Asia ◽  
Enteric Bacteria ◽  
Sub Saharan Africa ◽  
Fluoroquinolone Resistance ◽  
E Coli ◽  
Antimicrobial Usage ◽  
Sub Saharan ◽  
Usage Data

AbstractAntimicrobial resistance (AMR) dynamics are poorly understood in developing countries, where data on the prevalence of AMR in enteric bacteria are sparse, particularly among children and in the community setting. Here we use a combination of phenotyping, genomics and antimicrobial usage data to investigate patterns of AMR amongst atypical enteropathogenicE. coli(aEPEC) strains isolated from children <5 years old in seven countries (four in sub-Saharan Africa and three in South Asia) over a three-year period. We detected very high rates of AMR, with 65% of isolates displaying resistance to ≥3 drug classes; the rates of AMR were the same amongst strains associated with diarrhea and strains that were carried asymptomatically. Whole genome sequencing identified a diversity of genetic mechanisms for AMR, which could explain >95% of observed phenotypic resistance. Analysis of AMR gene co-occurrence revealed clusters of acquired AMR genes that were frequently co-located on small plasmids and transposons, providing opportunities for acquisition of multidrug resistance in a single step. We used discriminant analysis to investigate potential drivers of AMR within the bacterial population, and found that genetic determinants of AMR were associated with geographical location of isolation but not with phylogenetic lineage of theE. colistrain or disease status of the human host. Comparison with antimicrobial usage data showed that the prevalence of resistance to newer drugs (fluoroquinolones and third-generation cephalosporins) was correlated with usage, which was generally higher in South Asia than Africa. In particular, fluoroquinolone resistance-associated mutations ingyrAwere significantly associated with use of these drugs for treatment of diarrheic children. Notably resistance to older drugs such as trimethoprim, chloramphenicol and ampicillin, which are conferred by acquired AMR genes that were frequently clustered together in mobile genetic elements, were common in all locations despite differences in usage; this suggests that reversion to sensitivity is unlikely to occur even if these drugs are removed from circulation. This study provides much-needed insights into the frequencies of AMR in intestinalE. coliin community-based children in developing countries and to antimicrobial usage for diarrhea where the burden of infections is greatest.

scholarly journals Africa and the wider world: creole communities in the Atlantic and Indian Oceans

Tempo ◽  
2017 ◽  
Vol 23 (3) ◽  
pp. 465-481
Author(s):  
Malyn Newitt
Keyword(s):  
Technology Transfer ◽  
Indian Ocean ◽  
World Economy ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Cultural Appropriation ◽  
The World ◽  
African Slaves ◽  
The Indian Ocean ◽  
Sub Saharan

Abstract: Portuguese creoles were instrumental in bringing sub-Saharan Africa into the intercontinental systems of the Atlantic and Indian Ocean. In the Atlantic Islands a distinctive creole culture emerged, made up of Christian emigrants from Portugal, Jewish exiles and African slaves. These creole polities offered a base for coastal traders and became politically influential in Africa - in Angola creating their own mainland state. Connecting the African interior with the world economy was largely on African terms and the lack of technology transfer meant that the economic gap between Africa and the rest of the world inexorably widened. African slaves in Latin America adapted to a society already creolised, often through adroit forms of cultural appropriation and synthesis. In eastern Africa Portuguese worked within existing creolised Islamic networks but the passage of their Indiamen through the Atlantic created close links between the Indian Ocean and Atlantic commercial systems.

scholarly journals Resource frontiers and agglomeration economies: The varied logics of transnational land-based investing in Southern and Eastern Africa

AMBIO ◽  
2022 ◽  
Author(s):  
Dilini Abeygunawardane ◽  
Angela Kronenburg García ◽  
Zhanli Sun ◽  
Daniel Müller ◽  
Almeida Sitoe ◽  
...  
Keyword(s):  
Spatial Data ◽  
Large Scale ◽  
Agglomeration Economies ◽  
Sub Saharan Africa ◽  
Eastern Africa ◽  
Track Record ◽  
Level Data ◽  
Forestry Investments ◽  
Sub Saharan ◽  
Investment Location

AbstractActor-level data on large-scale commercial agriculture in Sub-Saharan Africa are scarce. The peculiar choice of transnational investing in African land has, therefore, been subject to conjecture. Addressing this gap, we reconstructed the underlying logics of investment location choices in a Bayesian network, using firm- and actor-level interview and spatial data from 37 transnational agriculture and forestry investments across 121 sites in Mozambique, Zambia, Tanzania, and Ethiopia. We distinguish four investment locations across gradients of resource frontiers and agglomeration economies to derive the preferred locations of different investors with varied skillsets and market reach (i.e., track record). In contrast to newcomers, investors with extensive track records are more likely to expand the land use frontier, but they are also likely to survive the high transaction costs of the pre-commercial frontier. We highlight key comparative advantages of Southern and Eastern African frontiers and map the most probable categories of investment locations.

scholarly journals Individual, community and societal correlates of insecticide treated net use among pregnant women in sub-Saharan Africa: a multi-level analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edward Kwabena Ameyaw
Keyword(s):  
Pregnant Women ◽  
Sub Saharan Africa ◽  
World Health ◽  
Health Concern ◽  
Maternal And Newborn Health ◽  
African Countries ◽  
The World ◽  
Itn Use ◽  
Multi Level ◽  
Sub Saharan

Abstract Background Malaria in pregnancy is a crucial public health concern due to the enormous risk it poses to maternal and newborn health. The World Health Organisation therefore recommends insecticide-treated net (ITN) for pregnant women. The world over, sub-Saharan Africa bears the highest prevalence of malaria and its associated complications. This study investigated the individual, community and society level factors associated with ITN use among pregnant women in sub-Saharan Africa. Methods The study was conducted with Demographic and Health Survey data of 21 sub-Saharan African countries. A total of 17,731 pregnant women who possessed ITN participated in the study. Descriptive computation of ITN use by survey country and socio-demographic characteristics was conducted. Further, five multi-level binary logistic regression models were fitted with MLwiN 3.05 package in STATA. The Markov Chain Monte Carlo (MCMC) estimation procedure was used in estimating the parameters whilst the Bayesian Deviance Information Criterion was used for the model fitness test. Results On average, 74.2% pregnant women in SSA used ITN. The highest prevalence of ITN use occurred in Mali (83.7%) whilst the least usage occurred in Namibia (7%). Women aged 30–34 were more likely to use ITN compared with those aged 45–49 [aOR = 1.14; Crl = 1.07–1.50]. Poorest women were less probable to use ITN relative to richest women [aOR = 0.79; Crl = 0.70–0.89]. Compared to women who did not want their pregnancies at all, women who wanted their pregnancies [aOR = 1.06; Crl = 1.04–1.19] were more probable to use ITN. Women in male-headed households had higher likelihood of ITN use compared to those from female-headed households [aOR = 1.28; Crl = 1.19–1.39]. On the whole, 38.1% variation in ITN use was attributable to societal level factors whilst 20.9% variation was attributable to community level factors. Conclusion The study has revealed that in addition to individual level factors, community and society level factors affect ITN use in SSA. In as much as the study points towards the need to incorporate community and societal variations in ITN interventions, active involvement of men can yield better outcome for ITN utilisation interventions in SSA.

scholarly journals The Relationship Between the Global Burden of Influenza From 2017 to 2019 and COVID-19: Descriptive Epidemiological Assessment (Preprint)

2020 ◽  
Author(s):  
Stefan David Baral ◽  
Katherine Blair Rucinski ◽  
Jean Olivier Twahirwa Rwema ◽  
Amrita Rao ◽  
Neia Prata Menezes ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Temporal Trends ◽  
Sub Saharan Africa ◽  
World Health ◽  
Respiratory Pathogens ◽  
Modes Of Transmission ◽  
The World ◽  
Influenza Activity ◽  
Sub Saharan ◽  
Health Organization

BACKGROUND SARS-CoV-2 and influenza are lipid-enveloped viruses with differential morbidity and mortality but shared modes of transmission. OBJECTIVE With a descriptive epidemiological framing, we assessed whether recent historical patterns of regional influenza burden are reflected in the observed heterogeneity in COVID-19 cases across regions of the world. METHODS Weekly surveillance data reported by the World Health Organization from January 2017 to December 2019 for influenza and from January 1, 2020 through October 31, 2020, for COVID-19 were used to assess seasonal and temporal trends for influenza and COVID-19 cases across the seven World Bank regions. RESULTS In regions with more pronounced influenza seasonality, COVID-19 epidemics have largely followed trends similar to those seen for influenza from 2017 to 2019. COVID-19 epidemics in countries across Europe, Central Asia, and North America have been marked by a first peak during the spring, followed by significant reductions in COVID-19 cases in the summer months and a second wave in the fall. In Latin America and the Caribbean, COVID-19 epidemics in several countries peaked in the summer, corresponding to months with the highest influenza activity in the region. Countries from regions with less pronounced influenza activity, including South Asia and sub-Saharan Africa, showed more heterogeneity in COVID-19 epidemics seen to date. However, similarities in COVID-19 and influenza trends were evident within select countries irrespective of region. CONCLUSIONS Ecological consistency in COVID-19 trends seen to date with influenza trends suggests the potential for shared individual, structural, and environmental determinants of transmission. Using a descriptive epidemiological framework to assess shared regional trends for rapidly emerging respiratory pathogens with better studied respiratory infections may provide further insights into the differential impacts of nonpharmacologic interventions and intersections with environmental conditions. Ultimately, forecasting trends and informing interventions for novel respiratory pathogens like COVID-19 should leverage epidemiologic patterns in the relative burden of past respiratory pathogens as prior information.

scholarly journals Prevalence and antibiotic resistance of bacterial pathogens isolated from childhood diarrhoea in four provinces of Kenya

2012 ◽  
Vol 6 (07) ◽  
pp. 572-578 ◽  
Author(s):  
Willie Kipkemboi Sang ◽  
Valerie Oundo ◽  
David Schnabel
Keyword(s):  
Antimicrobial Resistance ◽  
Rural Areas ◽  
Hospital Admissions ◽  
Sub Saharan Africa ◽  
Vibrio Cholera ◽  
Antimicrobial Drug Resistance ◽  
E Coli ◽  
Shigella Isolate ◽  
Stool Samples ◽  
Sub Saharan

Introduction: Diarrhoea is one of the main causes of morbidity and mortality among children in sub-Saharan Africa, and one of the main causes of hospital admissions in rural areas of Kenya. In Kenya, antimicrobial resistance surveillance has been conducted only at the institutional levels, with limited sharing of information and analysis of data. As a result, the actual scale of regional or national antimicrobial drug resistance is not well defined. Methodology: Stool samples were collected between 1 October 2007 and 30 September 2008 from a total of 651 outpatients with diarrhoea who were under five years of age in four provinces of Kenya.  Conventional, biochemical methods, multiplex PCR and antimicrobial susceptibility were conducted to identify the bacterial causes and virulence factors in the isolates, respectively.  Results: Of the 651 patients screened, we identified the causes of 115 cases (17.7%) as follows: Pathogenic E. coli (11.2%) [enteroaggregative (8.9%), enterotoxigenic (1.2%), enteroinvasive (0.6%), shigatoxigenic (0.5%)], Salmonella (3.5%), Shigella (2%) and Vibrio cholera O1 (0.7%). The highest levels of resistance among the E. coli isolates were observed in ampicillin and trimethoprim/sulphamethoxazole each at 95% followed by tetracycline at 81%. Shigella isolate levels of resistance ranged from 80% to 100% for ampicillin, tetracycline and trimethoprim/sulphamethoxazole. Conclusion: The highest prevalence of antimicrobial resistance was to ampicillin followed by trimethoprim/sulphamethoxazole and tetracycline. Though still at low levels, the major concern from our findings is the emerging resistance of enteric pathogens that was observed to quinolones (ciprofloxacin, nalidixic acid, norfloxacin) and gentamycin.

Pregnancy intention and gestational age at first antenatal care visit in Lesotho

2021 ◽  
Vol 15 (1) ◽  
pp. 1-11
Author(s):  
Paul Mkandawire ◽  
Joseph Kangmennaang ◽  
Chad Walker ◽  
Roger Antabe ◽  
Kilian Atuoye ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Gestational Age ◽  
Secondary Data ◽  
Universal Coverage ◽  
Sub Saharan Africa ◽  
World Health ◽  
Antenatal Visit ◽  
Life Saving ◽  
Sub Saharan ◽  
Health Organization

Background/aims With coverage of antenatal care in sub-Saharan Africa approaching a universal level, attention is now turning to maximising the life-saving potential of antenatal care. This study assessed the gestational age at which pregnant mothers make their first antenatal visit in the context of high antenatal coverage in Lesotho. Methods For the purposes of this study, secondary data from the Demographic and Health Survey of 2014 was analysed. These data were collected in 2014, via an interviewer administered questionnaire. Survival analysis was applied to the data, using Stata SE 15 to compute time ratios that estimate time to first antenatal visit in Lesotho. Results Despite near universal coverage, only 24% of mothers start antenatal care before 12 weeks of gestation, as recommended by the World Health Organization. In addition, mothers with unwanted pregnancies are most likely to delay antenatal care until later in gestation, followed by mothers with mistimed pregnancies. Education, but not wealth, correlates with the start of antenatal care. Conclusions Having achieved near universal coverage, emphasising a prompt start and adherence to recommended visits could optimise the life-saving potential of antenatal care in Lesotho.

Feasibility and acceptability of frequent vaginal self-sampling at home by Rwandan women at high risk of urogenital tract infections

2021 ◽  
pp. sextrans-2020-054816
Author(s):  
Marijn C Verwijs ◽  
Stephen Agaba ◽  
Marie-Michele Umulisa ◽  
Janneke H H M van de Wijgert
Keyword(s):  
Group Discussion ◽  
Amplicon Sequencing ◽  
Randomised Clinical Trial ◽  
Sub Saharan Africa ◽  
16S Rrna Amplicon Sequencing ◽  
Resource Setting ◽  
Vaginal Swabs ◽  
Sub Saharan ◽  
Tract Infections ◽  
At Home

ObjectivesTo establish temporal links between vaginal microbiota (VMB) data and incident clinical events, frequent longitudinal vaginal sampling is required. Self-collection of swabs at the participant’s home may be useful to avoid overburdening research clinics and participants. One-off vaginal self-sampling for STI or cervical cancer screening programmes has been shown to be feasible and acceptable to women in multiple studies, including in sub-Saharan Africa, but the feasibility and acceptability of frequent longitudinal vaginal sampling in the context of VMB sequencing studies is unknown.MethodsTwelve participants of a randomised clinical trial in Kigali, Rwanda, self-collected vaginal swabs three times a week for a month. We studied feasibility by comparing DNA concentrations, proportions of samples with >1000 16S rRNA amplicon sequencing reads and VMB composition outcomes of self-collected swabs with clinician-collected swabs. We evaluated the acceptability of self-collection using structured face-to-face interviews and a focus group discussion.ResultsThe participants collected vaginal swabs at 131 different time points. One woman stopped self-sampling after one try due to a social harm. All self-sampled swabs generated >1000 rRNA amplicon sequencing reads, and the DNA concentration of self-sampled swabs and clinician-sampled swabs did not differ significantly (Kruskal-Wallis p=0.484). Self-sampled and clinician-sampled swabs generated similar VMB composition data. Participants reported feeling very comfortable during self-sampling (11/12; 91.7%) and that self-sampling had become easier over time (12/12; 100%). They mentioned reduced travel time and travel costs as advantages of self-sampling at home.ConclusionsFrequent longitudinal vaginal sampling at home is feasible and acceptable to participants, even in the context of a low-resource setting, as long as adequate counselling is provided.Trial registration numberNCT02459665.

Sign in / Sign up

Export Citation Format

Share Document