The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed.

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Antibiotic resistance—the need for global solutions

Objective
To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15–49 years, in 2016.

Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016.

Background: access to safe drinking-water is a fundamental requirement for good health and is also a human right. Global access to safe drinking-water is monitored by WHO and UNICEF using as an indicator “use of an improved source,” which does not account for water quality measurements. Our objectives were to determine whether water from “improved” sources is less likely to contain fecal contamination than “unimproved” sources and to assess the extent to which contamination varies by source type and setting. Methods and findings: studies in Chinese, English, French, Portuguese, and Spanish were identified from online databases, including PubMed and Web of Science, and grey literature. Studies in low- and middle-income countries published between 1990 and August 2013 that assessed drinking-water for the presence of Escherichia coli or thermotolerant coliforms (TTC) were included provided they associated results with a particular source type. In total 319 studies were included, reporting on 96,737 water samples. The odds of contamination within a given study were considerably lower for “improved” sources than “unimproved” sources (odds ratio [OR] = 0.15 [0.10–0.21], I2 = 80.3% [72.9–85.6]). However over a quarter of samples from improved sources contained fecal contamination in 38% of 191 studies. Water sources in low-income countries (OR = 2.37 [1.52–3.71]; p Conclusion: access to an “improved source” provides a measure of sanitary protection but does not ensure water is free of fecal contamination nor is it consistent between source types or settings. International estimates therefore greatly overstate use of safe drinking-water and do not fully reflect disparities in access. An enhanced monitoring strategy would combine indicators of sanitary protection with measures of water quality

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Fecal Contamination of Drinking-Water in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Antimicrobial resistance (AMR) is widely acknowledged as a global problem, yet in many parts of the world its magnitude is still not well understood. This review, using a public health focused approach, aimed to understand and describe the current status of AMR in Africa in relation to common causes of infections and drugs recommended in WHO treatment guidelines. PubMed, EMBASE and other relevant databases were searched for recent articles (2013–2016) in accordance with the PRISMA guidelines. Article retrieval and screening were done using a structured search string and strict inclusion/exclusion criteria. Median and interquartile ranges of percent resistance were calculated for each antibiotic-bacterium combination. AMR data was not available for 42.6% of the countries in the African continent. A total of 144 articles were included in the final analysis. 13 Gram negative and 5 Gram positive bacteria were tested against 37 different antibiotics. Penicillin resistance in Streptococcus pneumoniae was reported in 14/144studies (median resistance (MR): 26.7%). Further 18/53 (34.0%) of Haemophilus influenza isolates were resistant to amoxicillin. MR of Escherichia coli to amoxicillin, trimethoprim and gentamicin was 88.1%, 80.7% and 29.8% respectively. Ciprofloxacin resistance in Salmonella Typhi was rare. No documented ceftriaxone resistance in Neisseria gonorrhoeae was reported, while the MR for quinolone was 37.5%. Carbapenem resistance was common in Acinetobacter spp. and Pseudomonas aeruginosa but uncommon in Enterobacteriaceae. Our review highlights three important findings. First, recent AMR data is not available for more than 40% of the countries. Second, the level of resistance to commonly prescribed antibiotics was significant. Third, the quality of microbiological data is of serious concern. Our findings underline that to conserve our current arsenal of antibiotics it is imperative to address the gaps in AMR diagnostic standardization and reporting and use available information to optimize treatment guidelines.

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Antimicrobial resistance in Africa: a systematic review

Antibiotic resistance in drinking water systems: Occurrence, removal, and human health risks.

Background: Escherichia coli is the leading cause of urinary tract, ear, wound and other infections in humans. Increasing rates of antimicrobial resistance among E. coli is a growing concern worldwide. Objectives: The aim of this study was to determine the prevalence and antimicrobial susceptibility of E. coli from clinical samples. Method: A retrospective review of culture results of urine, ear discharge, pus swab from wounds, and eye discharge was done. A total of 3,149 samples were analyzed for isolation and identification of bacteria and antimicrobial susceptibility testing. Results: E. coli was isolated from 446 (14.2%) samples. The highest isolation rate was obtained from urine samples 203 (45.5%). High resistance rates to erythromycin (89.4%), amoxicillin (86.0%) and tetracycline (72.6%) were documented. However, significantly high degree of sensitivity rates to nitrofurantoin (96.4%), norflaxocin (90.6%), gentamicin (79.6%) and ciprofloxacin were recorded (p<0.001). Multiple antimicrobial resistances of 74.6% and increased resistance rates to all antimicrobials except ciprofloxacin were also recorded. Conclusion: E. coli isolates showed high rates of resistance to erythromycin, amoxicillin and tetracycline. Nitrofurantoin, norflaxocin, gentamicin and ciprofloxacin are considered appropriate for empirical treatment of E. coli in the study area. Regular monitoring of antimicrobial susceptibility is recommended. Key words: E. coli , antimicrobial susceptibility, Ethiopia

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Antimicrobial susceptibility patterns of E. coli from clinical sources in northeast Ethiopia.

Background: Food borne diseases are a global public health problem. Food handlers play a major role for the transmission of food borne diseases. Objectives: This study was aimed at exploring the prevalence of intestinal parasites, S. typhi carrier rate and risk factors among food handlers at Bahir Dar town. Methods: A cross -sectional survey was conducted among food handlers working in different kitchens. A pre-tested structured questionnaire was used for collecting data. Stool samples were investigated for intestinal parasites and S. typhi as per the standard laboratory methods. Results: Among 384 food handlers, females comprised 300 (78%). The majority 371 (96.6%) were young adults (12-40 years). The median year of service was 1 year (1 month to 24 years). All food handlers had no previous medical checkup and 54 (14%) were certified as food handlers. One hundred fifty eight (41.1%) food handlers had intestinal parasites and 6 (1.6%) were found positive for S. typhi. Of these, 25 (6.5%) were suffering from diarrhoea. Nine species of intestinal parasites, 2 protozoa (E. histolytica/dispar 12.76% and G. lamblia 7. 0%) and 7 helminthes (A. lumbricoides, 11.7%, Hookworm, 8.1%, S. stercoralis, 2.86%, S. mansoni, 1.8%, Taenia species, 1.3%, H. nana, 0.5% and T. trichiuria, 0.5%) were detected. Conclusion: Inexperienced and poor personal hygienic food handlers play a role for transmission of food borne infections. Local health authorities should implement food handler’s training on food safety, institute periodic focused medical check up for food handlers and improve human waste disposal. [Ethiop. J. Health Dev. 2010;24(1):46-50]

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Prevalence of Salmonella typhi and intestinal parasites among food handlers in Bahir Dar Town, Northwest Ethiopia.

Antimicrobial resistance (AMR) is a major global public health problem both in hospital and community acquired infections. The present study assessed the knowledge and beliefs on AMR among physicians and nurses in 13 hospitals in Amhara region, Ethiopia, which is a low-income country. A cross-sectional study using a self-administered questionnaire was applied. A total of 385 participants (175 physicians and 210 nurses) took part in the study. Sixty five percent of physicians and 98% of nurses replied that they need training on antimicrobial stewardship. Only 48% of physicians and 22.8% of nurses had exposures for local antibiogram data. Overall, 278 (72.2%) of participants were knowledgeable about AMR. Majority of participants agreed or strongly agreed AMR as worldwide and national problem but few considered AMR as problem in their own hospitals. The two most important factors mentioned for AMR development were patients’ poor adherence to prescribed antimicrobials (86%) and overuse of antibiotics (80.5%). The most leading local factors identified for AMR development were: self-antibiotic prescription (53.5%), lack of access to local antibiogram data (12.3%) and prescriber poor awareness about AMR (9.2%). Factors perceived for excessive antibiotic prescriptions were: patient drive (56%), treatment failure (79%), unknown febrile illnesses (39.7%) and upper respiratory tract infections (33.4%). Majority of physicians and nurses lack up to-date knowledge on AMR. Unavailability of local antibiogram data, self-prescription by patients and poor awareness on AMR are areas of interventions for prevention and control of AMR.

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Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are the two most important agents of infectious diseases. Both HBV and HIV share common modes of transmission and have serious effects on both pregnant women and infants. In Bahir Dar city administration, there is a scarcity of information on sero-prevalence of HIV and HBV infection among pregnant women. The main objective of this study was to assess sero-prevalence and risk factors of HIV and HBV infection among pregnant women attending antenatal care in Bahir Dar city, Northwest Ethiopia. A cross-sectional study was conducted from March 2013 to April 2013. Socio-demographic and explanatory variables were collected using a structured questionnaire by face to face interview. Hepatitis B surface antigen (HBsAg) was detected using an enzyme linked immunosorbent assay (ELISA). HIV infection was also detected using the national HIV test algorithms. The results were analyzed with descriptive statistics and binary logistic regression. The odds ratio and 95% Confidence intervals were calculated. A total of 318 pregnant women with the mean age of 25.72 (SD. ±5.14) years old were enrolled. Overall, 21/318 (6.6%) and 12 /318 (3.8%) of the pregnant women were positive for HIV and HBsAg, respectively. Of these, HIV/HBV co-infection rate was 4 (19.0%). Previous history of blood transfusion (AOR = 3.7, 95% CI, 9.02-14.84), body tattooing (AOR = 5.7, 95% CI, 1.24-26.50), history of surgery (AOR = 11.1, 95% CI, 2.64-46.88) and unsafe injection (AOR = 5.6, 95% CI, 1.44-22.19) were significantly associated with HBV infection. Previous history of piercing with sharp materials (AOR = 3.0, 95% CI 1.17-7.80) and history of abortion (AOR = 6.6, 95% CI 2.50-17.71) were also statistically significant for HIV infection. This study indicates that HIV and HBV infections are important public health issues in our region that need to be addressed. All pregnant women need to be screened for both HIV and HBV infections during antenatal care. Furthermore, health education about modes of transmission of HIV and HBV has to be given.

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Sero-prevalence and risk factors of hepatitis B virus and human immunodeficiency virus infection among pregnant women in Bahir Dar city, Northwest Ethiopia: a cross sectional study

Background: Lack of basic infrastructure, poor knowledge of hygiene and practices in food service establishments can contribute to outbreaks of foodborne illnesses. The aims of this study were to investigate the food safety knowledge and practices of food handlers and to assess the sanitary conditions of food service establishments in Bahir Dar town. Methods: A cross-sectional study was conducted in Bahir Dar in May 2011 and data were collected using questionnaire and observation checklist on employees’ knowledge of food hygiene and their practices as well on sanitary conditions of the food service establishments. Results: The median age of the food handlers was 22 years and among the 455 subjects 99 (21.8%) have had food hygiene training. Sixty six percent of the establishments had flush toilets whereas 5.9% of the establishment had no toilet. Only 149 (33.6%) of the establishments had a proper solid waste collection receptacle and there was statistically significant association between the sanitary conditions and license status of the establishments (p=0.01). Most of all, knowledge gap in food hygiene and handling practice was observed. In addition, there was statistically significant difference between trained (professional) handlers and non-trained handlers with regard to food hygiene practices (p<0.05). While more than 50% of the handlers prepare meals ahead of the peak selling time, more than 50% of the left over was poorly managed. Conclusion: This study revealed poor sanitary conditions and poor food hygiene practices of handlers. Educational programs targeted at improving the attitude of food handlers and licensing and regular inspections have been recommended.

https://www.ajol.info/index.php/ejhs/article/download/77674/68103

Bayeh Abera

Papers

Antimicrobial susceptibility patterns of E. coli from clinical sources in northeast Ethiopia.

Prevalence of Salmonella typhi and intestinal parasites among food handlers in Bahir Dar Town, Northwest Ethiopia.

Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia

Sero-prevalence and risk factors of hepatitis B virus and human immunodeficiency virus infection among pregnant women in Bahir Dar city, Northwest Ethiopia: a cross sectional study

The Sanitary Conditions of Food Service Establishments and Food Safety Knowledge and Practices of Food Handlers in Bahir Dar Town