One Health and Antimicrobial Resistance in Ethiopia: A Structured Literature Review Public

Abstract

Antimicrobial resistance (AMR) is an increasingly important issue in global health which has led to less effective antimicrobials and more deadly infections. AMR occurs when an antimicrobial agent has a decreased ability or is unable to kill bacteria. Given AMR bacteria or mobile genetic elements conferring resistance can be exchanged between humans and the environment and animals in multidirectional pathways, a One Health approach integrating human, animal, and environmental health is required to address the problem. AMR has only recently been recognized as a major health problem and health priority in low-income countries included Ethiopia. We carried out a structured narrative literature review to synthesize all published data on rates of bacterial AMR among human, animal, and environmental studies conducted in Ethiopia from 2016-2020. The goal of this review was to use a One Health perspective to provide a detailed review of the AMR literature which can be used to help guide AMR prevention and management strategies. Utilizing 6 databases we found a total of 1534 articles of which 46 met our inclusion criteria. Overall, there very high rates of resistance were reported against several World Health Organization Global Antimicrobial Resistance Surveillance System (GLASS) organisms (Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp., Staphylococcus aureus/Methicillin resistant staphylococcus aureus (MRSA), Streptococcus pneumoniae, Salmonella spp., and Shigella spp.) as well as Enterobacter spp., Serratia spp., Proteus spp., and Citrobacter spp. antimicrobials across human, animal, and environmental studies. A majority of isolates across studies were Gram negative organisms. Many isolates showed resistance over 25% and many were 100% resistant to an antimicrobial. Human studies reported the most consistently high rates of resistance (over 25%) with the highest rates seen against ampicillin, gentamicin, sulfamethoxazole-trimethoprim (cotrimoxazole), ciprofloxacin, ceftazidime, ceftriaxone, meropenem, cefepime, and cefoxitin. Fewer antimicrobials were tested in animal studies, however high rates were reported against ampicillin, SXT, cefoxitin, and cefuroxime. As in human and animal studies, environmental studies reported high ampicillin resistance (≥39%). This study recommends further research on the drivers of AMR from a One Health perspective due to the gaps in literature as well as lack of comprehensive knowledge of the issue.

Table of Contents

Distribution Agreement................................................................................................................... i

Approval Sheet............................................................................................................................. ii

Abstract Cover Page....................................................................................................................... iii

Abstract.......................................................................................................................................... iv

Cover Page...................................................................................................................................... v

Acknowledgements........................................................................................................................ vi

Table of Contents.......................................................................................................................... vii

Abbreviations............................................................................................................................... viii

1. Introduction..................................................................................................................... 1

Overview of AMR................................................................................................................. 1-3

One Health and AMR........................................................................................................... 3-5

    AMR in Low-and Middle -Income Countries.................................................................... 5-6

Ethiopia and AMR................................................................................................................. 6-8

 2. Methods............................................................................................................................... 8

Search Strategy................................................................................................................... 8-9

Selection Criteria................................................................................................................... 9

3. Results................................................................................................................................. 10

Study Selection..................................................................................................................... 10

Study Characteristics.......................................................................................................... 10

Human Studies................................................................................................................... 10-16

Animal Studies.................................................................................................................. 17-19

Environmental Studies.................................................................................................... 19-24

4. Discussion..................................................................................................................... 24-30

5. Conclusion........................................................................................................................ 31

References....................................................................................................................... 32-37

Appendix.................................................................................................................................. 38

Tables and Figures........................................................................................................... 38-47

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Global Antimicrobial Resistance Surveillance System Chickens Antimicrobial stewardship Ethiopia Cows Food animals Gram negative Gram positive One Health Environment Antimicrobial resistance Humans
Committee Chair / Thesis Advisor	Rebolledo, Paulina, Emory University
Committee Members	Kempker, Russell, Emory University Jacob, Jesse, Emory University

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