Alhassan Jacob Albin Korem, Abdallah Clement Kamil
Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Ad Astra Foundation, Tamale, Ghana.
PLOS Glob Public Health. 2024 Sep 18;4(9):e0003688. doi: 10.1371/journal.pgph.0003688. eCollection 2024.
The global rise in antimicrobial resistance (AMR) is claiming the lives of more than 1.2 million people each year. According to the World Health Organization (WHO) this global health crisis is particularly acute in Africa, largely due to fragile and underfunded health systems. Efforts to combat this public health threat have led to the implementation of health system interventions worldwide aimed at managing and containing the spread of AMR. However, the literature on the real time impacts and the barriers that hinder the implementation of these interventions in the African context is limited. The objective of this scoping review was to identify AMR interventions in African health systems, their impact, and the challenges of the implementation. Drawing on Muka and colleague's 24 step approach for scoping reviews, two major public health databases (PubMed and Global Health) were searched for articles in accordance with the PRISMA guidelines resulting in 4,783 records. Screening and retrieval of articles was done using Rayyan software based on specified inclusion criteria and 36 articles included in the final list. These articles were synthesized after extracting specific data on AMR interventions and their impact on African health systems. The review identified four broad impacts of AMR interventions including 1. Reduction in antibiotics use, 2. Increased adherence to guidelines and protocols, 3. Enhanced laboratory-based AMR surveillance, 4. Development of antimicrobial stewardship (AMS) Action Plans and Teams. However, challenges such as poor laboratory infrastructure, logistical challenges, poor financial commitment and inadequate education and training were identified as challenges impeding the successful implementation of AMR interventions in Africa. Our findings reveal a range of successful AMR interventions in African health systems although infrastructural and financial challenges remain. Better standardization and reporting of AMR diagnosis while leveraging the available information is needed to improve the optimization of treatment guidelines across Africa.
全球抗菌药物耐药性（AMR）的上升每年导致超过120万人死亡。根据世界卫生组织（WHO）的数据，这一全球卫生危机在非洲尤为严重，主要原因是卫生系统脆弱且资金不足。为应对这一公共卫生威胁所做的努力促使全球实施了旨在管理和控制AMR传播的卫生系统干预措施。然而，关于这些干预措施在非洲背景下的实时影响以及阻碍其实施的障碍的文献有限。本范围综述的目的是确定非洲卫生系统中的AMR干预措施、其影响以及实施过程中的挑战。借鉴穆卡及其同事用于范围综述的24步方法，按照PRISMA指南在两个主要的公共卫生数据库（PubMed和全球卫生数据库）中搜索文章，共得到4783条记录。使用Rayyan软件根据指定的纳入标准对文章进行筛选和检索，最终列表中有36篇文章。在提取关于AMR干预措施及其对非洲卫生系统影响的具体数据后，对这些文章进行了综合分析。该综述确定了AMR干预措施的四大广泛影响，包括：1. 抗生素使用减少；2. 对指南和规程的依从性增加；3. 基于实验室的AMR监测得到加强；4. 制定抗菌药物管理（AMS）行动计划和团队。然而，诸如实验室基础设施差、后勤挑战、资金投入不足以及教育和培训不够等挑战被确定为阻碍非洲成功实施AMR干预措施的因素。我们的研究结果表明，尽管存在基础设施和资金方面的挑战，但非洲卫生系统中仍有一系列成功的AMR干预措施。需要更好地对AMR诊断进行标准化和报告，同时利用现有信息来优化非洲各地的治疗指南。
