Ayodele O. Majekodunmi

Background: Drawing on the Fleming Fund's work to strengthen antimicrobial resistance (AMR) surveillance across Africa and Asia during 2018–2026, this article provides one of the first syntheses of AMR surveillance data use in low- and middle-income countries. Methods: A participatory synthesis for narrative review was conducted to summarize experience across administrative levels (facility, subnational, national, and regional). Results: Data use was most evident at the facility level, in human health systems where resistance patterns, antimicrobial use, and clinical data increasingly informed antimicrobial stewardship, infection prevention and control, and other quality improvement initiatives. Data use in other sectors required different approaches. At the national level, Fleming Fund investments were associated with revisions of treatment guidelines, updates of essential medicines lists, and regulatory measures, primarily through improved governance and policy communities. Regional platforms supported member country data use at the national level. Subnational data use was undertaken in countries with decentralized health systems. Across levels, data use pathways driven by local priorities helped surveillance inform action. Conclusions: Fleming Fund experience suggests that surveillance is more likely to inform action when data use is built into system design. Continued investment will be needed if AMR surveillance is to improve policy and practice in low- and middle-income countries.

One Health (OH) professions, specifically doctors, pharmacists and veterinarians, play central roles in antimicrobial stewardship (AMS), serving as the primary gatekeepers of antimicrobial use. Considering that antimicrobial resistance (AMR) is a global health priority, it is essential that these gatekeepers are equipped with the necessary skills for effective AMS at day-one. As part of the Ducit Blue Foundation (DBF) programme, this study assesses the level of day-one competencies for AMS in pre-service curricula across OH professions using the respective global competency frameworks. Pre-service training curricula for OH professions in five African countries were compared to their respective World Health Organization (WHO) and World Organisation for Animal Health (WOAH) competency frameworks to determine alignment with specific AMS competencies. Intersectoral comparisons were also conducted to understand variations across OH sectors. AMS preparedness among OH graduates in Africa was not determined by profession alone, as alignment varied both within and across the OH professions reviewed. The strongest alignment was observed in UniLorin veterinary medicine (77%), UniPort pharmacy (67%), and ABU Zaria medicine (51%), showing that stronger AMS integration is achievable across professional groups. However, lower alignment was also observed across the same professions, including Addis Ababa University medicine (33%), UniLomé pharmacy (39%), and EISMV veterinary medicine (48%). While the AMS components of WHO AMR competency framework emphasises a clinical and research focus, the WOAH competency recommendations extend further by adding OH and public health focus. These findings suggest that AMS preparedness depends less on professional category and more on how explicitly and consistently AMS competencies are embedded within each curriculum. There is a need to strengthen pre-service AMR education across OH professions in Africa. Regional initiatives such as DBF internship programme that target early-career OH professionals for AMR training are essential for bridging existing gaps in pre-service AMR education in Africa and beyond.

Objective: Antimicrobial resistance (AMR) and healthcare-associated infections pose serious public health threats, particularly in Africa with limited health resources. Weak infection prevention and control (IPC) implementation worsens these challenges. To address this, Africa Centre for Disease Control (CDC) developed the IPC legal framework. This study compares Kenya, Nigeria, and Tanzania’s IPC guidelines with the framework and evaluates their alignment. Methods: This policy analysis compares the IPC guidelines of three countries and assesses their alignment against the attributes of the Africa CDC Legal IPC Framework. Scores were assigned based on the level of alignment with the attributes, aggregated into percentages, and compared across countries. This study was developed under the 2023–24 cohort 3, of Ducit Blue Foundation’s pioneering and award-winning AMR One Health Pan-African Internship/Mentorship Program. Results: Facility-level IPC budgeting was included in Nigeria and Tanzania’s guidelines but absent in Kenya. Training responsibilities differed, with Kenya and Tanzania authorizing national and regional bodies, while Nigeria assigned this solely to facility IPC teams. Overall alignment of the IPC guidelines with the Africa CDC Legal Framework was 69%. Tanzania had 76% alignment, while Kenya and Nigeria recorded 65% each. There were no significant variations in alignment between countries with the benchmark framework (X ² = 3.75, p -value = .153). Conclusion: This study represents the first attempt at a detailed policy analysis of IPC guidelines across Africa against a backdrop of the relevant regional instruments. The countries show good IPC alignment with the benchmark instrument, reflecting both regional commitment and local adaptation.

Antimicrobial stewardship (AMS) is central to antimicrobial resistance (AMR) control, yet its prioritization varies across Africa. We analyzed AMS components of five African National Action Plans on AMR against global and regional policy benchmarks, identifying areas of alignment and critical gaps that should inform future AMR strategies.

A meeting, sponsored by the Bill and Melinda Gates Foundation (BMGF) and organised by Clinglobal, was held at The International Livestock Research Institute (ILRI) in Nairobi, Kenya, from 19th – to 21st October 2022. The meeting assembled a unique group of experts on tick control in Africa. Academia, international agencies (FAO and ILRI), the private Animal Health sector and government veterinary services were represented. The significant outcomes included: (i) a shared commitment to standardisation and improvement of acaricide resistance bioassay protocols, particularly the widely used larval packet test (LPT); (ii) development of novel molecular assays for detecting acaricide resistance; (3) creation of platforms for disseminating acaricide resistance data to farmers, veterinary service providers and veterinary authorities to enable more rational evidence-based control of livestock ticks. Implementation of enhanced control will be facilitated by several recently established networks focused on control of parasites in Africa and globally, whose activities were presented at the meeting. These include a newly launched community of practice on management of livestock ticks, coordinated by FAO, an African module of the World Association for the Advancement of Veterinary Parasitology (WAAVP-AN) and the MAHABA (Managing Animal Health and Acaricides for a Better Africa) initiative of Elanco Animal Health. Graphical Abstract

Introduction: Diarrhoea accounts for high morbidity and mortality in children and adults worldwide. Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL-PE) and Diarrhoeagenic Escherichia coli (DEC) contribute to prolonged hospitalization because of their resistance and virulence properties aiding in the spread of diarrhoeal disease and delayed treatment. Aim: To determine DEC and the antimicrobial resistance of ESBL-PE isolated among diarrhoea patients attending two health facilities in Ghana. Methods: Stool samples were collected from 122 diarrhoeal patients who attended Maamobi General Hospital and Kaneshie Polyclinic between January 2019 and March 2020. Identification of bacteria was performed by using the Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Using disk diffusion, antimicrobial susceptibility testing (AST) was conducted and interpreted according to the 2018 CLSI guidelines. Detection of ESBL and DEC genes was performed using Polymerase chain reaction (PCR). Results: A total of 80.3% (98/122) Enterobacteriaceae was recovered from the patients in the study with an overall ESBL occurrence of 20.4% (20/98), predominantly among E. coli showed 13.2% (10/76), Klebsiella pneumoniae,35.7%(5/14) and Proteus mirabilis, 57.1%(4/7). Among the ESBL genes detected, bla_TEM (n = 14) was common, followed by bla_CTX-M (n = 13) and bla_SHV (n = 4). Thirty-four E. coli isolates possessed the heat labile (Lt) gene of Enterotoxigenic E. coli (ETEC). Conclusion: Our findings confirm the existence of DEC and the antimicrobial resistance patterns of ESBL-PE among stool isolates, limiting the options of commonly used drugs for diarrhoeal treatment in Ghana. Routine laboratory testing in health care facilities and strengthened surveillance systems among hospital networks are encouraged for a better understanding of their epidemiology and clinical implications.

In this study, the seroprevalence of the intestinal worms Taenia solium and Trichinella spiralis in humans and pigs was assessed. A cross‐sectional serological study design was performed. Blood samples were collected from 322 humans and 245 pigs used in the study. These were tested for markers of antibodies for Taenia solium and Trichinella spp. Demographic data such as sex, age, education, pig farming practices, and water source used were also obtained. An overall seroprevalence of 3.1% was recorded for Taenia solium in humans. There was also a statistical association between pig management system employed by pig farmers and seropositivity to Taenia solium (p = 0.005). Factors such as mode of waste disposal (p = 0.003) and water source used statistically correlated with Taenia solium seroprevalence among humans. For the pig samples, a Taenia solium seroprevalence of 24.9% was recorded. All the pig samples which tested positive for Taenia solium were reared on the free‐ranged system. This study also recorded a seroprevalence of 0.31% for Trichinella spp. for humans and a seroprevalence of 4.5% for Trichinella spp. for pigs. Again, all the samples that showed serological evidence of Trichinella spp. among pigs came from those pigs which were raised on the free‐ranged system. Proper pig management practice is a very important tool for controlling these intestinal parasites in both humans and animals. This study recommends public health education among the general public and good pig farming practices.