Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening.

BACKGROUND: A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia. METHODS: This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. FINDINGS: Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures. CONCLUSION: The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.

National action plan on antimicrobial resistance: An evaluation of implementation in the World Health Organization Africa region

In line with global instruments, within the last five years, two-thirds of all countries in the WHO Africa Region (WHO AFR) have developed a National Action Plan (NAP) on Antimicrobial Resistance (AMR). We sought to evaluate progress made across the countries implementing NAP for effective response to AMR. A semi-structured survey tool was administered to obtain information from national focal persons on the implementation of strategic elements of NAP on AMR. This was followed by a Lessons Learnt Workshop in June 2019 at Douala, Cameroon, where focal persons made presentations on the country's progress. Later, a desktop review of the LLW report and other key documents was conducted. Countries in WHO AFR that have set up a national surveillance system and are enrolled into the WHO global antimicrobial resistance surveillance system have progressively increased to 30 (of 47 countries), of which 15 are already submitting surveillance data. Of the 20 countries at the Lessons Learnt Workshop, 14 have infection prevention and control (IPC) policies and functional healthcare facility IPC programs, 15 participate in the commemoration of the annual world hand hygiene days. Although almost all countries surveyed have national standard treatment guidelines, only five have incorporated the WHO AWaRe classification into the national essential medicines list. Fourteen of 20 countries have established an active/functional national secretariat/coordinating center for AMR. Discernible progress is being made on the implementation of NAP in WHO AFR region. Gaps identified in the strategic elements of action plans need to be filled for effective AMR control.

The burden of HIV / AIDS on the Zambian health system.

PIP: This article presents the impact of HIV/AIDS on the Zambian health system. The Ministry of Health is expecting an increase in hospital bed occupancy from 6% in 1990 to 43% in 2005. The increase is a result of the continued increasing number of AIDS patients hospitalized which also require longer hospital stays (15-80 days) and intensive medical care compared with other diseases. In addition, treatment of AIDS-related opportunistic infections places a considerable strain on health service expenditures; wherein 90% are treated in hospitals or health centers. In 1999, the World Bank estimated that the cost of treating an AIDS patient from the time of diagnosis until death ranged from US$100-1100. In Zambia, the average cost ranges from US$3.31-7.25. An average daily cost of US$5 would accumulate to US$150 for a cumulative 30-day stay of an AIDS-infected individual. The cost could reach US$200 per AIDS patient if pharmaceuticals and other direct costs were added. AIDS care expenditure is anticipated to increase from US$1.7 million in 1990 to US$12.9 million in 1995, and to US$21 million in 2005. The increased expenditure in AIDS care threatens the deviation of fund allocation necessary for other important health care needs. This article underscores the burden on district health services in assuming responsibility for delivery of essential service package in terms of health care reforms.^ieng

Utilisation of antimalarial drugs by pregnant women attending the antenatal clinic at Muhimbili Medical Centre, Dar es Salaam.

Two hundred women in early second trimester were recruited in a study to monitor the utilisation of antimalarial drugs prescribed for prophylaxis or treatment of malaria during their attendance at the antenatal clinic of Muhimbili Medical Centre. Information regarding the use of antimalarial drugs was obtained during an interview using a structured questionnaire and antenatal cards. The study revealed that 51.5% had taken antimalarials for treatment of acute malaria while 23.5% had taken for prophylaxis. There was thus a total exposure of 75%. most of them were exposed to choloroquine (69.5l%). There was no statistically significant association between the taking of chloroquine and its presence in urine and between the level of education and the taking of chloroquine prophylactically.