Knowledge, attitudes, and perceptions about antibiotic use and antimicrobial resistance among final year undergraduate medical and pharmacy students at three universities in East Africa.

INTRODUCTION: Proper measures to combat antimicrobial resistance development and spread in Sub Saharan Africa are very crucial bearing in mind the projected burden of antimicrobial resistance which is expected to be increase by 2050. Training of medical doctor and pharmacy students in antimicrobial stewardship is vital to combat antimicrobial resistance. This study was designed to evaluate the knowledge, attitude, and perception of final year medical and pharmacy students on antimicrobial use and antimicrobial resistance at three universities in Uganda, Kenya, and Tanzania. METHODOLOGY: A cross-sectional survey was carried out among final year undergraduate medical and pharmacy students at three universities in East Africa. A Self-administered questionnaire was developed which included dichotomous questions and questions using a 4-point Likert scale. The questions were based on knowledge and attitude about antibiotics, and preparedness to use antibiotics in clinical scenarios. Data were analyzed using STATA version 16 following the objective of the study. RESULTS: Three hundred and twenty-eight final year students participated in the survey from MUK 75, MKU 75 and CUHAS 178. Slightly majority of participants were male 192(58.5%) and their median age was 25 [23 - 27] years. In general, 36.6% (120/328) of students had good overall total knowledge. More students at MUK had good knowledge compared to MKU, and CUHAS (72% vs, 40% vs. 20.2%; p<0.001). The mean scores for overall good total knowledge, general knowledge about antibiotics, knowledge about antibiotic resistance, and knowledge about antibiotic use in clinical scenarios were 58% (CI: 57%- 60%), 95% (CI: 94%- 97%), 54% (CI: 52% - 56%), and 46% (CI:44% - 48%) respectively. More pharmacy students compared to medical students had a good attitude and perception on antibiotic use (79.6% vs. 68.4%; p = 0.026). The students at CUHAS perceived being more prepared to use antibiotic in district hospitals compared to MKU and MUK (75.3% vs. 62.7% vs. 65.3%; p = 0.079). While two hundred and seventy (82.3%) students perceived knowing when to start antimicrobial therapy, 112 (34.2%) did not know how to select the appropriate antibiotic (p<0.0001), 97 (29.6%) did not know the antibiotic dose to give (p<0.0001), and 111 (33.8%) did not know when to switch form an intravenous antibiotic to oral regimen (p<0.0001). CONCLUSION: Final year students have low scores in knowledge about antimicrobial resistance and antibiotic use in clinical scenarios. This has exposed gaps in practical training of students, while they may feel confident, are not fully prepared to prescribe antibiotics in a hospital setting. A multidisciplinary and practical approach involving medical schools across the East African region should be undertaken to train final year undergraduate students in antimicrobial resistance and antimicrobial stewardship programs. Antimicrobial resistance and antimicrobial stewardship courses should be introduced into the curriculum of final year medicine and pharmacy programs.

Escherichia coli pathotypes and Shigella sero-groups in diarrheic children in Nairobi city, Kenya.

AIM: In the present study, we investigated the prevalence of E. coli pathotypes and Shigella sero-groups and their antimicrobial profiles among diarrheic children in Nairobi city, Kenya. BACKGROUND: Although diarrheagenic E. coli pathotypes and Shigella sero-groups are leading causes of diarrhea in children under five years in developing countries, their distribution and antimicrobial resistance vary from place to place and over time in a given region. METHODS: In a cross-sectional study, we enrolled diarrheic children (n=354) under five years seeking treatment at Mbagathi Hospital, Nairobi city, Kenya,. Stool samples were collected from all children for bacterial culture. Bacterial isolation and identification was performed by conventional microbiological methods. Polymerase chain amplification was used to detect aspU, aggR, andpcvd432 for EAEC, est and elt for ETEC, eae for EPEC, stx for EHEC, and ipaH for EIEC and Shigella species. Antimicrobial profile was determined by disk diffusion method. RESULTS: The prevalence of EAEC, ETEC, EPEC (eae), EIEC (ipaH) was 21.2%, 10.5%, 4.5%, and 0.6%, respectively, while that of mixed infection was 0.6%for ETEC/EAEC and 0.3%for EAEC/EPEC/ETEC. No EHEC strain was isolated. Pathogenetic analysis for EAEC showed that5.9% carried aspU,8.2% possessed both aspU and aggR and 7.1% had a combination of aspU, aggR andpcvd432 while that of ETEC was 2.3% for elt, 6.5% for both elt and est and 1.7% for est. The combination of aspU with aggR, elt and est, and pcvd432 with aggR, aspU and est was 0.3% for each case of ETEC/EAEC mixed infection. The aspU gene co-existed with aggR, pcvd432, eae and elt in the EAEC/EPEC/ETEC mixed infection. The prevalence of S. boydii, S. dysenteriae, S. flexneriand,S. sonnei was 0.8%, 0.6%, 1.7%, and 0.8%, respectively. No E. coli pathotype and shigella co-infection was detected. In addition, both E. coli pathotypes and Shigella species were resistant to ampicillin, trimethoprim/sulfamethoxazole, streptomycin, chloramphenicol and tetracycline while gentamycin and kanamycin resistance occurred in diarrheagenic E. coli. CONCLUSION: E. coli pathotypes and Shigella sero-groups harboring virulent genes are important causes of diarrhea in children in Kenya. The increasing spectrum of antibiotic resistance in diarrheagenic E. coli and Shigella species necessitates the development of antimicrobial stewardship education-programs to influence prescribing behavior as well as optimizing the use of effective antimicrobials in Kenya.

Presence and distribution of mosquito larvae predators and factors influencing their abundance along the Mara River, Kenya and Tanzania.

Among all the malaria controlling measures, biological control of mosquito larvae may be the cheapest and easiest to implement. This study investigated baseline predation of immature mosquitoes by macroinvertebrate predators along the Mara River, determined the diversity of predators and mosquito larvae habitats and the range of their adaptive capacity to water physico-chemical parameters. Between July and August 2011, sampling sites (n=39) along the Mara River were selected and investigated for the presence of macroinvertebrate predators and mosquito larvae. The selected sampling sites were geocoded and each dipped 20 times using standard mosquito larvae dipper to sample mosquito larvae, while a D-frame dip net was used to capture the macroinvertebrate predators. Water physico-chemical parameters (dissolved oxygen, temperature, pH, conductivity, salinity and turbidity) were taken in situ at access points, while hardness and alkalinity were measured titrimetically. The influence of macroinvertebrate predator occurrence was correlated with mosquito larvae and water quality parameters using Generalized Linear Model (GLM). Predators (n=297) belonging to 3 orders of Hemiptera (54.2%), Odonata (22.9%) and Coleoptera (22.9%), and mosquito larvae (n=4001) belonging to 10 species, which included An.gambiae s.l (44.9%), Culex spp. (34.8%) and An. coustani complex (13.8%), An. maculipalpis (3.6%), An. phaorensis (1.2%), An. funestus group (0.5%), An. azaniae (0.4%), An. hamoni (0.3%), An. christyi (0.3%), An. ardensis (0.08%), An. faini (0.07%), An. sergentii (0.05%) and 0.05% of Aedes mosquito larvae which were not identified to species level, due to lack of an appropriate key, were captured from different habitats along the Mara river. It was established that invasion of habitats by the macroinvertebrate predators were partially driven by the presence of mosquito larvae (p < 0.001), and the prevailing water physico-chemical parameters (DO, temperature, and turbidity, p <0.001). Understanding abiotic and biotic factors which favour mosquitoes and macroinveterbrate co-occurrence may contribute to the control of malaria.