Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 3;12(1):15.
doi: 10.1186/s13756-023-01224-0.

Antimicrobial resistance from a One Health perspective in Zambia: a systematic review

Avis A Nowbuth  1   2   3 , Akwi W Asombang  4   5 , Nkengeh N Tazinkeng  4   5   6 , Opeoluwa Y Makinde  4   7 , Lincoln R Sheets  8   4
Affiliations

Antimicrobial resistance from a One Health perspective in Zambia: a systematic review

Avis A Nowbuth et al. Antimicrob Resist Infect Control. .

Abstract

Background: Antimicrobial resistance (AMR) is widely acknowledged as a global health problem, yet its extent is not well evaluated, especially in low-middle income countries. It is challenging to promote policies without focusing on healthcare systems at a local level, therefore a baseline assessment of the AMR occurrence is a priority. This study aimed to look at published papers relating to the availability of AMR data in Zambia as a means of establishing an overview of the situation, to help inform future decisions.

Methods: PubMed, Cochrane Libraries, Medical Journal of Zambia and African Journals Online databases were searched from inception to April 2021 for articles published in English in accordance with the PRISMA guidelines. Retrieval and screening of article was done using a structured search protocol with strict inclusion/exclusion criteria.

Results: A total of 716 articles were retrieved, of which 25 articles met inclusion criteria for final analysis. AMR data was not available for six of the ten provinces of Zambia. Twenty-one different isolates from the human health, animal health and environmental health sectors were tested against 36 antimicrobial agents, across 13 classes of antibiotics. All the studies showed a degree of resistance to more than one class of antimicrobials. Majority of the studies focused on antibiotics, with only three studies (12%) highlighting antiretroviral resistance. Antitubercular drugs were addressed in only five studies (20%). No studies focused on antifungals. The most common organisms tested, across all three sectors, were Staphylococcus aureus, with a diverse range of resistance patterns found; followed by Escherichia coli with a high resistance rate found to cephalosporins (24-100%) and fluoroquinolones (20-100%).

Conclusions: This review highlights three important findings. Firstly, AMR is understudied in Zambia. Secondly, the level of resistance to commonly prescribed antibiotics is significant across the human, animal, and environmental sectors. Thirdly, this review suggests that improved standardization of antimicrobial susceptibility testing in Zambia could help to better delineate AMR patterns, allow comparisons across different locations and tracking of AMR evolution over time.

Keywords: Antimicrobial resistance; One Health; Review; Zambia.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow-chart illustrating the study selection process on antimicrobial resistance in Zambia
Fig. 2
Fig. 2
Map of Zambia showing study sites and number of articles used in the review
Fig. 3
Fig. 3
Microorganisms isolated across human, animal, and environmental sectors in Zambia
Fig. 4
Fig. 4
One Health approach to antimicrobial resistance
See this image and copyright information in PMC

References

    1. WHO. AMR and Covid-19. World Health Organization. 2020 [cited 2021 Feb 28]. Available from: https://www.euro.who.int/__data/assets/pdf_file/0004/441751/COVID-19-AMR....
    1. Iskandar K, Molinier L, Hallit S, Sartelli M, Hardcastle TC, Haque M, et al. Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture. Antimicrob Resist Infect Control. 2021;10(1):1–19. doi: 10.1186/s13756-021-00931-w. - DOI - PMC - PubMed
    1. Caudell MA, Dorado-Garcia A, Eckford S, Creese C, Byarugaba DK, Afakye K, et al. Towards a bottom-up understanding of antimicrobial use and resistance on the farm: a knowledge, attitudes, and practices survey across livestock systems in five African countries. PLoS ONE. 2020;15(1):e0220274. doi: 10.1371/journal.pone.0220274. - DOI - PMC - PubMed
    1. Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–655. doi: 10.1016/S0140-6736(21)02724-0. - DOI - PMC - PubMed
    1. Haque M, Rahman NAA, McKimm J, Sartelli M, Kibria GM, Islam MZ, et al. Antibiotic use: a cross-sectional study evaluating the understanding, usage and perspectives of medical students and pathfinders of a public defence university in Malaysia. Antibiotics. 2019;8(3):154. doi: 10.3390/antibiotics8030154. - DOI - PMC - PubMed

Publication types

Substances