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Antimicrobial resistance in humans and animals in the Somali region of Ethiopia: a one-health approach

Muhummed, Abdifatah Muktar. Antimicrobial resistance in humans and animals in the Somali region of Ethiopia: a one-health approach. 2024, Doctoral Thesis, University of Basel, Associated Institution, Faculty of Science.

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Abstract

The rampant spread of antimicrobial resistance (AMR) in humans, food-producing animals, agriculture and the environment presents an alarming and significant global crisis. Unless action is taken, AMR is projected to claim 10 million lives annually by 2050, disproportionally impacting low- and middle income countries (LMICs). Due to the severity, vastness, intricacy and multifaceted nature of AMR, a holist One Health approach is widely considered the strategy to address and combat AMR. However, prior evidence to this thesis, demonstrated the dearth of studies that truly applied a One Health approach implementing genomic analysis in LMICs. The broad goal of this research was to provide evidence on AMR genes in children and animals, as well as the knowledge and attitude of rural communities regarding AMR.
The first part of the research provides an overview of the existing evidence of molecular AMR studies utilizing a One Health approach in Africa, aiming to determine the prevalence of resistance genes in humans, animals and the environment. The findings from the systematic review and meta-analysis showed very limited studies truly implementing this approach in Africa. However, within the limited studies, sul1, sul2, tetA, strB, and blaTEM were the most prevalent genes identified in humans and animals.
Thus, due the scarcity of studies utilizing unified approach in Africa, we examined the genetic characterization of fecal carriage of ESBL-producing E. coli in rural children and livestock, studied diarrheagenic pathogens and their resistance genes in urban children, as well as assessed the communities’ knowledge and attitude regarding AMR and climate change in the Somali region of Ethiopia. The results showed a high prevalence of ESBL-producing E.coli in rural and urban children, and a low prevalence in livestock, predominantly harboring blaCTX-M-15. Conversely, the carbapenemase-producing diarrheagenic E. coli, Salmonella spp. and Shigella spp. were exclusively detected in urban children. Moreover, the first whole genome sequencing analysis employed in rural communities in Ethiopia, revealed a high diversity of sequence types (ST), with ST2353 being among the most prevalent, harboring multiple resistance genes. Notably, this is the first study to report ST2353 in Ethiopia. The findings also shed light on Shigella spp. harboring blaNDM and blaOXA-48, which has been rarely described to date, indicating the widespread of AMR genes in both rural and urban children aged less than five years. These findings are concerning as the identified genes confer resistance to most commonly used antibiotics, potentially hampering treatment of infections caused by these bacteria.
In addition to the spread of AMR genes, a significant association between ESBL carriage in rural children and being both wasted and stunted, water treatment (with chlorine), and chicken ownership were found. Furthermore, the findings highlighted the limited knowledge of AMR and climate change, with noticeable gender disparity, where females showed lower levels of knowledge compared to males. Further, the limited knowledge of mothers was seen to significantly increase the odds of ESBL-producing E. coli carriage in children.
The overall findings indicated the wide spread of AMR resistance genes in urban and rural children, showcasing diverse sequence types such as ST2353, a first report in Ethiopia. Additionally, this research identified Shigella spp. harboring carbapenemase genes, rarely reported globally. This is alarming, as these strains might complicate treatment options, possibly prolong hospital stay and increase costs. Moreover, the limited knowledge of AMR and climate change, mainly among females, adds to the burden. Therefore, with the emergence and spread of AMR in the country, it is imperative to implement an integrated AMR surveillance system using a One Health approach that involves both hospital and community settings in order to mitigate and control AMR. Addressing other relevant issues such as malnutrition and water, sanitation and hygiene (WASH) is also of paramount importance. Further, we recommend comprehensive community-based educational programs tailored for women to promote responsible antimicrobial use and environmental conservation.
In addition, the research of this thesis provided the foundation for future research work on various aspects of AMR. Furthermore, the research showed the need for robust study designs suitable for determining the acquisition and dynamics of AMR.
Advisors:Vonaesch, Pascale
Committee Members:Cissé, Guéladio and Zinsstag, Jakob Z and Jores, Jörg
Faculties and Departments:05 Faculty of Science
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Human and Animal Health > One Health (Zinsstag)
UniBasel Contributors:Cissé, Guéladio
Item Type:Thesis
Thesis Subtype:Doctoral Thesis
Thesis no:15466
Thesis status:Complete
Number of Pages:1 Band (verschiedene Seitenzählungen)
Language:English
Identification Number:
  • urn: urn:nbn:ch:bel-bau-diss154669
edoc DOI:
Last Modified:13 Sep 2024 13:33
Deposited On:12 Sep 2024 10:37

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