This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.

Background: Antimicrobial resistance (AMR) has emerged as a leading global health and economic threat of the 21st century, with Africa bearing the greatest burden of mortality from drug-resistant infections. Optimization of the use of antimicrobials is a core strategic element of the response to AMR, addressing misuse and overuse as primary drivers. Effectively, this requires the whole society comprising not only healthcare professionals but also the public, as well as the government, to engage in a bottom-up and a top-down approach. We determined the progress of African national governments in optimizing antimicrobial drug use.Methods: From September 2021 to June 2022, all 47 member states of the World Health Organization African region (WHO AFRO) were invited to participate in a survey determining the implementation of strategies to optimize antimicrobial use (AMU). We used the WHO antimicrobial stewardship (AMS) assessment tool, National core elements—A checklist to guide the country in identifying existing national core elements for the implementation of AMS Programs, to obtain information from national AMR focal persons. The tool consists of four sections—national plans and strategies; regulations and guidelines; awareness, training, and education; and supporting technologies and data—with a total of 33 checklist items, each graded from 0 to 4. The responses were aggregated and analyzed using Microsoft Excel 2020^®.Results: Thirty-one (66%) of the 47 countries returned completed forms. Only eight (25.8%) countries have developed a national AMS implementation policy incorporating defined goals, targets, and operational plans. There are no budget lines for AMS activities in 23 (74.2%) countries. The WHO Access, Watch, Reserve (AWaRe) classification of optimizing AMU has been integrated into the national essential medicines list or formulary in 19 (61.3%) countries, while the incorporation of the AMS principles and WHO AWaRe classification into national clinical guidelines for the management of infections is present in only 12 (38.7%) and 11 (34.5%) countries, respectively. Although regulations on the prescription-only sale/dispensing of antibiotics are present in 68% of countries, their enforcement is poor. Systems identifying pathogens and antibiotic susceptibility for optimal use of antibiotics are lacking in 38% of countries.Conclusion: In Africa, wide gaps exist in the governments’ implementation of the core elements of optimizing antimicrobial drug use. Responding to AMR constitutes a long journey, and technical and financial support needs to be deployed to optimize the use of antimicrobials.

The African Journal of Laboratory Medicine focuses on the role of the laboratory and its professionals in the clinical and public healthcare sectors, and is specifically based on an African frame of reference.

Introduction: Klebsiella pneumoniae is a World Health Organization high-priority antibiotic-resistant pathogen. However, little is known about the population structure and evolution of Klebsiella circulating in Nigeria. Methods: We performed whole genome sequencing (WGS) of 141 Klebsiella isolated between 2016 and 2018 from clinical specimens at 3 antimicrobial-resistance (AMR) sentinel surveillance tertiary hospitals in southwestern Nigeria. We conducted in silico multilocus sequence typing, AMR gene, virulence gene, plasmid, and K and O loci profiling, as well as phylogenetic analyses, using publicly available tools and Nextflow pipelines. Results: Phylogenetic analysis revealed that the majority of the 134 K. pneumoniae and 5 K. quasipneumoniae isolates from Nigeria characterized are closely related to globally disseminated multidrug-resistant clones. Of the 39 K. pneumoniae sequence types (STs) identified, the most common were ST307 (15%), ST5241 (12%), ST15 (~9%), and ST25 (~6%). ST5241, one of 10 novel STs detected, is a single locus variant of ST636 carrying dfrA14 , tetD , qnrS , and oqxAB resistance genes. The extended-spectrum β lactamase (ESBL) gene bla CTX_M-15 was seen in 72 % of K. pneumoniae genomes, while 8% encoded a carbapenemase. Four likely outbreak clusters from one facility, within STs 17, 25, 307, and 5241, were ESBL but not carbapenemase-bearing clones. Conclusion: This study uncovered known and novel K. pneumoniae lineages circulating in Nigeria that include multidrug-resistant ESBL producers. Carbapenemase-producing isolates remain uncommon. WGS retrospectively identified outbreak clusters, pointing to the value of genomic approaches in AMR surveillance for improving infection prevention and control in Nigerian hospitals. summary: We performed whole genome sequencing (WGS) of 141 Klebsiella isolated in 2016-2018 at 3 antimicrobial-resistance (AMR) sentinel surveillance tertiary hospitals in southwestern Nigeria. This study uncovered known and novel K. pneumoniae lineages circulating in Nigeria that include multidrug-resistant ESBL producers. FUNDING: This work was supported by Official Development Assistance (ODA) funding from the National Institute of Health Research [16/136/111: NIHR Global Health Research Unit on Genomic Surveillance of Antimicrobial Resistance]. This research was commissioned by the National Institute of Health Research using Official Development Assistance (ODA) funding. INO is an African Research Leader supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement that is also part of the EDCTP2 program supported by the European Union. The funders had no role in the content, crafting or submission of this paper. The views expressed in this publication are those of the authors and not necessarily those of the funders or their affiliates. CONFLICT OF INTEREST: The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Tients, Materials and Methods: It was a descriptive cross-sectional study that involved 250 postmenopausal women recruited from three health-care facilities in Osun State over a period of 2 months (June 2022 to August 2022). The data were collected with structured questionnaires and were analysed with appropriate descriptive and inferential statistics. Results: Majority of the 250 women attained menopause at the ages between 55 and 64 years (n = 129; 51.6%), with a mean age at menopause being 58.7 years (±7.8). They commonly attained menarche at 15–19 years (n = 147; 58.8%) and had five or more previous pregnancies (n = 133; 53.2%). Hypertension and diabetes were present in 87 (34.8%) and 26 (10.4%) women, respectively. Use of contraceptives was recorded in 128 (51.2%) women, with intrauterine contraceptive devices being the most common method. The most common menopausal symptom was internal heat in 52% of women; of the women with this symptom, 48% were relieved with medications. Having 4 or less previous pregnancies, having 4 or less children and previous use of contraceptives had a significant association with late menopause. Conclusions: This study concludes that age at menopause is slightly advanced in our environment and there is a high prevalence of menopausal symptoms. There is a need for support programmes for postmenopausal and elderly women to facilitate prompt and appropriate treatment of these ailments as well as providing intensive health education for the women....

Background: Surveillance of drug-resistant infections is crucial for antimicrobial resistance (AMR) control. Implementing surveillance in low- and middle-income countries (LMICs) is challenging. Aim: To investigate bacteraemia and describe AMR surveillance. Setting: Tertiary healthcare facility. Methods: Case finding was by WHO Global AMR and Use Surveillance System (GLASS). Blood samples were processed between May 2017 and June 2018, using BACTEC blood culture system. Bacterial identification, antibiotic susceptibility testing and detection of AMR genes followed standard protocols. Results: Aerobic blood cultures were conducted in a third of clinical sepsis cases (n = 601/1851), of which 114 (19.0%) were true positives, with a 2.2% contamination rate. Pathogens recovered included six priority blood pathogens reportable to WHO GLASS. Sixteen (30.2%) of 53 Gram-negative isolates were extended-spectrum beta-lactamase producers, predominantly harbouring blaCTX-M, three (5.7%) were AmpC beta-lactamase producers, and 20 (37.7%) were carbapenem-resistant, predominantly harbouring blaKPC. Twenty-nine (50.9%) of 57 Staphylococcus aureus isolates were methicillin-resistant; 17 (58.6%) of these harboured mecA genes. Hospital-acquired infection (odds ratio [OR] = 0.3, 95% confidence interval [CI]=0.1–0.7, p = 0.004) was identified as a predisposing factor for the development of multidrug-resistant (MDR) bacteraemia. Bacteraemia with MDR organisms was significantly associated with mortality (OR = 3.8, 95% CI = 1.6–9.1, p = 0.001). Conclusion: A wide variety of bacteria are responsible for bacteraemia in our setting, with more than half being multidrug-resistant. Bacteraemia with multidrug-resistant organisms was significantly associated with mortality, hence, the need for this AMR surveillance initiative. Contribution: Implementing healthcare facility-based surveillance of AMR in LMICs is achievable despite limited microbiological laboratory capacity.