Background: Antimicrobial resistance (AMR) poses a threat to public health globally. Despite its consequences, there is little information about the knowledge, awareness, and practices towards AMR among healthcare workers (HCWs). Therefore, this study assessed the knowledge, awareness and practices regarding antimicrobial use (AMU), AMR and antimicrobial stewardship (AMS) among HCWs who are involved in the implementation of AMS activities across eight hospitals in Zambia. Methods: A cross-sectional study was conducted among 64 HCWs from October to December 2023 using a semi-structured questionnaire. Data were analysed using IBM SPSS version 25.0. Results: Of the 64 HCWs, 59.4% were females, 60.9% were aged between 25 and 34 years, 37.5% were nurses, 18.7% were pharmacists, 17.2% were medical doctors and only one was a microbiologist. Overall, 75% of the HCWs had good knowledge, 84% were highly aware and 84% had good practices regarding AMU, AMR and AMS. Most of the HCWs (90.6%) responded that they had a multidisciplinary AMS team at their hospitals and were implementing the use of the WHO AWaRe classification of antibiotics. Conclusion: This study found good knowledge levels, high awareness and good practices regarding AMU, AMR and AMS among HCWs who were involved in the implementation of AMS activities in hospitals in Zambia. Additionally, most hospitals have been conducting AMS training and implementing the use of the WHO AWaRe classification of antibiotics. However, there is still a need to address some identified gaps in AMU and AMR through the strengthening of AMS activities in hospitals.

Background: Health worker retention in remote and hard-to-reach areas remains a threat in most low- and middle-income countries, and this negatively impacts health service delivery. The health workforce inequity is catastrophic for countries like Uganda that still has a low health worker to patient ratio, and remote areas like Lira District that is still recovering from a long-term civil war. This study explores factors associated with retention of health workers in remote public health centers in Lira district in Northern Uganda. Methods: A descriptive cross-sectional study with quantitative methods of data collection was used among health workers namely; doctors, clinical officers, nurses, midwives, pharmacists and, laboratory technicians. The study utilized a structured questionnaire with closed ended questions to obtain quantitative information. Results: Most of the respondents were females (62.90%), married (84.62%), with certificate level (55.74%), and nurses as qualification (36.60%) as well as attached to Health Center 3 level (61.28%). Significant individual factors associated with retention included having a certificate as highest level of education, staying with family, and working at facility for 6 or more years. The health system factors were good physical state of facility, equipment availability, availability of sundries, feeling comfortable with rotations, receiving adequate support from staff, feeling valued and respected by colleagues at workplace and access to incentives while career factors were job satisfaction, job motivation, promotion, and further training on scholarship. Conclusion: The study established that indeed several individual and social demographics, health system and career-related factors are significantly associated with retention of Health workers in the rural public health facilities and these are critical policy recommendations for establishing retention guidelines in a national human resources for health manual.

Introduction: Bacterial contamination in milk is increasingly becoming a global health threat that is predisposing humans to various food-borne pathogens. This study is carried out to isolate and identify the possible common bacteria which cause milk contamination and the risks associated with it in Biharwe. Methods: A cross-sectional study was carried out in Biharwe small holder dairy farms, Kashari Sub County, Mbarara district, from March 2022 to October 2022 to assess bacterial contamination, isolate, identify, and test antibiotic susceptibility patterns of organisms. A total of 20 milk samples were randomly collected from 20 privately owned small holder dairy farms with healthy lactating animals. Isolation and identification of organisms was carried out by using biochemical tests. The bacteria so identified and their isolation rate were E. coli (20%), Citrobacter freundii (40%), Enterobacter Cloacae (30%), Enterobacter agglomerans (10%). These are indicative of significant contamination of milk and important human pathogens. The antibiotic susceptibility test was performed on Mueller-Hinton agar by the Kirby-Bauer disk diffusion method. About 100 % of E. coli isolates was sensitive to Tetracycline with 0% resistance, 75% of Citrobacter freundii was sensitive to Tetracycline with 25% resistant isolates, 100% of Entrobacter cloacae was sensitive to Tetracycline with 0% resistance, and 100% of E. agglomerans was sensitive with 0% resistance. Overall 90% of the isolates were sensitive to Tetracycline with only 10% resistance. All the bacterial isolates were 100% sensitive to Gentamicin with 0% resistant. 100% of Citrobacter freundii, Entrobacter cloacae and Enterobacter agglomerans isolateswas resistant to Ampicillin while only 50% of E.coli isolates was sensitive to Ampicillin. 100% of Entrobacter cloacae, E.coli and Enterobacter agglomerans isolates was sensitive to Streptomycin while 75% of Citrobacter freundii was sensitive and 25% was resistant to Streptomycin. Citrobacter freundii was the only isolated organism resistant to more than one antibiotic (100% resistant to Ampicillin and 25% resistant to Tetracycline and Streptomycin). Therefore, the pattern of antibiotic susceptibility tests among the isolates is statistically significant in Gentamicin (P=0.00). Conclusion: This study revealed that raw cow’s milk in the study area could be an important source of infection with a wide range of organisms, particularly gram-negative bacteria. An important source of microbial contamination of milk is fecal pollution probably cow dung. There is need for instituting effective control measures to protect public health. This includes mandatory milk pasteurization by traders and improved hygienic handling of containers during milking, ensuring milking is not done on floors with cow dung.

The Journal of Public Health in Africa (JPHiA) is a peer-reviewed, academic journal that focuses on health issues in the African continent. The journal editors seek high quality original articles on public health related issues, reviews, comments and more. The aim of the journal is to move public health discourse from the background to the forefront. The success of Africa’s struggle against disease depends on public health approaches.

BACKGROUND One of the greatest threats to global public health in the twenty first century is AMR (1-3) . AMR occurs when microorganisms such as bacteria, fungi, parasites, and viruses undergo evolutionary processes that make them resistant to antimicrobial drugs, such antibiotics which were previously used to treat them (1, 4, 5).This growing issue is mostly linked to the consequences of un-judicious use of antibiotics in a variety of settings, primarily in clinical treatment, farming, veterinary medicine, times of war, and the food chain (6-9). AMR, sometimes referred to as the "Silent Pandemic" demands prompt, total and effective action rather than being put off until a later time (10). According to the WHO, AMR in bacteria, viruses, and parasites is "one of the greatest challenges in public health" and may result into "a post-antimicrobial era" where prevalent illnesses could recur (11). Resistant pathogens have the potential to spread rapidly among patients, nations, and regions (12). Since AMR can spread over the borders, it is no longer a local concern but rather an international issue (13). According to 2019 statistics, the number of deaths attributed to AMR on a global scale exceeded 1.2 million. If effective strategies are not taken to counteract this menace, the number is expected to rise to almost 10 million deaths annually by 2050 (14) . The World Bank also estimates that drug-resistant diseases could cost the global economy up to 3.8% of its annual gross domestic product (GDP) by 2050 (15). AMR is a notable barrier to attaining the Sustainable Development Goals (SDG) framework's health-related objectives such as Universal Health Coverage (UHC). AMR is imperative to a number of other SDGs in addition to Goal 3, for example SDG 1 (no poverty), SDG 2 (zero hunger), and SDG 8 (decent work and economic growth) (16). It has disastrous effects on people's health and well-being, but also significantly affects financial prosperity. According to a World Bank evaluation, AMR will cause animal production to decline by 7.5% annually and world exports to drop up to 3.8%. By 2050, it will also lead to a $1 trillion increase in healthcare-related expenses (17). OBJECTIVE In this review, I highlighted a synopsis of the procedures used in the development of AMR, its global burden and factors that contribute to it, the information gaps that exist currently, monitoring parameters, and global mitigation strategies for AMR. METHODS A systematic literature search was conducted across multiple databases including PubMed, EMBASE, Science Daily, the Cochrane Database, AMR Journals, and Google Scholar for English-language articles published between January 1, 2013, and January 31, 2014 (102). The initial search yielded 41 references, of which 19 were selected after screening, while 22 were excluded due to irrelevance. Additionally, four older articles were included based on expert recommendation, resulting in a total of 23 articles for final analysis. The data were reviewed for inconsistencies and presented in both descriptive and tabular formats. Keywords included “Antimicrobial Resistance,” “AMR Mechanism,” “AMR on Public Health,” and “AMR Drivers” (102). RESULTS AMR as an Emerging Global Public Health Concern According to a recent estimate, AMR was linked to 3.57 million of the 4.95 million fatalities that occurred globally in 2019 (14), which is more than many other well-known causes of death, such as HIV/AIDS and malaria. The research indicates that the global burden of AMR surpasses the 700,000 annual deaths estimated by the WHO and the United Nations (25). AMR was once predicted to kill 10 million people annually by 2050 (26), however it has since been shown that the actual number is closer than previously believed. Globally, AMR developments varies greatly between different nations and frequently confront distinct main obstacles. AMR is a global issue affecting all countries, regardless of income. Although the development of new antibiotic classes once helped reduce infectious diseases, bacteria quickly developed resistance. For example, resistance to streptomycin in tuberculosis patients was reported just a year after its approval by the US FDA (19). When treating infections brought on by bacteria that produce a broad range of β-lactamases or are multidrug-resistant, antibiotics such as carbapenems and colistin are often reserved for last resort (27). One of the WHO's priority infections, Enterobacteriaceae, has become more resistant to carbapenems and colistin worldwide (28-30). Concerningly high resistance rates of about 83.35% were found in research for extensively drug-resistant (XDR) Klebsiella pneumoniae in newborn sepsis (31). Furthermore, multidrug resistance (MDR) was present in almost 500,000 new cases of rifampicin-resistant tuberculosis (RR-TB) that were detected globally in 2018 (32). The persistence of antibiotic tolerance can exacerbate medical conditions linked to diseases like HIV, cancers, and malaria (33). As the standard antibiotic treatment regimen becomes antiquated, the risks of AMR are expected to escalate sharply. This could potentially result in situations where patients who are terminally ill require palliative care, but the medications are no longer clinically effective (34). Additionally, hospital intensive care units (ICUs) could become breeding grounds for nosocomial MDR pathogens. Finally, it has been estimated by several studies that AMR-related diseases could cost USD 60–100 trillion by 2050, resulting in a 2% to 3.5% drop in the world total GDP (35-37). The ability of the human immune system to combat infectious infections is weakened by antibiotic resistance, which also increases the risk of many problems in susceptible individuals undergoing dialysis, surgery, chemotherapy, and joint replacement (38). Furthermore, antibiotic resistance will have a significant effect on individuals who have...