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LETTER TO THE EDITOR
Year : 2018  |  Volume : 21  |  Issue : 3  |  Page : 179-180

Antimicrobial resistance surveillance system in Nigeria: Suggested models


1 Department of Medical Microbiology and Parasitology, College of Health Sciences, Usmanu Danfodiyo University; Nigerian Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
2 Nigerian Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
3 Department of Biological Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria

Date of Web Publication4-Oct-2018

Correspondence Address:
Dr. Yahaya Mohammed
Department of Medical Microbiology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, Sokoto
Nigeria
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DOI: 10.4103/smj.smj_17_17

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How to cite this article:
Mohammed Y, Ibrahim BS, Galalain SM, Dalhat MM, Nguku P. Antimicrobial resistance surveillance system in Nigeria: Suggested models. Sahel Med J 2018;21:179-80

How to cite this URL:
Mohammed Y, Ibrahim BS, Galalain SM, Dalhat MM, Nguku P. Antimicrobial resistance surveillance system in Nigeria: Suggested models. Sahel Med J [serial online] 2018 [cited 2018 Dec 14];21:179-80. Available from: http://www.smjonline.org/text.asp?2018/21/3/179/242738



Dear Sir,

Antimicrobial resistance (AMR) is viewed globally as a public health problem that threatens the successful treatment of an ever-increasing range of infections. This is because AMR adds to the high cost of care, severity and high mortality of otherwise easy to treat infections. Governments around the world are devoting efforts to combat this important threat.[1]

The WHO recognizes AMR as a health-care problem with global repercussion. Consequently, strengthening global AMR surveillance has been prioritized for the purpose of combating drug resistance, detecting new trends/threats, and monitoring the effectiveness of public health interventions.[2] The May 2015 World Health Assembly adopted a global action plan on AMR with the main aim of improving awareness, strengthen evidence base through surveillance and research, and the use of appropriate control and preventive measures to reducing the incidence of infection.[2]

It is puzzling that Nigeria, a member state of the WHO has no existing surveillance for AMR. Considering that an effective and standardized laboratory network is necessary for a reliable AMR surveillance program, a quality assessment of the existing laboratories is timely. However, efforts are underway by the Nigerian Center for Disease Control to design a program of AMR for the country in the near future.

We hereby proposed three models in order of importance that can be modified and adopted by the Nigerian government to for the purpose of establishing a national AMR surveillance for the country.

(a) Sentinel survey - At least one sentinel sites (a Teaching Hospital) would be selected from all the six zones of Nigeria. A committed focal person would be identified from the center for coordination. Capacity building for staff would be carried out. Materials would be provided for the susceptibility testing. Incentive would be provided to motivate staff. Any isolates of Gram negatives or Gram positives that are resistant to two or more classes of antimicrobial agents would be selected for additional resistance testing. The isolates would be transported to a national reference center for quality assurance testing and further storage at a national sample bank.

The strength of this model is that a near true picture of the burden of AMR would be available since teaching hospital receives patients from usually all states within their zone. The teaching hospitals are under supervision of the Federal Ministry of Health; hence, compliance might not be an issue. One of the limitations of this model is that loss of trained staff due to attrition would affect the quality of work. The focal person has to be committed. Another limitation to this model is selection bias of the appropriate patient population. A similar model in the Centers for Disease Control (CDC) is the National Nosocomial Surveillance System - for Healthcare-associated infections.[3]

(b) Transborder surveillance for antimicrobial surveillance - The sites would be the major international airports in the country. In conjunction with the port health, any patient traveling abroad for medical care would be required to provide a rectal swab specimen (regardless of his medical condition) for characterization. The specimen would then be transported in transport media to the national reference center for characterization. Any Gram negative therein isolated would be tested for its susceptibility profile.

The strength of this study is that there is abundance of port health personnel that could be trained on specimen collection and transportation. However, patient might refuse consent especially when they feel the test has no bearing to their condition. A similar model in the CDC is the Emerging Infection Program - Community based until 2005.[4]

(c) Periodic survey (active surveillance system) - In this model, a purposive sampling would be carried out to pick some sites. Personnel and infrastructure would be drafted during the survey period to carry out on the site testing and reporting. The target population could be community-based population (food vendors, abattoir workers) or hospital-based population. Specimen would be obtained and transported through a transport media to the national reference laboratory for identification. Isolates of Gram positives and negatives (bacteria) would be selected for susceptibility testing and resistance profiling.

The strength of this model is that workforce would not be an issue since there are enough residents of the Nigerian Field Epidemiology and Laboratory Training Program in various parts of Nigeria that can be deployed for that purpose. It might ensure more qualitative results. The weakness of this model is the ability to sustain the periodic surveys in a timely manner might be an issue. The survey might not provide the true national picture. A similar model in the CDC is the Active Bacterial Core Surveillance.[5]

Finally, we recommend that the Nigerian government should urgently design and invest in a national AMR program with a central coordination and feedback for control and prevention. The suggested models have been presented in order of priority and importance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Holloway K, Mathai E, Gray A, Community-Based Surveillance of Antimicrobial Use and Resistance in Resource-Constrained Settings Project Group. Surveillance of antimicrobial resistance in resource-constrained settings - Experience from five pilot projects. Trop Med Int Health 2011;16:368-74.  Back to cited text no. 1
    
2.
World Health Organization. Global Action Plan on Antimicrobial Resistance. The Definitive Version of the Global Action. Available from: http://www.who.int. [Last accessed on 2016 Dec 24].  Back to cited text no. 2
    
3.
Center for Disease Control and Prevention. National Nosocomial Surveillance System-For HAIs. Available from: http://www.cdc.gov/hai/surveillance. [Last accessed on 2016 Dec 24].  Back to cited text no. 3
    
4.
Center for Disease Control and Prevention. Emerging Infection Program (EIP)-Community Based. Available from: http://www.cdc.gov/ncezid/dpei/eip. [Last accessed on 2016 Dec 24].  Back to cited text no. 4
    
5.
Center for Disease Control and Prevention. Active Bacterial Core (ABC) Surveillance. Available from: http://www.cdc.gov/abcs/index.html. [Last accessed on 2016 Dec 24].  Back to cited text no. 5
    




 

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