AMR platform in action

The proposed solutions aim to comprehensively address antimicrobial resistance challenges. They include establishing an AST laboratory, surveillance for susceptibility profiles, standardized infection prevention services, an online susceptibility reporting and aggregating database, prescription monitoring system, and developing machine and deep learning algorithms for impact estimation. These measures aim to enhance antimicrobial resistance management.

Musa Mohammed Ali, an Associate Professor at Hawassa University, Ethiopia, with a Ph.D. in Medical Microbiology, excels in research, and community service. His focus includes infectious diseases and antimicrobial resistance.  

Antimicrobial resistance (AMR) presents a pressing public health challenge globally particularly in Ethiopia, where resistance rates to key antibiotics range from 30% to 85%. Limited diagnostics, antibiotic misuse, and poor sanitation exacerbate the issue, with Ethiopia facing significant healthcare infrastructure gaps. Globally, AMR leads to around 700,000 deaths annually, a figure projected to escalate to 10 million by 2050. Causes of AMR in Ethiopia include unrestricted antibiotic access, inadequate regulation in human and veterinary medicine, and limited public awareness of antimicrobial consequences. Additionally, challenges in healthcare delivery, such as diagnostic limitations and inadequate infection control, contribute to antibiotic misuse. Poverty and limited access to clean water further worsen the problem.

The proposed solutions aim to address these challenges comprehensively. Establishing a dedicated laboratory for Antimicrobial Susceptibility Testing (AST) at Hawassa University will ensure standardized monitoring, while surveillance programs will monitor AR in clinical and non-clinical environments. Enhancing infection prevention and control services, creating an online reporting and aggregating database for AST data, developing an application to monitor antibiotic use, evaluating the efficacy of antimicrobials, and utilizing machine and deep learning algorithms will collectively bolster efforts to combat AMR in Ethiopia and beyond.

The proposed solutions aim to serve various stakeholders involved in healthcare delivery, public health, veterinary medicine, pharmaceutical regulation, and policymaking in Ethiopia and globally. Specifically, these solutions address the needs of healthcare professionals, researchers, policymakers, regulatory authorities, and the general public. Healthcare professionals require standardized monitoring tools like the dedicated laboratory for Antimicrobial Susceptibility Testing (AST) to guide appropriate antibiotic prescribing practices. Researchers benefit from enhanced surveillance programs and the online database for AST data to conduct comprehensive studies on antimicrobial resistance patterns and trends. Policymakers and regulatory authorities rely on accurate data and information to formulate effective policies and regulations to combat AMR. Additionally, the general public requires education and awareness campaigns to understand the consequences of antimicrobial misuse and adopt appropriate behaviors.

To understand the needs of these target audiences, extensive stakeholder engagement, consultations, and collaboration with relevant institutions, healthcare facilities, governmental agencies, and community organizations are essential. This involves conducting needs assessments, gathering feedback through surveys and focus groups, and fostering ongoing communication channels to ensure that the proposed solutions align with the priorities and requirements of the stakeholders. Through these collaborative efforts, the solutions aim to support stakeholders in effectively addressing the multifaceted challenges posed by antimicrobial resistance in Ethiopia and globally.

Establishing an independent AMR laboratory and database in southern Ethiopia serves to enhance the dissemination of information regarding the AMR trend at the local and national levels, as well as contribute to various research publications. It also serves as a valuable resource for researchers and policy makers to conduct further studies and develop effective strategies against AMR. Additionally, it provides international-level information on the efficacy of different drugs, enabling physicians to make informed decisions when prescribing medications for patients based on their specific conditions. This not only reduces the healthcare costs for patients by avoiding ineffective treatments due to AMR, but also helps in minimizing the transmission of AMR organisms within the community and facilitates better control measures.

Provide different service for patients, community and physician.  

• Improving patient health with early detection of AMR organism at genome level and indicate prescription appropriate antimicrobial for them.
• It will help in reducing medical errors; means miss understanding of disease clinical  diagnosis by providing accurate information regarding sensitivity and resistance level of organism to the different antimicrobial.
• Reduction in patients’ medical facility running costs due to AMR cases.
• Provide accurate, up-to-date patient information regarding AMR for patients, physician and community.

For research purpose:

• Promote comfortable area and lab setup for researchers, students and different institutions which need to conduct different research and experiments.   
• Provide secondary data for surveillance and study purpose.
• Used as indicators for the implication for national stakeholder and policymaker.

• We will assess the magnitude and trend of AMR organisms in the southern Ethiopia. Reduce the challenge of getting access AMR diagnosis for patients to obtain an AMR diagnosis and the overcrowding in medical facilities as a result of AMR illnesses.  

• At this moment, there is hardly any data reported from the community settings. So first the baseline will be established by getting data from primary level health facilities to the comprehensive hospital AMR sentinel sites. Once the baseline data is established that will be used as an indicator to determine the coverage and the quality of the data captured. Secondly, there are approximately 25 medical centers  all over Hawassa City. So our objective is to enroll all these facilities. If the reporting from all these facilities biannually is achieved as per the standardized level, then we can say that we have achieved 100% coverage. 

• At this moment, there is no concept of community based data screening, capturing and reporting. This it the biggest barrier of establishing something that don’t exist, and something for which medical professionals have no awareness.

• So our progress will be on step by step basis with stage
  1. Stage 1: Dealing with awareness
  2. Stage 2: Baseline data
  3. Stage 3: Regular data capturing for evidence based actions. 

We are applying to the Trinity Challenge since it brings a strategy for sustainable reduction of morbidity, mortality and poverty related to antimicrobial resistance (AMR), one of the major health threats to people and animals in low-income countries. We have a Health extension program (HEP) primarily targeted to access Primary Health care throughout the countries. Financial and technical supports require for integration of AMR stewardship by already established HEP and National Diagnostic Network. Trinity Challenge is an opportunity to initiate AMR community-level surveillance and management through engaging health extension workers of HEP and optimizing the national diagnostic network, focusing on the detection of resistance of bacteria to antibiotics from human, animal and environmental sources and applying user-friendly software for data collection, processing, analysis and dissemination of findings

We are eager to collaborate with international, regional and national organizations such as World Organization of Animal Health (WOAH), the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), Global Alliance for improved nutrition (GAIN), African Societies of Laboratory Medicine (ASLM), at national level with Ministry of Health and ministry of agriculture  and other organizations working on health and health related activities to initiate community level AMR surveillance and to integrate with  the national health extension program and diagnostic network for sustainable AMR management.

We will have technical and financial benefit from collaborations to standardize comprehensive community level sample collection, sample referral system and testing services for sustainable surveillance system and AMR management throughout the established health tier system and to establish electronic data management system for data collection, processing, analysis and reporting/communication. In addition, the collaboration will open for technology transfer, skilled manpower development and to build center of excellence in AMR management for the African region and globally at large.