One Health Surveillance of Antimicrobail resitance and utilization

This project focuses on the development of data collection, sharing, analyses, and visualization systems for antimicrobial resistance (AMR), antimicrobial use (AMU), and antimicrobial consumption (AMC) from human, animal health, and environmental sectors. It is built on the One Health approach to surveillance, bringing together multi-sectoral stakeholders to share surveillance data.

Seid Tiku Mereta is a Professor in Environmental health and director of  Center for One Health Education, research, and Outreach at Jimma University, Ethiopia

The widespread use and misuse of antimicrobials are the major driving factors for antimicrobial resistance that threaten the health of humans, animals, and the ecosystem. The World Health Organisation has identified Antimicrobial resistance (AMR) as one of the top ten global public health threats. Ethiopia has the 170th highest age-standardized mortality rate per 100,000 populations associated with AMR across 204 countries. The AMR situation in Ethiopia has become more complicated due to a lack of clean water, hygiene, and sanitation infrastructure, suboptimal animal-food farming practices, and the habit of eating raw meat and milk. Therefore, strengthening AMR, AMC, and AMU surveillance is critical for ensuring evidence-based policy-making and supporting effective strategies to promote the responsible use of antibiotics for controlling the spread of antimicrobial resistance. However, owing to the limited capacity of health systems and technological hurdles, comprehensive and robust surveillance tools is lacking in Ethiopia. This project aims to (1) develop AMC and AMU data collection and sharing system; (2) establish national AMC and AMU data warehouse and visualization dashboard; (3) link AMC and AMU with AMR WHONET and WHOGLASS (4) build capacity of public health, animal and environmental/agriculture professional on OH surveillance and antimicrobial stewardship.  

This project supports the establishment of a One Health surveillance framework for AMR and AMU in Ethiopia. This facilitates data sharing among human, environmental, and animal health sectors thereby guiding the development of policies and clinical practices. The AMU data provides the amount of antimicrobials used, which in turn helps to assess the risk of AMR resulting from exposure to antimicrobials. It also provides early warning of emerging and re-emerging human, animal, and plant infectious diseases

Healthcare professionals: Collecting and sharing AMR surveillance data with healthcare professionals will improve their understanding of resistance trends, monitor the effectiveness of antibiotics, inform appropriate antibiotics, and develop infection control strategies. In addition, the capacity of healthcare professionals will be enhanced through capacity-building training. The training will focus on AMC and AMU surveillance, integration of AMU data to DHIS2, and sharing of data to the National data warehouse. 

Community: In this project, AMU data will be collected from community pharmacies, drug vendors, and farms (poultry, animal fattening, and dairy) and reported to the national data warehouse. These stakeholders will receive capacity-building training mainly on electronic data collection and data sharing and optimal use of antibiotics

This project provides knowledge, skills, data, and services to various stakeholders: 

Knowledge/skill: Training sessions will be organized to strengthen the AMC and AMU surveillance for public health, and animal and environmental health professionals. The training will focus on AMC and AMU surveillance, integration of AMC and AMU data to DHIS2, and sharing of data to the National data warehouse.

Data:  Generate information on AMR, AMC, and AMU from human, animal and agriculture sectors

Services: A national data warehouse will be established at the national reference laboratory (Ethiopian Public Health Institute, EPHI). This allows data analysis and visualization for monitoring of AMR and AMU. 

Strengthening AMR surveillance is critical for ensuring evidence-based policy-making and supporting effective strategies to promote the responsible use of antibiotics for controlling the spread of antimicrobial resistance. Surveillance of antimicrobial utilization, consumption, and resistance is critical to provide early warning of emerging and re-emerging human, animal, and plant infectious diseases, to monitor changing patterns of resistance, and to target and evaluate antimicrobial resistance prevention and containment measures. This project promotes data sharing on antimicrobial utilization, consumption, and resistance to trigger changes in the behavior of human, agriculture, environmental, and veterinary healthcare professionals

The ongoing AMR data sharing project limited 16 sentinel public health, five animal, and five environmental laboratories. On the other hand, the proposed AMU data collection and sharing system includes the 16 sentinel public health identified for AMR data sharing, 48 pharmacies and 16 animal drug vendors located in the sentinel sites, 30 farm data (10 dairy, 10 poultry, and 10 animal fattening). In the first year of the project, data will be collected and shared with the National data warehouse, where it is analyzed and visualized and eventually shared with the GLASS.  In the second year of the project, the data collection system and sharing platform will be evaluated and amendments will be made accordingly. In the third year, the solution will be expanded to additional regional and zonal hospitals, pharmacies, drug vendors, and farms situated near these hospitals.

Measuring project success/ Performance Indicators. The following indicators will be used as project performance indicator 

• One Health platform created and promoted
• Data capturing tool
• Guidelines, surveillance tools, protocols, SOPs
• Data availability and utilization
• AMR and AMU visualization Dashboard
• Number of facilities/institutions share  AMC and AMU
• Number of databases
• Multisectoral AMR surveillance system
• Best practices for optimal AMU in critical sectors
• Integrated AMR/AMU monitoring and surveillance systems, and databases
• AMR management and governance
• Number of actors sensitized in the different sectors

Institutional/professional silos: Despite the presence of a national strategic plan that emphasizes multi-sectoral AMR data sharing, there might be resistance from government sector offices and professionals working in those sectors to share their data with the national database. Higher level advocacy, awareness creation, and communication are our strategies to overcome those resistances: 

Financial sustainability: There might be financial constraints to scale up and sustain this initiative after three years, at the end of the project period. The project has been aligned with the national one health AMR prevention and containment strategy with the health sector transformation and livestock master plans and environment policy and the national action plan for health security that ensures sustainability

We are applying for the Trinity challenge as we have financial constraints to  develop antimicrobial consumption and utilization data collection and sharing system, establishing national data warehouse and develop AMR/AMU data visualization dashboard. The financial support obtained from the Trinity challenge will be also used for the scale-up and expansion of the solution into other regional and zonal laboratories, pharmacies, drug vendors and farms. It is also a very good opportunity to netwoking and obtain mentorship support from Trinity collaborators that is instrumental for the implemntation of our solution.

We have identified key collaboratory who would be ideal partners:

1: Prof. John Stelling: Co-Director, WHO Collaborating Centre for Surveillance of Antimicrobial Resistance, Boston, USA. Provide advisory support on the establishment of a national data warehouse and visualization dashboard. 

2. Dr. Ahmad Hussen Tareq,  AMR lead, World Health Organization ETHIOPIA. Facilitate the linkage of AMR and AMU surveillance with the WHO GLASS system   

3. Prof. John Lewis,  DHIS2 consultant for the University of Oslo who can give expert advice on the customization to DHIS2 for sharing Antimicrobial utilization data