I. Factors that favor the emergence, dissemination and/or persistence of AMR | |
a) Factors common to human and animal studies | |
• Ease of access (cheap, widely available) to antibiotics | Kenya [19,32,36,51,123]; Uganda [22]; Ethiopia [30]; Tanzania [39,85] |
• Antibiotic use practices, including self-medication, high frequency of antibiotic use, sub-therapeutic use or indiscriminate use | Kenya [19,26,31,32,36,51,54,77,108,129]; Ethiopia [27,47,88,89,120,125]; Tanzania [85,113] |
b) Human studies | |
• Over-prescription at health facilities due to limited diagnostics resources | Ethiopia [89]; Kenya [38] |
• Severe infections requiring different antibiotics | Rwanda [79] |
• Human importation of antibiotic resistant bacteria | Burundi [75] |
• Nosocomial or community transmission of resistant bacteria | Kenya [14,36,78]; Rwanda [44] |
c) Animal studies | |
• Resistant bacteria imported via contaminated food | Kenya [26]; Ethiopia [122,125,126] |
• Antibiotic use in humans | Kenya [105-107]; Ethiopia [122,125] |
• Animal-animal contact | Ethiopia [119] |
• Animal-human close co-existence increasing contact | Kenya [103] |
• High antibiotic use in animals in small production systems, poor farm management practices disseminating resistant bacteria | Kenya [107]; Ethiopia [126] |
• Housing contamination | Ethiopia [124] |
• Contamination during handling animal products. | Kenya [107]; Ethiopia [115,117,125] |
II. Factors that contribute to the reduction of AMR | |
• High cost of antibiotic | Kenya [36]; Ethiopia [117,118]Ɨ |
• Limiting antibiotic availability | Uganda [22]; Rwanda [79]; Ethiopia [118,119]Ɨ |
• Periodic withdrawal of antibiotics from public use | Kenya [37]; Rwanda [79] |
• Parenteral administration of antibiotics | Ethiopia [47] |
• Infrequent or prudent use of antibiotics | Kenya [104,107,123]Ɨ; Ethiopia [115,117,120,125,127]Ɨ |