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