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Table 3 Factors that explain the prevailing state of AMR in eastern Africa

From: A review of 40 years of enteric antimicrobial resistance research in Eastern Africa: what can be done better?

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
  1. List of risk factors that are thought to contribute to the state of antimicrobial resistance in Eastern Africa as suggested both by studies on AMR in humans and animals. Country and relevant citation shown in the column on the right. ƗAnimal studies.