Table 2 The contributory factors to the scattered picture on AMR surveillance in LMICs
From: Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture
Contributory factors | Potential issues | Proposed interventions |
|---|---|---|
Weak Laboratory infrastructure | Inadequate construction including[24,25,26,27,28]: Quality of water Electricity supply Light sources Climate control and ventilation Biosafety requirements Limited internet coverage and connection speed Lack of infection prevention and control products Insufficient toilet facilities | National action plan Gap analysis Sentinel sites Cross borders and International cooperation Laboratory Accreditation Periodic audits for quality assurance and control Strict national rules and regulations Standard operating procedures Funding |
Limited staff capacity and training | Lack of dedicated staff Lack or Limited number of trained clinical and laboratory personnel[13, 14, 24,25,26] Lack or limited number of microbiologists and healthcare professionals with expertise in the field Lack or limited number of staff trained in data management process | Government plan for strengthening health workforces Educational grants for continuous education and training Educational grants for post-graduate education and specialization National coordinating committee Interventions of specialized scientific societies in the field Enhancement of postgraduates programs Continuous trainings on-site and off-site, l Establishing mandatory number of continuous credit per year for license eligibility Training on standard operating procedure, data management and on Antimicrobial susceptibility testing standards |
Communication issues | Lack of trust between prescribers and laboratories due to[13, 15, 26, 32, 34, 36]: Lack of standardized Antimicrobial susceptibility testing Lack of expertise or unqualified staff Lack of trust in diagnostic products and equipment’s Laboratory items and diagnostics shortages | Role of the national coordinating committee in improving communication Accreditation of laboratories t improve quality Quality control for diagnostics manufacturing Standardization Rules and regulations to solve the supply chain issues Standard operating procedures National awareness and education programs |
Limited or lack of Availability of Consumables, Diagnostics, and Reagents | Environmental factors like high temperature and humidity may affect the transport, storage and quality of the supplies Questionable supply chains Low quality of locally manufactured diagnostics High maintenance cost of equipment’s High energy consumption for equipment’s High waste generation | Quality control of local manufacturer diagnostics Standardization f quality requirements for good manufacturing practices Government role in preventing supply shortages and supervision of the supply chain Periodic audit Diagnostics and reagents adapted to the harsh environment Funding local manufacturing Examining alternatives to save energy and providing low cost services |
Relying heavily on Funding | Grants and funds may be short-term[15] Lack of national budget for internal funding | Government intervention for internal funding Role of National coordinating committee National action plan Re-structuring funds to invest in educational grants for better sustainability |
Poor data management | Fragmented, low quality data that lack of reliability and representativeness[13,14,15, 26] | Standardization Aligning systems Training on data collection Management and analysis Data sharing International support through training, and use of new technologies Grants |