Assessment of antimicrobial resistance surveillance systems in Nigeria

Okolie, Obiageli

Abstract

Antimicrobial resistance (AMR) is among the top ten public health threats worldwide. This problem is further compounded by poor surveillance and oftentimes lack of good quality data to enable accurate estimation and description of the magnitude (prevalence and incidence), burden (health and economic) and distribution (geographical areas and population) of AMR globally. Consequent upon this paucity of information, data needed to guide strategic intervention is lacking and thus leading to poor management and investment decisions. The Nigeria National Action Plan (NAP) recognises surveillance as a critical component for the control of AMR. However, the current AMR surveillance system (AMRSS) may not be representing the actual burden of AMR in the country. With the knowledge of this problem, the aim of this research was to evaluate the capacity and sustainability of AMRSS in Nigeria and to provide suggestions to optimise and strengthen the AMRSS effectiveness and efficiency.

Methods
This research utilised a three dimensional study approach to enrich and triangulate data from different sources: 1) a systematic review of twenty-three surveillance systems was conducted to generate an overview of AMR surveillance approaches and methodologies in Africa; 2) a cross-sectional study of 302 laboratories was carried out to assess the technical capacity of laboratories involved in AMR surveillance in Nigeria as well as identify gaps, vulnerabilities and opportunities for improving data quality and performance using surveillance quality indicators (SQIs) and; 3) in-depth qualitative interview which explored perceptions, views, and opinions of 34 stakeholders which was used to access governance areas of NAP implementation as well as gauge active participation, political will and stakeholder engagement which are crucial to AMRSS success and sustainability.

Results
The systematic review highlights a number of methodological and reporting flaws in existing surveillance systems that impact completeness, representativeness, accuracy, validity, reliability and usefulness of data. The cross-sectional study reveals that the weakest and most vulnerable of all SQIs were items related to data recording. Even though the weaknesses and strengths varied among laboratories, the tertiary laboratories reported highest performance levels. Generally, the performance of one indicator influenced the other thus strengthening one indicator will potentially affect overall laboratory performance. Responses from the qualitative interview reveals under-resourcing and poor multi-sectoral engagement as the key themes impacting AMRSS performance and sustainability. It also suggests that some governance domain essential for effective administration of the NAP were not effectively implemented.

Conclusion
The current AMRSS in Nigeria has limited capacity. This alongside other confounders could potentially lead to possible over-representation of resistance in the population. There is urgent need to strengthen the system and this study has helped to provide better insights to the enablers and critical focus areas for improving overall performance and for sustainability of the surveillance system. This will enable the surveillance system to leverage on the technical capacity, strength and opportunities provided by eligible laboratories to optimise data quality for a more robust and representative surveillance.

• Thesis Type: Thesis
• Deposit Date: Nov 1, 2023
• Publicly Available Date: Aug 1, 2024
• Public URL: https://uwe-repository.worktribe.com/output/11405263
• Award Date: Aug 1, 2024