Antimicrobial resistance surveillance in Ethiopia: Implementation experiences and lessons learned

Introduction: Antimicrobial resistance (AMR) poses a global threat. High levels of AMR to commonly used antibiotics have been reported in East Africa. A situation analysis of AMR in Ethiopia also indicated high resistance levels. To prevent and contain AMR, Ethiopia established a national surveillance network. Objectives: This article describes the steps taken to prioritise AMR and establish the National Antimicrobial Resistance Surveillance System in Ethiopia, as well as present the challenges and lessons learned through implementation. Methods: In April 2017, Ethiopia had developed and approved the National AMR Surveillance Plan for laboratory-based AMR surveillance. The World Health Organization recommendations and Ethiopias’s current microbiology capacity were used to prioritise organisms for reporting. The surveillance system is comprised of a network linking the national reference laboratory with surveillance sentinel sites. Roll-out of the AMR surveillance network occurred in three phases in order to ensure successful implementation. Results: Electronic capture and transmission of data, supply chain for the microbiology laboratory and communication problems were challenges observed after implementation started. Support from Ethiopian Public Health Institute focal persons for data entry, regular scheduled communication establishment and procurement of supplies by the American Society for Microbiology were some of the measures taken to address the challenges. Conclusion: Ethiopia has demonstrated that setting up AMR surveillance in lower resource settings is possible with strong leadership and stakeholder engagement

Evaluation of the efficacy of insecticide-treated scarves to protect children from the trachoma vector Musca sorbens (Diptera: Muscidae): A phase II randomised controlled trial in Oromia, Ethiopia.

Background: The eye-seeking fly Musca sorbens can act as a vector for ocular Chlamydia trachomatis, causing trachoma, yet there has been very little research on control measures. We investigated whether insect repellent products, specifically insecticide-treated clothing, could provide personal protection to the user from eye-seeking flies. Methods: We first conducted a series of phase I laboratory studies to inform our choice of field intervention. We then conducted a phase II randomised controlled trial testing the efficacy of permethrin-treated scarves (PTS) in reducing fly-face contact in Oromia, Ethiopia. Children aged 4-10 years in full health and with no known adverse reactions to permethrin or other insecticides were allocated to either arm using restricted randomisation. Intervention arm children wore Insect Shield® versatile wraps (as PTS) for 28 days. The primary outcomes, fly-eye, -nose and -mouth contact, were assessed on the first day (0/30/60/180 minutes), on day 7 and on day 28. All participants present per timepoint were included in analyses. This trial was registered with ClinicalTrials.gov (NCT03813069). Findings: Participants were recruited to the field trial between 29/10/2019 and 01/11/2019, 58 were randomised to test or control arm. More fly (-eye, -nose and -mouth) contacts were observed in the PTS arm at baseline. After adjusting for baseline contact rates, across all timepoints there was a 35% decrease in fly-eye contacts in the PTS relative to control arm (rate ratio [RR] 0.65, 95% CI 0.52-0.83). Similar cross-timepoint reductions were seen for fly-nose and fly-mouth contacts (RR 0.69, 95% CI 0.51-0.92 and RR 0.79, 95% CI 0.62-1.01, respectively). All children were included on day 0. Two in the control arm were absent on day 7, one left the study and four were excluded from analysis at day 28. No adverse events occurred in the trial. Interpretation: Musca sorbens flies are sufficiently repelled by PTS to reduce fly-eye contacts for the wearer, thus possibly reducing the risk of trachoma transmission. Permethrin-treated scarves may therefore an alternative to insecticide space spraying for protection from these flies. Funding: Wellcome Trust