Review of the effectiveness of the medicines regulatory systems in Zambia over the period 1995 to 2015

Magister Scientiae - MSc (Pharmacy Administration and Policy Regulation)Due to inadequacy of data on the effectiveness of medicines regulatory systems in Zambia, this study was framed. The aim was to evaluate legislative provisions for medicines regulation under three legalregulatory- frameworks in place over the period from 1995 to 2015. The study was structured in two distinct phases: the first involved document review of available legislation and secondary data relevant to the subject matter, covering the study period; the second involved a questionnaire survey for health practitioners to gather opinions on the effectiveness of the medicines regulatory systems in Zambia. Assessment of secondary data reported by Ministry of Health, and World Health Organisation on treatment outcomes and medicines regulation was conducted. Reviewed data showed relative reduction in incidence of some selected diseases of national importance. It was also evident that the regulatory systems had improved considerably over the study period. Responses from Health Practitioners and other players in the health and pharmaceutical sectors indicated that they were aware of medicines regulatory requirements, supported the need for medicines regulation, and indicated the need for regional collaboration and increased public awareness raising as means for improving current medicines regulatory systems. It was recommended that more comprehensive studies be undertaken to establish causal relationships between medicines regulatory systems, and disease outcomes. A further recommendation was made to implement more integrated information management systems in the Ministry of Health, and the Zambia Medicines Regulatory Authority

Review of the effectiveness of the medicines regulatory systems in Zambia over the period 1995 to 2015

Magister Scientiae - MSc (Pharmacy Administration and Policy Regulation)Due to inadequacy of data on the effectiveness of medicines regulatory systems in Zambia, this study was framed. The aim was to evaluate legislative provisions for medicines regulation under three legalregulatory- frameworks in place over the period from 1995 to 2015. The study was structured in two distinct phases: the first involved document review of available legislation and secondary data relevant to the subject matter, covering the study period; the second involved a questionnaire survey for health practitioners to gather opinions on the effectiveness of the medicines regulatory systems in Zambia. Assessment of secondary data reported by Ministry of Health, and World Health Organisation on treatment outcomes and medicines regulation was conducted. Reviewed data showed relative reduction in incidence of some selected diseases of national importance. It was also evident that the regulatory systems had improved considerably over the study period. Responses from Health Practitioners and other players in the health and pharmaceutical sectors indicated that they were aware of medicines regulatory requirements, supported the need for medicines regulation, and indicated the need for regional collaboration and increased public awareness raising as means for improving current medicines regulatory systems. It was recommended that more comprehensive studies be undertaken to establish causal relationships between medicines regulatory systems, and disease outcomes. A further recommendation was made to implement more integrated information management systems in the Ministry of Health, and the Zambia Medicines Regulatory Authority

Towards a bottom-up understanding of antimicrobial use and resistance on the farm: A knowledge, attitudes, and practices survey across livestock systems in five African countries.

The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and inadequately controlled access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N = 110) and Kenya (N = 76), pastoralists keeping cattle, sheep, and goats in Tanzania (N = 195), and broiler farmers in Zambia (N = 198), and Zimbabwe (N = 298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralist households. Multivariate models showed that variation in knowledge, attitudes and practices is related to several factors, including gender, disease dynamics on the farm, and source of animal health information. Study results emphasize that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat antimicrobial resistance globally

Identification of <i>Escherichia coli</i> and Related Enterobacteriaceae and Examination of Their Phenotypic Antimicrobial Resistance Patterns: A Pilot Study at A Wildlife–Livestock Interface in Lusaka, Zambia

A cross-sectional study was used to identify and assess prevalence and phenotypic antimicrobial resistance (AMR) profiles of Escherichia coli and other enterobacteria isolated from healthy wildlife and livestock cohabiting at a 10,000 acres game ranch near Lusaka, Zambia. Purposive sampling was used to select wildlife and livestock based on similarities in behavior, grazing habits and close interactions with humans. Isolates (n = 66) from fecal samples collected between April and August 2018 (n = 84) were examined following modified protocols for bacteria isolation, biochemical identification, molecular detection, phylogenetic analysis, and antimicrobial susceptibility testing by disc diffusion method. Data were analyzed using R software, Genetyx ver.12 and Mega 6. Using Applied Profile Index 20E kit for biochemical identification, polymerase chain reaction assay and sequencing, sixty-six isolates were identified to species level, of which Escherichia coli (72.7%, 48/66), E. fergusonii (1.5%, 1/66), Shigella sonnei (22.7%, 14/66), Sh. flexinerri (1.5%, 1/66) and Enterobacteriaceae bacterium (1.5%, 1/66), and their relationships were illustrated in a phylogenetic tree. Phenotypic antimicrobial resistance or intermediate sensitivity expression to at least one antimicrobial agent was detected in 89.6% of the E. coli, and 73.3% of the Shigella isolates. The E. coli isolates exhibited the highest resistance rates to ampicillin (27%), ceftazidime (14.3%), cefotaxime (9.5%), and kanamycin (9.5%). Multidrug resistance (MDR) was detected in 18.8% of E. coli isolates while only 13.3% Shigella isolates showed MDR. The MDR was detected among isolates from impala and ostrich (wild animals in which no antimicrobial treatment was used), and in isolates from cattle, pigs, and goats (domesticated animals). This study indicates the possible transmission of drug-resistant microorganisms between animals cohabiting at the wildlife–livestock interface. It emphasizes the need for further investigation of the role of wildlife in the development and transmission of AMR, which is an issue of global concern