The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis

Background A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. Methods We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen–drug combinations for countries in the WHO African region in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). We obtained data from research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. Findings In the WHO African region in 2019, there were an estimated 1·05 million deaths (95% UI 829 000–1 316 000) associated with bacterial AMR and 250 000 deaths (192 000–325 000) attributable to bacterial AMR. The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119 000 deaths [92 000–151 000], or 48% of all estimated bacterial pathogen AMR deaths), bloodstream infections (56 000 deaths [37 000–82 000], or 22%), intra-abdominal infections (26 000 deaths [17 000–39 000], or 10%), and tuberculosis (18 000 deaths [3850–39 000], or 7%). Seven leading pathogens were collectively responsible for 821 000 deaths (636 000–1 051 000) associated with resistance in this region, with four pathogens exceeding 100 000 deaths each: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Third-generation cephalosporin-resistant K pneumoniae and meticillin-resistant S aureus were shown to be the leading pathogen–drug combinations in 25 and 16 countries, respectively (53% and 34% of the whole region, comprising 47 countries) for deaths attributable to AMR. Interpretation This study reveals a high level of AMR burden for several bacterial pathogens and pathogen–drug combinations in the WHO African region. The high mortality rates associated with these pathogens demonstrate an urgent need to address the burden of AMR in Africa. These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen–drug combinations. Funding Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund

African Humanities and the Global Academy: A Reflection on the North–South Intellectual Landscape1

This article reflects on Africa’s relationship to the global academy in terms of global knowledge production, dissemination and consumption, with particular interest in the politics of location, mobility and positionality of knowledge in the humanities. Among the questions posed are: What bodies of knowledge and conceptual tools gain legitimacy in the global academy, and why? Does location of knowledge production matter? The article argues that despite important advances in the field of African studies, this area remains problematic as Africa continues to produce raw data, while the global North appears to provide the conceptual tools for ‘reading’ African experiences. The article stresses the importance of revisiting questions posed above, and the implications of uni-directional flows of ideas across the global North-South axis

Satire and the Politics of Corruption in Kenya

Corruption in Kenya has been a matter of intense concern for foreign donors and the international financial institutions. External efforts to change the ‘governance culture’ in this regard are not simply instrumental, composed of material restrictions and incentives. They are also inherently rhetorical, seeking to establish the plausibility of a set of values rooted in political economy. This paper examines two widely reported speeches of a former British High Commissioner that can be read together as a highly figurative satire on political standards in Kenya. Having developed a reading of anti-corruption governance as satire, we extend it to the role of the legal profession in the illegal and irregular allocation of public land. We argue that, as well as demonstrating an application of the rhetorical analysis of neo-liberal governance, the case of land grabbing in Kenya also highlights the instability of many of the key binary oppositions underpinning dominant anti-corruption strategies. This instability can be understood in rhetorical terms by drawing on the work of post-colonial writers and critics on the category of excremental satire. Rather than a clear binary opposition, these suggest the interrelation, or more precisely the mutual contamination, of corruption and normal capitalist accumulation