Resilience of Organic versus Conventional Farming Systems in Tropical Africa: The Kenyan Experience

In Kenya, agriculture is largely carried out by smallholder farmers, in a mixed farming noncommercialised setting where application of synthetic fertilisers and pesticides is minimal. Agricultural production is low and constrained by declining soil fertility, pest and diseases and increasingly unpredictable weather due to global warming. This calls for more resilient farming systems

First season maize performance in a long-term farming systems comparison trial at KARI-Thika, Kenya

Kenya’s smallholder farmers contribute 65% to total agricultural output in a predominantly mixed farming system where application of inorganic fertilizers and pesticides is minimal. By contrast, agriculture in developed temperate countries is dominated by large-scale farming and heavy reliance on fertilizers and pesticides to sustain high yields. Research conducted in temperate developed countries has shown that organic farming is superior to conventional farming in resource use efficiency, ecosystem functioning, soil fertility conservation and economic performance but results cannot be transferred directly to the tropics because of disparities in climate, soils and socio-economic environments. A long-term farming systems comparisons experiment was initiated at KARI-Thika in 2006 to assess the contribution of organic agriculture to food security, poverty alleviation and environmental conservation. Four treatments (Conventional High, Conventional Low, Organic High and Organic Low) were imposed in 8m x 8m plots using a randomized complete block design and replicated five times. The ‘High’ treatments received 118 kgN/ha and 66+5kgP/ha while the ‘Low’ treatments received 65 kgN/ha and 27 kgP/ha. Conventional treatments received the nutrients from farmyard manure, diammonium phosphate and calcium ammonium phosphate while compost, Tithonia diversifolia, and phosphate rock were applied in the organic treatments. Maize variety Pannar was planted at the onset of rains in April 2007 and harvested in August from a net plot area of 6m x 6m. The plots were hand weeded while stock borer was controlled using a Neem extract and ash/soil mixture in organic treatments and Bulldock® in conventional treatments. Stover dry weights were significantly higher in Conventional High than Organic Low (P=0.034) and indistinguishable from those observed in Conventional Low and Organic High. It was reasoned that availability of applied nutrients and the low poorly distributed rainfall received during the flowering and grain filling stages impacted negatively on grain yield

Nitrogen dynamics in organic and conventional farming systems in the sub-humid highlands of central Kenya

Nitrogen (N) deficit is one of the limiting factors to food security in most developing countries while the excessive use of N has resulted in environmental contamination. Timely N availability, at the right rate is crucial to improving crop yield and N use efficiency in farming systems. Therefore, understanding nitrogen dynamics under different farming systems is essential to improve N use and recovery efficiencies of crops and in addressing environmental impacts associated with increased use of inorganic and organic inputs. This study focused on N dynamics in conventional (Conv) and organic (Org) farming systems as practiced by small scale farmers (at ∼50 kg N ha−1yr−1, Low input) and at recommended levels of input (∼225 kg N ha−1yr−1, High input) for commercial use in the sub humid and humid regions of Central Kenya. Data was collected during three cropping seasons between October 2012 and March 2014 in an on-going long-term trial established since 2007 at Chuka and at Thika sites located in central highlands of Kenya. Mineral N-based fertilizer and cattle manure were applied in Conv-High and Conv-Low while composts and other organic inputs were applied at similar N rates for Org-High and Org-Low. Farming systems were laid down in a randomized complete block design with 4 and 5 replications at Chuka and Thika respectively. The trial follows a 2 season-three-year crop rotation envisaging maize, legumes, vegetables and potatoes. N mineralization was studied using a modified buried bag approach while N loss was measured using Self-Integrating Accumulator (SIA) cores. N synchrony was assessed using daily N flux differences constructed as daily N release minus daily N uptake at different stages of the crops. N uptake was assessed at various stages of the crop through destructive sampling while nitrogen use efficiency (NUE) was assessed at harvest. Surface N balances were constructed using N applied as inputs, N deposition via rainfall, biological N fixation and crop yield and biomass as outputs. Out of the total N applied from inputs, only 61, 43 and 71 % was released during potato, maize and vegetable seasons respectively. Farming systems did not show a major impact in their influence on N synchrony, i.e. matching N supply to meet N demand. Rather the N synchrony varied with crop and N demand stages. Positive N flux differences were observed (higher N release compared to N demand) during the initial 20-30 days of incubation for all the farming systems, and negative N flux differences (higher N demand than release) at reproductive stages of the crops. Nitrogen uptake efficiency (NUpE) of potato was highest in Conv-Low and Org-Low at Thika and lowest in Org-High and Org-Low at Chuka where late blight disease affected potato performance. In contrast, NUpE of maize was similar in all systems at Chuka site, but was significantly higher in Conv-High and Org-High compared to the low input systems at Thika site. The NUpE of cabbage was similar in Conv-High and Org-High while the NUpE of kale and Swiss chard were similar in the low input systems. Potato N utilization efficiencies (NUtE) and agronomic efficiencies of N use (AEN) in Conv-Low and Conv-High were higher than those from Org-Low and Org-High, respectively. The AEN of maize was similar in all the systems at Chuka but was higher in the high input systems compared to the low input systems at the site in Thika. The AEN of vegetables under conventional systems were similar to those from organic systems. Both conventional and organic systems lost substantial amounts of mineral-N into lower soil horizons before crop establishment (0-26 days). Cumulative NO3--N leached below 1 m was similar in all the farming systems but was higher at the more humid Chuka site compared to Thika site during the maize season. Significantly more N was leached during potato season compared to maize and vegetable seasons. When NO3--N leached was expressed over total N applied, 63-68% more NO3--N was leached from the low input systems compared to the high input systems. Org-High showed a positive partial N balance at both sites and in all the cropping systems except during the vegetable season at Chuka. All the other systems exhibited negative partial N balances for the three cropping seasons with exception of Conv-High during potato season and Conv-Low and Org-Low during vegetable season at Thika site. In summary, organic and conventional had similar effects on N release, synchrony and N loss through leaching. Furthermore, more N was leached (when expressed as a fraction of N applied) during potato and vegetables cropping seasons in the low input systems compared to the high input systems. In addition, conventional and organic farming systems had similar effects on NUpE, AEN, NUtE and NHI for maize and vegetables, while conventional systems improved NUE of potato compared to organic systems. The research therefore concludes that organic and conventional farming systems at high input level are viable options of increasing food security in sub-Saharan Africa (SSA) for maize and vegetables as demonstrated by similar yields, NUE, N supply and loss. Ability to meet food security in conventional and organic system at low input is hampered by high N losses, negative N balances coupled with low productivity due to biotic and abiotic stresses. In both conventional and organic systems, there is a need to reduce N application at planting and increase N applied at reproductive stages to minimize potential loss during the initial 20-30 days after application and improve N supply midseason when crop demand is high. Since organic systems depend on organic inputs, there is a critical need to improve the quality of manure, composts and other organic inputs to improve N supply and availability.Stickstoff-(N)-Mangel für Kulturpflanzen ist einer der limitierenden Faktoren für die Ernährungssicherheit in den meisten Entwicklungsländern, wohingegen die übermäßige Verwendung von N zu einer Umweltverschmutzung geführt hat. Eine rechtzeitige N-Verfügbarkeit ist entscheidend für die Verbesserung der Ernteerträge und der N-Nutzungseffizienz in der Landwirtschaft. Daher ist ein besseres Verständnis der Stickstoffdynamik unter verschiedenen Produktionssystemen unerlässlich, um die N-Nutzung und die N-Rückgewinnungseffizienz von Nutzpflanzen zu verbessern und die Umweltauswirkungen im Zusammenhang mit der verstärkten Nutzung anorganischer und organischer Betriebsmittel zu verringern. Die vorliegende Studie beschäftigt sich mit der N-Dynamik in konventionellen (Conv) und ökologischen (Org) Produktionssystemen, wie sie von Kleinbauern (~50 kg N ha-1 yr-1, Low Input) oder mit den empfohlenen Nährstoffwerten für den kommerziellen Einsatz (∼225 kg N ha−1 yr−1, High Input) in den subhumiden und humiden Regionen Zentralkenias praktiziert werden. Die vorliegenden Daten wurden während drei Vegetationsperioden zwischen Oktober 2012 und März 2014 in einem seit 2007 laufenden Langzeitversuch an den Standorten Chuka und Thika im Zentralen Hochland Kenias erhoben. In den Produktionssystemen Conv-High und Conv-Low wurden N-basierte Mineraldünger und Rindermist eingesetzt, wohingegen in Org-High und Org-Low Kompost und andere organische Düngemittel mit ähnlichen N-Mengen eingesetzt wurden. Die Anbausysteme wurden in einem komplett randomisierten Blockdesign mit 4 bzw. 5 Replikationen in Chuka und Thika angelegt. Der Versuch folgt einer dreijährigen Fruchtfolge, die Mais, Hülsenfrüchte, Gemüse und Kartoffeln beinhaltet. Die N-Mineralisierung wurde mithilfe eines modifizierten Buried-Bag-Ansatzes ermittelt, während der N-Verlust mit Hilfe von Selbst-Integrierenden Akkumulatoren (SIA) gemessen wurde. Die N-Synchronität wurde anhand der Differenz der täglichen mineralischen N-Freisetzung minus der N-Pflanzenaufnahme in verschiedenen Wachstumsstadien errechnet. Die Dynamik der N-Aufnahme während verschiedener Kulturstadien wurde durch destruktive Probenahme ermittelt, während die Effizienz der Stickstoffnutzung (NUE) zum Zeitpunkt der Ernte bewertet wurde. Partielle N-Bilanzen wurden anhand des ausgebrachten N, sowie dem Verlust durch die pflanzliche Biomasse berechnet. Von dem insgesamt zugeführten organischem N wurden 61, 43 und 71 % während der Kartoffel-, Mais- und Gemüsesaison freigesetzt. Die landwirtschaftlichen Produktionssysteme hatten keinen unterschiedlichen Einfluss auf die N-Synchronität, d.h. die Anpassung des N-Angebots an die N-Nachfrage. Vielmehr variierte die N-Synchronität mit den Kulturstadien und der N-Nachfrage. Es wurden positive Differenzen des N-Fluxes (höhere N-Freisetzung im Vergleich zum N-Bedarf) während der ersten 20-30 Tage der Inkubation und negative Differenzen des N-Fluxes (N-Bedarf höher als Freisetzung) in den Reproduktionsstadien der Kulturen für alle Produktionssystemen beobachtet. Die Stickstoffaufnahmeeffizienz (NUpE) der Kartoffel war am höchsten in den Produktionssystemen Conv-Low und Org-Low in Thika und am niedrigsten in Org-High und Org-Low in Chuka, wo die Krautfäule die Kartoffelproduktion beeinträchtigte. Die NUpE von Mais war in allen Systemen am Standort Chuka gleich, während sie in Thika für die High-Input-Systemen höher war als in den Low-Input-Systemen. Die NUpE von Weiẞkohl war in High-Input-Systemen gleich, wiederum war die NUpE von Grünkohl und Mangold nur in den Low-Input-Systemen gleich. Die N-Nutzungseffizienz der Kartoffel (NUtE) und die agronomische Effizienz der N-Nutzung (AEN) in den Produktionssystemen Conv-Low und Conv-High waren höher als die in Org-Low bzw. Org-High. Die AEN von Mais war in allen Systemen in Chuka vergleichbar, war aber in den High-Input-Systemen höher als in den Low-Input-Systemen in Thika. Die AEN von Gemüse in den konventionellen Produktionssystemen war vergleichbar mit denen aus ökologischen Systemen. Sowohl konventionelle als auch organische Produktionssysteme verloren erhebliche Mengen an mineralischen N in die unteren Bodenhorizonte bereits vor dem Auflaufen der Kulturen (0-26 Tage). Die kumulative Nitrat-N Auswaschung unter 1 m war in allen Anbausystemen gleich, lag aber am feuchteren Standort Chuka höher als am Standort Thika während der Maissaison. Deutlich mehr N wurde in der Kartoffelsaison ausgewaschen als in der Mais- und Gemüsesaison. Wenn das ausgewaschene Nitrat-N im Verhältnis zur eingesetzten Gesamtmenge N ausgedrückt wurde, wurden 63-68 % mehr Nitrat aus den Low-Input-Systemen ausgewaschen als aus den High-Input-Systemen. Org-High zeigte eine positive partielle N-Bilanz an beiden Standorten und in allen Produktionssystemen mit Ausnahme der Gemüsesaison in Chuka. Alle anderen Systeme wiesen für die drei Vegetationsperioden mit Ausnahme von Conv-High während der Kartoffelsaison und Conv-Low und Org-Low während der Gemüsesaison am Standort Thika negative partielle N-Bilanzen auf. Zusammenfassend lässt sich sagen, dass ökologische und konventionelle Produktionssysteme ähnliche Auswirkungen auf die N-Freisetzung, die Synchronität und den N-Verlust durch Auswaschung hatten. Darüber hinaus wurde während der Kartoffel- und Gemüsesaison in den Low-Input-Systemen relative mehr N ausgewaschen (ausgedrückt als Anteil des eingesetzten N) als in den High-Input-Systemen. Zudem hatten konventionelle und ökologische Produktionssysteme ähnliche Auswirkungen auf NUpE, AEN, NUtE und NHI für Mais und Gemüse, während konventionelle Systeme die NUE von Kartoffeln im Vergleich zu ökologischen Systemen verbesserten. Die Studie kommt daher zu dem Schluss, dass ökologische und konventionelle Anbausysteme auf hohem Inputniveau für Mais und Gemüse eine tragfähige Option zur Erhöhung der Ernährungssicherheit in Subsahara-Afrika (SSA) sind, wie ähnliche Erträge, NUE, N-Versorgung und Verluste zeigen. Die Fähigkeit, die Ernährungssicherheit im konventionellen und ökologischen System mit niedrigem Input zu gewährleisten, wird durch hohe N-Verluste, negative N-Bilanzen und geringe Produktivität aufgrund biotischer und abiotischer Belastungen eingeschränkt. Sowohl in konventionellen als auch in ökologischen Produktionssystemen besteht die Notwendigkeit, den Einsatz von N bei der Aussaat zu verringern und andererseits die N-Düngung in der reproduktiven Phase zu erhöhen, um die potenziellen Verluste während der ersten 20-30 Tage nach der Aussaat zu minimieren und das N-Angebot in der Hauptwachstumsphase zu verbessern. Da ökologische Produktionssysteme von organischen Inputs abhängen, ist es dringend notwendig, die Qualität von Mist, Kompost und anderen organischen Inputs zu verbessern, um die N-Versorgung und Verfügbarkeit zu verbessern

Site-specific organic and conventional crop yields in a long-term farming systems comparison in sub-humid central Kenya

Organic farming is increasingly being taken up by farmers and agricultural development agencies in tropics. This is in a bid to improve world food security and rural livelihoods in a sustainable way. Long-term field trial that compares organic and conventional systems was set up in sub-humid central Kenya since 2006 to provide a scientific basis for organic agriculture in the region. The project seeks to gather data on how organic farming affects: yield and yield stability; stability of the agro-ecological system; and natural and economic resource efficiency. The experiments were set up at two sites namely Chuka and Thika. Both sites are at an altitude of 1500m asl. While Chuka lies in a high potential area with 2000 mm of rainfall and good soil phosphorus availability, Thika has fair yield potential, 1000 mm rainfall and low phosphorus availability. Crop rotations include maize, beans and vegetables.” The trials compares organic and conventional systems at two input levels, namely subsistence and commercial levels, resulting in four treatments: Conventional high input, organic high input, conventional low input and organic low input. In Chuka, organic yields were on average the same as conventional yields. On the low potential site of Thika, organic yields reached an average 55% of the conventional yields. Organic yields on the low input level were on average 13% lower than conventional yields on the low input level. On the high input level, organic yields were on average 26% lower than conventional yields. Organic maize yields achieved on average 77% of conventional maize yields, whereas organic brassica yields were 66% lower than conventional brassica yields. No significant difference was observed between mean organic and conventional legume crop yields. Our results suggest that: on high potential site of Chuka, organic crops can be grown without yield reduction; on low potential site of Thika, especially if low nutrient availability coincide with low rainfall, considerable yield reductions must be expected in organic systems in the transition phase; low input systems are less sensitive to conversion to organic agriculture than high input systems and relative yield levels in organic systems vary between crops

Long-term performance of organic crop rotations in the tropics: First results from a high and a medium potential site in sub-humid Central Kenya

Organic Agriculture is perceived by many stakeholders as a promising approach to increase food security in developing countries. However, only few attempts have been made so far to assess agronomic and economic performance of Organic Agriculture in these regions in a systematic way. The Research Institute of Organic Agriculture (FiBL), together with its partners, is presently establishing long-term comparisons of farming systems in various agro-ecological and socio-economic contexts to study the different parameters that are essential for sustainable development. To date, three study areas have been selected: (a) a sub-humid area in Kenya where farming is subsistence-oriented; (b) a semi-arid area in India where cotton is produced for the export market; and (c) a humid area in Bolivia where cacao and other perennial products are produced for the export and domestic markets. The key elements are replicated long-term field trials. These are complemented by farm surveys and short-term trials under on-farm conditions. This network of comparison of farming systems in the tropics is expected to (1) put the discussion on the benefits and drawbacks of Organic Agriculture on a rational basis; (2) help to identify challenges for Organic Agriculture that can then be addressed systematically; (3) provide physical reference points for stakeholders in agricultural research and development and thus support agricultural policy dialogue at different levels. In Kenya, the two trials sites are located in a high potential zone in Meru South District (Chuka) and in a medium potential zone in Maragua District (Thika). They consist of four treatments: conventional and organic, each at a low and a high input level, representing subsistence oriented and commercial farming, respectively. Maize, brassicas and maize were planted during the first, second and third season respectively in both organic and conventional plots. In the first three seasons, we found the following results: in Chuka, organic yields of the low input treatments were on average 4% lower than conventional yields. On the high input level, organic yields were 6% lower. In Thika, organic yields were on average 57% (low input level) and 33% (high input level) lower than conventional yields. It is assumed that the organic crops in Chuka could benefit from N and P mobilisation from the soil. In Thika, where N and P were probably less available, the crop depended on the easily soluble nutrients applied in the conventional treatments. The effect of lower nutrient availability in the organic treatments in Thika was possibly aggravated by serious drought spells during the second and third season. The questions of interest are a) whether the organic treatments can keep the yield level of the conventional treatments in Chuka or if they will go through a depression typical for conversion from conventional to Organic Agriculture; and b) if the organic treatments can improve soil fertility and thus the organic yield levels in Thika in the coming years

The impact of conventional and organic farming on soil biodiversity conservation: a case study on termites in the long-term farming systems comparison trials in Kenya

A long-term experiment at two trial sites in Kenya has been on-going since 2007 to assess the effect of organic and conventional farming systems on productivity, profitability and sustainability. During these trials the presence of significant numbers of termites (Isoptera) was observed. Termites are major soil macrofauna and within literature they are either depict as ‘pests’ or as important indicator for environmental sustainability. The extent by which termites may be managed to avoid crop damage, but improve sustainability of farming systems is worthwhile to understand. Therefore, a study on termites was added to the long-term experiments in Kenya. The objectives of the study were to quantify the effect of organic (Org) and conventional (Conv) farming systems at two input levels (low and high) on the abundance, incidence, diversity and foraging activities of termites. The results showed higher termite abundance, incidence, activity and diversity in Org-High compared to Conv-High, Conv-Low and Org-Low. However, the termite presence in each system was also dependent on soil depth, trial site and cropping season. During the experiment, nine different termite genera were identified, that belong to three subfamilies: (i) Macrotermitinae (genera: Allodontotermes, Ancistrotermes, Macrotermes, Microtermes, Odontotermes and Pseudocanthotermes), (ii) Termitinae (Amitermes and Cubitermes) and (iii) Nasutitiermitinae (Trinervitermes). We hypothesize that the presence of termites within the different farming systems might be influenced by the types of input applied, the soil moisture content and the occurrence of natural enemies. Our findings further demonstrate that the organic high input system attracts termites, which are an important, and often beneficial, component of soil fauna. This further increases the potential of such systems in enhancing sustainable agricultural production in Kenya

Insecticide contamination in organic agriculture: Evidence from a long-term farming systems comparison trial

Synthetic pesticides applied in conventional agriculture to control pests tend to compromise ecosystem services, and their residues may contaminate organic agriculture. To understand the significance of this contamination, also in small-scale farming systems in sub-Saharan Africa, quantitative data is required. Therefore, we compared synthetic insecticide and botanical/biopesticide residues in conventional and organic agricultural production systems after nine years of continuous cultivation of a maize-based crop rotation system at two sites in Kenya. Our results show high detectable concentrations of synthetic insecticide residues (imidacloprid, acetamiprid, chlorpyrifos, and chlorantraniliprole) in conventional plant produce and soil. Furthermore, the organophosphate chlorpyrifos was detected at concentrations above European Union Maximum Residue Limits (MRL) for plant produce, indicating potential risks for human health. Additionally, we detected imidacloprid, acetamiprid, chlorpyrifos, and chlorantraniliprole concentrations in the soil, indicating potential environmental harm. No residues of biopesticide/botanicals were detected in any of the production systems. However, we detected imidacloprid and chlorantraniliprole in organic plots. The findings indicate that the MRLs can be crossed even if synthetic insecticides are applied according to or below the recommended rates on the conventional plots. Thus, synthetic insecticides potentially risk human health and the environment, while botanicals and bio-pesticides represent a safe alternative

Improving Phosphate Rock Use Efficiency In Organic Farming

Between 45 to 81% of the total phosphorus (P) fertilizer applied to soils in sub-Saharan Africa is absorbed in the soil, which among other factors reduce crop yield and contributes to high poverty in the region.  The objective of the study was to assess the effect of different phosphorus rock (PR) management on carrot yields, P recovery and use efficiency.  Different volumes (100, 200, 300, 400, and 500 mLs) of organic (lemon and pineapple) juices and water were used to dissolve 100 g of PR. The available P concentration in the solution was determined using a standard protocol. The solution with the high P concentration as well as powdered PR was each composted with manure and crop residues. Thereafter, a field experiment was set up on Humic andosols and Orthic acrisols to compare the effect of the dissolved PR applied directly with compost, to dissolved PR composted,  powder PR composted, powdered PR applied directly with compost, Triple supper phosphate applied directly with compost, compost and the soil alone (as a control). Our findings showed that lemon juice could release over 65% of the available P from PR and the combined application of the dissolved PR and compost at planting increased P recovery and use efficiency, and carrot yields on both soils as compared to the other treatments

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication