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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Modelling road fatalities from tricycle crashes in Ashanti Region, Ghana: An application of regression with ARIMA errors

Tricycles contribute to road crashes globally, especially in Asia where it is a popular means of transport. Safety assessment of tricycles has discovered that associated fatality rate and severity of injuries from tricycle crashes, which has risen steadily, are due to their flawed designs especially the absence of seatbelts and paddings of hard surfaces. Tricycle related crashes were sourced weekly from the regional office of the National Road Safety Authority from January 2012 to June 2022 and modelled with Autoregressive Integrated Moving Average Model. The results showed ARIMA (1,0,3) errors were retained as the best model for estimating road fatalities caused by tricycle crashes. The exogenous factors: tricycle crashes, time of day, season of the year, and road design were tested and found to be statistically significant relative to its contribution to the fatalities. The time series components were deemed to be relevant contributing factors to fatalities for the study period. Further, crash data forecasted to October 2022 largely exhibited a sinusoidal behaviour with spikes at various weeks. It was recommended that tricycle drivers undergo mandatory refresher courses on safe driving techniques and general road safety regulations as a policy intervention. In addition, the licensing regime for tricycles should be strengthened, and government should create separate lanes along some major routes within the metropolitan, municipal, and district assemblies to eliminate or reduce the negative incidents

Auto-Rickshaw Repair, Servicing and Maintenance for Youth-in-Entrepreneurship in Kumasi

Knowledge and skill acquisition is a driver to the socioeconomic growth of a country, yet economic challenges, rapid urbanization, and migration have contributed to youth unemployment in Ghana. The introduction of auto-rickshaws in 2015 has increased access coverage to transportation, augmented existing public transportation, and created avenues for both operators’ and mechanics’ employment through co-ordinated skill development actions to empower youth-in-entrepreneurship. However, these have not been fully utilized and developed by the Government. The study seeks to identify basic needs of auto-rickshaw mechanics in establishing a sustainable repair and maintenance enterprise, identify challenges confronting auto-rickshaw mechanics, and analyze activities of the youth who repair, maintain, and service auto-rickshaws within the formal and informal sectors for sustainable enterprises. The study is underpinned by both resource-based and human capital theories: education and apprenticeship bothers on human capital theory, while entrepreneurial experience, shop space, business duration, and so on projects the resource-based theory. Questionnaires were administered to 237 auto-rickshaw mechanics and interviews were conducted for some selected auto-rickshaw mechanics to investigate challenges in the business in the Kumasi Metropolitan Area through a clustered and systematic sampling technique. Data analyzed using SPSS v.26 indicated a very youthful auto-rickshaw mechanic population with low educational level that operates without licensed garages. About 68.8% of the mechanics possessed some form of apprenticeship training, though they are not specific to auto-rickshaw repair and maintenance. Further, 71.7% auto-rickshaw mechanics do not keep records of their activities and there is a general lack of entrepreneurial skills among them. Lack of financial support from financial institutions was found to be a major challenge. The binary logistic regression model retained and confirmed six out of the seven predictors, including sex, age, education, marital status, duration of repairs and/or maintenance, shop space, tools and equipment, and mechanical training, as significant contributing factors to entrepreneurship training offered to enterprises within the Kumasi metropolis. The study recommends the urgent need to upgrade the technical and entrepreneurial skills of auto-rickshaw mechanics through the establishment of targeted and result-oriented training centers for better efficiency. The authors further recommend financial institutions to consider giving financial support to auto-rickshaw mechanics to help sustain their businesses

Auto-Rickshaw Repair, Servicing and Maintenance for Youth-in-Entrepreneurship in Kumasi

Knowledge and skill acquisition is a driver to the socioeconomic growth of a country, yet economic challenges, rapid urbanization, and migration have contributed to youth unemployment in Ghana. The introduction of auto-rickshaws in 2015 has increased access coverage to transportation, augmented existing public transportation, and created avenues for both operators&rsquo; and mechanics&rsquo; employment through co-ordinated skill development actions to empower youth-in-entrepreneurship. However, these have not been fully utilized and developed by the Government. The study seeks to identify basic needs of auto-rickshaw mechanics in establishing a sustainable repair and maintenance enterprise, identify challenges confronting auto-rickshaw mechanics, and analyze activities of the youth who repair, maintain, and service auto-rickshaws within the formal and informal sectors for sustainable enterprises. The study is underpinned by both resource-based and human capital theories: education and apprenticeship bothers on human capital theory, while entrepreneurial experience, shop space, business duration, and so on projects the resource-based theory. Questionnaires were administered to 237 auto-rickshaw mechanics and interviews were conducted for some selected auto-rickshaw mechanics to investigate challenges in the business in the Kumasi Metropolitan Area through a clustered and systematic sampling technique. Data analyzed using SPSS v.26 indicated a very youthful auto-rickshaw mechanic population with low educational level that operates without licensed garages. About 68.8% of the mechanics possessed some form of apprenticeship training, though they are not specific to auto-rickshaw repair and maintenance. Further, 71.7% auto-rickshaw mechanics do not keep records of their activities and there is a general lack of entrepreneurial skills among them. Lack of financial support from financial institutions was found to be a major challenge. The binary logistic regression model retained and confirmed six out of the seven predictors, including sex, age, education, marital status, duration of repairs and/or maintenance, shop space, tools and equipment, and mechanical training, as significant contributing factors to entrepreneurship training offered to enterprises within the Kumasi metropolis. The study recommends the urgent need to upgrade the technical and entrepreneurial skills of auto-rickshaw mechanics through the establishment of targeted and result-oriented training centers for better efficiency. The authors further recommend financial institutions to consider giving financial support to auto-rickshaw mechanics to help sustain their businesses

Assessing knowledge of sickle cell disease and health beliefs on premarital genetic screening among healthcare trainees at a tertiary institution: A cross‐sectional study

Abstract Background The uptake of sickle cell trait (SCT) test is challenged by several factors. A community of healthcare professionals educating the public to undergo screening is critical in reducing the disease burden. We investigated knowledge and attitude towards premarital SCT screening among healthcare trainee students who are the next generation of healthcare practitioners. Methods A cross‐sectional design was employed, and quantitative data were collected from 451 female students pursuing healthcare programs at a tertiary institution in Ghana. Descriptive, bivariate, and multivariate logistic regression analysis was performed. Results More than half of the participants were 20–24 years (54.55%) and had good knowledge (71.18%) about sickle cell disease (SCD). Age and school or social media as sources of information were significantly associated with good knowledge about SCD. Students between the age 20–24 (adjusted odds ratio [AOR] = 2.54, confidence interval [CI] = 1.30–4.97) and knowledge (AOR = 2.19, CI = 1.41–3.39) were 3 times and 2 times more likely to have a positive perception about SCD severity. Students who have SCT (AOR = 5.16, CI = 2.46–10.82), whose source of information was family member/friends (AOR = 2.83, CI = 1.44–5.59) and social media (AOR = 4.59, CI = 2.09–10.12) were 5 times, 2 times and 5 times likely to have a positive perception about the susceptibility of SCD. Students whose source of information is school (AOR = 2.06, CI = 1.11–3.81) and who have good knowledge of SCD (AOR = 2.25, CI = 1.44–3.52) were 2 times more likely to have a positive perception about the benefits of testing. Students with SCT (AOR = 2.64, CI = 1.36–5.13) and source of information was social media (AOR = 3.01, CI = 1.36–6.64) were about 3 times more likely to have a positive perception about the barriers to testing. Conclusion Our data shows that high level of SCD knowledge influences positive perceptions about the severity of SCD, the benefits and relatively low barriers to SCT or SCD testing and genetic counseling. Dissemination of SCT, SCD and premarital genetic counseling education should be intensified especially in schools

BU case confirmation by PCR and ZN.

<p>BU case confirmation by PCR and ZN.</p

Laboratory confirmation of Buruli ulcer cases in Ghana, 2008-2016

<div><p>Background</p><p>Buruli ulcer (BU), a necrotizing skin infection caused by <i>Mycobacterium ulcerans</i> is the third most important mycobacterial disease globally after tuberculosis and leprosy in immune competent individuals. This study reports on the retrospective analyses of microbiologically confirmed Buruli ulcer (BU) cases in seventy-five health facilities in Ghana.</p><p>Method/Principal findings</p><p>Pathological samples were collected from BU lesions and transported either through courier services or by car directly to the laboratory. Samples were processed and analysed by IS<i>2404</i> PCR, culture and Ziehl-Neelsen staining for detection of acid-fast bacilli. From 2008 to 2016, we analysed by PCR, 2,287 samples of 2,203 cases from seventy-five health facilities in seven regions of Ghana (Ashanti, Brong Ahafo, Central, Eastern, Greater Accra, Northern and Volta). The mean annual positivity rate was 46.2% and ranged between 14.6% and 76.2%. The yearly positivity rates from 2008 to 2016 were 52.3%, 76.2%, 56.7%, 53.8%, 41.2%, 41.5%, 22.9%, 28.5% and 14.6% respectively. Of the 1,020 confirmed cases, the ratio of female to male was 518 and 502 respectively. Patients who were 15 years of age and below accounted for 39.8% of all cases. The median age was 20 years (IQR = 10–43). Ulcerative lesions were 69.2%, nodule (9.6%), plaque (2.9%), oedema (2.5%), osteomyelitis (1.1%), ulcer/oedema (9.5%) and ulcer/plaque (5.2%). Lesions frequently occurred on the lower limbs (57%) followed by the upper limbs (38%), the neck and head (3%) and the least found on the abdomen (2%).</p><p>Conclusions/Significance</p><p>Our findings show a decline in microbiological confirmed rates over the years and therefore call for intensive education on case recognition to prevent over-diagnosis as BU cases decline.</p></div

Regional BU cases confirmed by IS<i>2404</i> PCR.

<p>Regional BU cases confirmed by IS<i>2404</i> PCR.</p