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

Climate change adaptation in the Nigerian agricultural sector

West Africa is expected to suffer yield and production losses of staple crops under climate change, with more severe yield reductions occurring in the period between 2030 and 2050 (Ittersum et al., 2016). In addition, extreme events, including droughts and floods, are expected to become more frequent under climate change, also potentially affecting yields (Abiodun, Lawal, Salami, & Abatan, 2013). Internal displacement and natural resource conflicts are another expected climate impact, as are pest and disease outbreaks (Gregory, Johnson, Newton, & Ingram, 2009; Obioha, 2008). Given these potentially serious climate impacts, a team comprising researchers from Michigan State University and Nigerian partner universities conducted studies intended to inform Nigerian agricultural policy around climate adaptation. This brief presents a summary of findings from 4 of these studies conducted between 2016 and 2019.Non-PRIFPRI2; DCA; Feed the Future Initiative; Feed the Future Innovation Laboratory for Food Security Policy (FSP)DSG

Coping with and Adapting to Climate Change: A Gender Perspective from Smallholder Farming in Ghana

The negative impacts of climate change on agriculture could erode gains made toward gender equality in Ghana. Much of the literature on gender dimensions of climate change adaptation has focused on assessing differences in coping and adaptation practices of smallholder farmers. Mostly overlooked is whether gender influences influenced perception of effectiveness of adaptation practices and preferences for institutional support for future adaptation. Using key informant interviews, household surveys, and focus group discussions, we address these gaps by exploring coping and adaptation measures adopted by heads of farm households to counter climate change impacts on their livelihood activities and household well-being in the Guinea Savanna agroecological zone in Ghana. Additionally, we assessed the preferred institutional adaptation support of heads of farm households in adapting to future projected impacts. We find that female heads of farm households relied mainly on borrowed money from village savings and loans group as a coping measure; male heads of farm households depended primarily on sales of livestock. Varying planting and harvesting dates, crop diversification, and use of improved crop varieties were the major adaptation strategies adopted by farmers. We argue that provision of dams and/or dugouts, postharvest processing facilities, adaptation capacity-building resources, and improved access to markets and credit could enhance the adaptive capacity of male and female heads of farm households to mitigate projected climate change impacts on their livelihood activities and household well-being

Why Don’t More Farmers Go Organic? Using A Stakeholder-Informed Exploratory Agent-Based Model to Represent the Dynamics of Farming Practices in the Philippines

In spite of a growing interest in organic agriculture; there has been relatively little research on why farmers might choose to adopt organic methods, particularly in the developing world. To address this shortcoming, we developed an exploratory agent-based model depicting Philippine smallholder farmer decisions to implement organic techniques in rice paddy systems. Our modeling exercise was novel in its combination of three characteristics: first, agent rules were based on focus group data collected in the system of study. Second, a social network structure was built into the model. Third, we utilized variance-based sensitivity analysis to quantify model outcome variability, identify influential drivers, and suggest ways in which further modeling efforts could be focused and simplified. The model results indicated an upper limit on the number of farmers adopting organic methods. The speed of information spread through the social network; crop yields; and the size of a farmer’s plot were highly influential in determining agents’ adoption rates. The results of this stylized model indicate that rates of organic farming adoption are highly sensitive to the yield drop after switchover to organic techniques, and to the speed of information spread through existing social networks. Further research and model development should focus on these system characteristics

Do participatory scenario exercises promote systems thinking and build consensus?

Abstract Participatory scenario processes are associated with positive social learning outcomes, including consensus-building and shifts toward more systemic thinking. However, these claims have not been assessed quantitatively in diverse cultural and socio-ecological settings. We convened three stakeholder workshops around the future of agricultural development and rural livelihoods in Burkina Faso, Nigeria, and Malawi, using a participatory scenario generation process to examine proposed research and action priorities under conditions of uncertainty. We administered pre- and post-workshop surveys, and used a paired t-test to assess how stakeholders’ rankings of research priorities changed after participating in the scenario visioning exercise. Workshop participants also listed their own priorities for research and implementation on both the pre- and post-survey forms. We found indications that the workshops promoted consensus-building around the research priorities, including a reduction in standard deviation of priority rankings post-workshop compared to pre-workshop; and a higher incidence of identical volunteered responses. We did not find evidence to support shifts in thinking to more systemic views of agricultural development. However, participants viewed themselves as having learned throughout the process. We conclude that scenario visioning does have the potential to foster consensus-building (one element of social learning) among diverse stakeholder groups. We urge researchers to continue to monitor and measure systems thinking outcomes from scenario visioning so that these processes may be designed to be more effective