AMR Surveillance Fellow Mabel Aworh focused her research on understanding and tracking antimicrobial resistance (AMR) in animals, providing valuable insights into how drug-resistant bacteria spread in animals and humans in slaughterhouse environments in Abuja and Lagos, Nigeria. The study 'Rare serovars of non-typhoidal Salmonella enterica isolated from humans, beef cattle and abattoir environments in Nigeria' was published in [PLOS ONE](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0296971).
Case Study: AMR in mothers and children in Nigeria
As part of World AMR Awareness Week (WAAW) − with the theme for 2024 ‘Educate. Advocate. Act now.’ − we hear from Fleming Fund Fellows on the importance of building AMR expertise in the health workforce and the impact of studying drug-resistance.
In 2019, Emmanuel Benyeogor participated in the Fleming Fund Fellowship Scheme as an Antimicrobial Resistance (AMR) Surveillance Fellow in Human Health, with mentoring support from the Host Institute, Technical University of Denmark (DTU). We look at how his research has highlighted critical findings and implications for public health in Nigeria.
The Nigeria Centre for Disease Control (NCDC) nominated Emmanuel for a Fleming Fund Professional Fellowship, following his role in supporting the Awareness and Surveillance unit of the AMR Technical Working Group, which has developed the country’s National Action Plan from 2024 to 2028.
(Above image) Emmanuel at the Nigeria CDC National Reference Laboratory in Abuja, Nigeria.
Emmanuel’s two-year fellowship focused on a cross-sectional community study on the ‘Prevalence of ESBL-Producing Faecal E. coli and Salmonella in Kano and Taraba’, targeting a sample population of mothers of children under five living in the Nigerian states.
The research examines how mothers and children from vulnerable populations are affected by AMR. The concern of ESBL bacteria and Salmonella resistance in Northern Nigeria; listed in the WHO Bacterial Pathogen Priority List, means the diarrhoea disease is at its highest.
AMR data analysis
Data collection and laboratory analysis of stool samples from eligible study participants during the COVID-19 pandemic caused obstacles with recruiting patients and obtaining samples from mothers and children. Accessing communities through local healthcare gatekeepers was the breakthrough.
Transporting the samples from Kano and Taraba to the reference laboratory in Abuja, while maintaining the integrity of the pathogen was another challenge, rectified by leveraging the sample transport arm of the national-subnational laboratory logistics.
Sample analysis involved a series of steps designed to isolate, identify, and examine the AMR of the pathogens.
Through statistical analyses, trends in resistance are visualised, and multi-drug resistance (MDR) profiles are calculated, providing valuable insights into the resistance landscape of Salmonella and ESBL-producing organisms.
Emmanuel Benyeogor, AMR Surveillance Fellow, Human Health.
The study highlighted the urgent need for effective surveillance and antimicrobial stewardship programmes to address the emergence and spread of MDR pathogens in Nigeria:
Pathogen prevelance
- 38% of the 120 isolates from the 180 stool samples identified as ESBL-producing E. coli microorganisms, and 3% as Salmonella. The distribution of isolates was 48% in Kano and 52% in Taraba.
Socioeconomic status
- Most mothers in Taraba were in the lowest wealth quintile, while more than half of the mothers in Kano were in the middle and highest wealth quintiles.
AMR
- ESBL-producing E. coli isolates exhibited high-resistance to the most commonly available antimicrobial agents. Additionally, 72% of these isolates were MDR. In Kano, MDR extended across up to seven antibiotic groups, whereas Taraba, was limited to five.
Drug usage
- Over-the-counter drug usage was reported in both states, with Taraba recording more than 50% and Kano 24%.
Emmanuel at his fellowship's Host Institute, the Technical University of Denmark, with the DTU team.
Gender and Equity
It also underscored the role of gender and equity in tackling AMR, particularly in the African context. Mothers’ health-seeking behaviours and risk perceptions significantly influence AMR dynamics, affecting their children and households.
Mothers and caregivers are often the first point of contact for under-five care. Identifying and diagnosing the need for care, perception risk, seeking care, and administering. The higher percentage of mothers in Taraba accessing antibiotics over the counter could indicate limited access to formal healthcare services, potentially due to financial constraints, which is reflected in their lower wealth quintile status.
Emmanuel Benyeogor, AMR Surveillance Fellow, Human Health.
In contrast, mothers in Kano, who are largely from the middle-higher wealth quintiles, may have better access to regulated healthcare services, reducing the need to obtain antibiotics without a prescription. This disparity highlights how wealth inequality can impact healthcare behaviours and access to proper medical guidance.
Emmanuel Benyeogor, AMR Surveillance Fellow, Human Health.
AMR transmission
AMR is transmissible: person-to-person (mother to child), from contaminated surfaces and food, zoonotic (animal/environment to human), and genetically (pregnancy and lactation). All of these are compounded or exacerbated by socioeconomic disparity. The study pointed to the broader issue of antimicrobial abuse and its drivers of the transmissibility of AMR in resource-limited settings. For example, the industrialisation and intensification of food production.
Such practices contribute to environmental degradation and climate change, spreading AMR through the environment and food systems. The use of antibiotics in agriculture, aquaculture, and animal husbandry is a major public health concern.
Emmanuel built upon his fellowship using genomics to explore possible crossover AMR between mother and child. Currently working towards his Planetary Health Doctor of Public Health (DrPH), he wants to steer policy conversations, raise awareness, and build on the success of the One Health approach.
Emmanuel at the Nigeria CDC National Reference Laboratory in Abuja, Nigeria.
Emmanuel's Fleming Fellowship enrollment certificate.
Health system resilience
Emmanuel built upon his fellowship using genomics to explore the possibility of crossover AMR between mother and child. Currently working towards his Planetary Health Doctor of Public Health (DrPH), he wants to steer policy conversations, raise awareness, and build on the success of the One Health approach.
Emmanuel’s thesis explores ecosystem, community-based approaches to nature-based solutions to reduce vulnerability to public health events like pandemics in low- and middle-income countries. The ongoing research evaluates health institutions' nature-related issues, emphasising green financing opportunities to build sustainable, resilient health systems.
My DrPH aligns directly with the overarching goals of sustainable health systems and AMR initiatives, given the interconnectedness between environmental sustainability and public health outcomes. The process identifies ways to reduce environmental pressures that contribute to infectious disease spread, including those related to AMR. Sustainable practices mitigate the ecological factors, which can drive AMR, such as waste management and environmental decline.
Emmanuel Benyeogor, AMR Surveillance Fellow, Human Health.
The continued study adds significant value to the AMR fellowship’s mission by bridging sustainability and healthcare, building a more holistic health system response by addressing environmental and financial investment, which are vital components of long-term strategies.
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