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.
Case Study: Building picture of how AMR bacteria spread in food production
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.
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.
Studying samples from slaughterhouse workers, handled cattle/meat, and the surrounding working areas, the fellowship aimed to build a complete picture of AMR in such settings and highlight the importance of coordinated actions across different sectors to control the transmission of resistant bacteria.
(Above image): Fleming Fund Fellow, Mabel Aworh, administering questionnaire on a mobile app to an abattoir worker in Lagos.
This One Health approach interconnects human, animal, and environmental health. Bacteria can move between animals, people, and the places they share, which means focusing on all three is essential to understanding and combating AMR. Mabel’s research explored how common drug-resistant bacteria are in certain settings, specifically E. coli and Salmonella, and sought to identify what factors increase the risk of their presence.
Stronger action for AMR control
Mabel found that multidrug-resistant Salmonella bacteria were common among abattoir workers, cattle, and slaughterhouse environments. These bacteria were resistant to several antibiotics commonly used in animal health in Nigeria, such as those used to treat animals and humans.
She discovered that some rare types of Salmonella were found in cattle; a risk to human health because these bacteria may cause infections in people. This proved the need for ongoing monitoring of Salmonella bacteria to track new strains that could harm humans.
To reduce the spread of these bacteria, it is important to encourage better hygiene practices among abattoir workers when handling cattle. Recommending that government agencies take stronger actions to control the use of antibiotics in farming and address the rise of new Salmonella strains.
Dr Mabel Aworh, Professional Fellow AMR Surveillance, Animal Health
Knowing that simple actions, such as handwashing with soap, could significantly reduce the spread of drug-resistant bacteria in slaughterhouses, Mabel notified the Federal Capital Territory Administration and the Lagos State Ministry of Agriculture so that handwash stations were provided.
Mabel at Host Institute DTU in Denmark at the beginning of her fellowship.
Research complexities
Through her fellowship, Mabel realised the complexity of addressing AMR, especially in slaughterhouses where people, animals, and the environment are in close contact.
One of the main challenges I faced was working in these busy environments to collect samples safely and consistently — it required much coordination and patience. It was also difficult to communicate the importance of AMR to people who may not see the impact right away, especially when the concept of drug-resistance is not always clear. Facilitating workshops to share findings with the slaughterhouse workers and seeing their interest in learning more about protecting their health was incredibly fulfilling.
Dr Mabel Aworh, Professional Fellow AMR Surveillance, Animal Health
Mabel also learnt that gathering samples wasn’t equally easy across different locations and introduced incentives to encourage participation.
I set up a health checkpoint offering free blood pressure checks to the slaughterhouse workers. This small health benefit motivated workers to participate in the study, helping us collect the data while giving back to the community.
Dr Mabel Aworh, Professional Fellow AMR Surveillance, Animal Health
Mabel and Damilola (AMU) Fellow providing health checks for abattoir workers in Lagos.
Importance of One Health framework
Applying surveillance methods in local, low-resource settings; Mabel’s research generated high-quality AMR data and built local capacity, allowing her to understand AMR patterns in Nigeria’s animal and food production systems.
Mabel provided training to slaughterhouse staff in Lagos and the Federal Capital Territory in Abuja, equipping them with the required skills for the project’s sample collection, and trained laboratory technicians on WHONET software for AMR data analysis. She also worked with other Fleming Fund Fellows to deliver training, extending the impact of their expertise and knowledge to a broader audience.
Confronting AMR head-on requires a coordinated effort between professionals in human, animal, and environmental health sectors, and policymakers. The One Health framework is fundamental to preventing the spread of harmful bacteria from animals to people, helping guide targeted interventions that protect public health.
Dr Mabel Aworh, Professional Fellow AMR Surveillance, Animal Health
Working with local health and agriculture officials, showed the power of collaboration in addressing health challenges. The fellowship experience gave me new skills and perspectives that I’m excited to continue using in my work. Being part of the Fleming Fund Alumni network allows for collaboration with other experts and leverages the resources available to ensure the continued success of these initiatives.
Dr Mabel Aworh, Professional Fellow AMR Surveillance, Animal Health
Mabel collecting abattoir wastewater samples in Lagos.
AMR data informing public health
Mabel’s research has made an important contribution to the AMR community by providing key data on the prevalence of resistant bacteria from animal and environmental sources. This data helps to analyse how AMR develops and spreads across different settings, from farms to retail meat products and to the environment.
Through these studies, I am helping to inform public health strategies and raise awareness about the importance of surveillance and interventions in controlling AMR and supporting One Health and its vital links between human, animal, and environmental health in weakening AMR.
Dr Mabel Aworh, Professional Fellow AMR Surveillance, Animal Health
As part of the Fleming Fund alumnus, Mabel wants to continue her AMR research and build on the study’s findings by expanding data collection across Nigeria and Africa. Strengthening local capacity at institutions and health authorities on AMR surveillance, training researchers and healthcare workers on AMR data collection and analysis.
Comparing AMR patterns in different settings, such as rural and urban areas to understand how resistant bacteria spread in diverse environments, could help identify targeted interventions and strategies to combat AMR across the continent.
Dr Mabel Aworh, Professional Fellow AMR Surveillance, Animal Health
Mabel plans to keep working with policymakers to encourage the use of data to improve the regulation of antibiotics in animal farming. As a result of her research, she hopes there will be a continued emphasis on hygiene importance and responsible antibiotic use in human and animal health.
Mabel analyzing samples for bacteria culture and identification at the National Reference Laboratory, Nigeria Centre for Disease Control and Prevention (NCDC) in Abuja.
Mabel processing cultures for antimicrobial susceptibility testing at the National Reference Laboratory, NCDC in Abuja.
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From Programme Update, Case Study: Breaking down AMR barriers in Uganda , Date: 05/08/2022
The Fleming Fund is working with Uganda’s health care system to break down the barriers to disease surveillance by strengthening laboratory and diagnostic capacity in antimicrobial resistance (AMR) - leveraging in-country infrastructure and sustainability - for global health security.