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Impact of Operational Research in Tackling Antimicrobial Resistance through the Structured Operational Research Training Initiative in Ghana, Nepal and Sierra Leone

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A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (31 July 2023) | Viewed by 16067

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Dr. Jaya Prasad Tripathy

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Guest Editor

Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
Interests: infectious disease epidemiology; implementation/operational research; modern methods in epidemiology and biostatistics

Dr. Elizabeth Tayler

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Guest Editor

Acting Regional Advisor AMR, WHO, Eastern Mediterranean Regional Office, Cairo, Egypt
Interests: antimicrobial resistance; health systems; One Health

Special Issue Information

Dear colleagues,

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites modify over time and no longer respond to antimicrobial drugs. As a result, treatments become ineffective and infections tend to persist and spread, causing prolonged illness and death. The World Health Organization declared AMR to be one of the top 10 global public health threats facing humanity.

This Special Issue highlights the impact of previously published research from the Structured Operational Research and Training Initiative (SORT IT), which is aimed at building sustainable operational research capacity to generate and utilize evidence to tackle the emergence, spread and health impact of AMR and emerging infections. This project was funded by the Department of Health and Social Care of the United Kingdom and Northern Ireland and aims to make the AMR response in countries “data rich, information rich and action rich”. More on SORT IT is available at: https://tdr.who.int/activities/sort-it-operational-research-and-training.

The publications in this series addressed the national research priorities in Ghana, Nepal and Sierra Leone, were led by national investigators and their peers, and involved regional and international collaborative partnerships, reflecting the philosophy, “thinking global but acting local”. Many of the co-authors are individuals trained through previous cycles of SORT IT and they have now successfully mentored their peers—an important indicator of capacity built and a step towards establishing an institutional culture of using operational research for informed decision making in public health.

The articles in this Special Issue are important as they showcase useful stories of how operational research has strengthened health systems, enhanced program performance and improved public health. In essence, the ‘field level impact’ of operational research.

We would like to welcome you to read this Special Issue.

Dr. Jaya Prasad Tripathy
Dr. Elizabeth Tayler
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

health systems strengthening
SORT IT
universal health coverage
SDGs
One Health
informed decision making

Published Papers (11 papers)

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13 pages, 653 KiB

Open AccessArticle

Hand Hygiene Practices and Promotion in Public Hospitals in Western Sierra Leone: Changes Following Operational Research in 2021

by Matilda N. Kamara, Sulaiman Lakoh, Christiana Kallon, Joseph Sam Kanu, Rugiatu Z. Kamara, Ibrahim Franklyn Kamara, Matilda Mattu Moiwo, Satta S. T. K. Kpagoi, Olukemi Adekanmbi, Marcel Manzi, Bobson Derrick Fofanah and Hemant Deepak Shewade

Trop. Med. Infect. Dis. 2023, 8(11), 486; https://doi.org/10.3390/tropicalmed8110486 - 27 Oct 2023

Viewed by 1507

Abstract

Hand hygiene is the most important intervention for preventing healthcare-associated infections and can reduce preventable morbidity and mortality. We described the changes in hand hygiene practices and promotion in 13 public hospitals (six secondary and seven tertiary) in the Western Area of Sierra Leone following the implementation of recommendations from an operational research study. This was a “before and after” observational study involving two routine cross-sectional assessments using the WHO hand hygiene self-assessment framework (HHSAF) tool. The overall mean HHSAF score changed from 273 in May 2021 to 278 in April 2023; it decreased from 278 to 250 for secondary hospitals but increased from 263 to 303 for tertiary hospitals. The overall mean HHSAF score and that of the tertiary hospitals remained at the “intermediate” level, while secondary hospitals declined from “intermediate” to “basic” level. The mean score increased for the “system change” and “institutional safety climate” domains, decreased for “training and education” and “reminders in the workplace” domains, and remained the same for the “evaluation and feedback” domain. Limited resources for hand hygiene promotion, lack of budgetary support, and formalized patient engagement programs are the persistent gaps that should be addressed to improve hand hygiene practices and promotion. Full article

(This article belongs to the Special Issue Impact of Operational Research in Tackling Antimicrobial Resistance through the Structured Operational Research Training Initiative in Ghana, Nepal and Sierra Leone)

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12 pages, 637 KiB

Open AccessArticle

Quality of Data Recording and Antimicrobial Use in a Municipal Veterinary Clinic in Ghana

by Cletus Kubasari, Wisdom Adeapena, Robinah Najjemba, George Kwesi Hedidor, Raymond Lovelace Adjei, Grace Manu, Collins Timire, Samuel Afari-Asiedu and Kwaku Poku Asante

Trop. Med. Infect. Dis. 2023, 8(11), 485; https://doi.org/10.3390/tropicalmed8110485 - 26 Oct 2023

Viewed by 1482

Abstract

The recording of antimicrobial use data is critical for the development of interventions for the containment of antimicrobial resistance. This cross-sectional study assessed whether dissemination activities and recommendations made after an operational research (OR) study in 2021 resulted in better data recording and improved the use of antimicrobials in a rural veterinary clinic. Routinely collected data from treatment record books were compared between 2013 and 2019 (pre-OR) and from July 2021 to April 2023 (post-OR). The most common animals presenting for care in the the pre – and post OR periods were dogs (369 and 206, respectively). Overall, antimicrobial use in animals increased from 53% to 77% between the two periods. Tetracycline was the most commonly used antimicrobial (99%) during the pre-OR period, while Penicillin-Streptomycin was the most commonly used antimicrobial (65%) during the post-OR period. All animals that received care at the clinic were documented in the register during both periods. Whereas the diagnosis was documented in 269 (90%) animals in the post-OR period compared to 242 (47%) in the pre-OR period, the routes and dosages were not adequately recorded during the both periods. Therefore, the quality of data recording was still deficient despite the dissemination and the recommendations made to some key stakeholders. Recommendations are made for a standardized antimicrobial reporting tool, refresher training, and continuous supervisory visits to the clinic. Full article

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14 pages, 892 KiB

Open AccessArticle

Have Hand Hygiene Practices in Two Tertiary Care Hospitals, Freetown, Sierra Leone, Improved in 2023 following Operational Research in 2021?

by Matilda Mattu Moiwo, Gladys Nanilla Kamara, Dauda Kamara, Ibrahim Franklyn Kamara, Stephen Sevalie, Zikan Koroma, Kadijatu Nabie Kamara, Matilda N. Kamara, Rugiatu Z. Kamara, Satta Sylvia Theresa Kumba Kpagoi, Samuel Alie Konteh, Senesie Margao, Bobson Derrick Fofanah, Fawzi Thomas, Joseph Sam Kanu, Hannock M. Tweya, Hemant Deepak Shewade and Anthony David Harries

Trop. Med. Infect. Dis. 2023, 8(9), 431; https://doi.org/10.3390/tropicalmed8090431 - 31 Aug 2023

Viewed by 1106

Abstract

In 2021, an operational research study in two tertiary hospitals in Freetown showed poor hand hygiene compliance. Recommended actions were taken to improve the situation. Between February–April 2023, a cross-sectional study was conducted in the same two hospitals using the World Health Organization hand hygiene tool to assess and compare hand hygiene compliance with that observed between June–August 2021. In Connaught hospital, overall hand hygiene compliance improved from 51% to 60% (p < 0.001), and this applied to both handwash actions with soap and water and alcohol-based hand rub. Significant improvements were found in all hospital departments and amongst all healthcare worker cadres. In 34 Military Hospital (34MH), overall hand hygiene compliance decreased from 40% to 32% (p < 0.001), with significant decreases observed in all departments and amongst nurses and nursing students. The improvements in Connaught Hospital were probably because of more hand hygiene reminders, better handwash infrastructure and more frequent supervision assessments, compared with 34MH where interventions were less well applied, possibly due to the extensive hospital reconstruction at the time. In conclusion, recommendations from operational research in 2021 contributed towards the improved distribution of hand hygiene reminders, better handwash infrastructure and frequent supervision assessments, which possibly led to improved hand hygiene compliance in one of the two hospitals. These actions need to be strengthened, scaled-up and guided by ongoing operational research to promote good hand hygiene practices elsewhere in the country. Full article

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11 pages, 892 KiB

Open AccessEditor’s ChoiceArticle

Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019–2023)

by Indira Shrestha, Sulekha Shrestha, Mathavaswami Vijayageetha, Pramesh Koju, Saugat Shrestha, Rony Zachariah and Mohammed Ahmed Khogali

Trop. Med. Infect. Dis. 2023, 8(8), 420; https://doi.org/10.3390/tropicalmed8080420 - 18 Aug 2023

Viewed by 2037

Abstract

(1) Background: Surgical antibiotic prophylaxis (SAP) is important for reducing surgical site infections. The development of a dedicated hospital SAP guideline in the Dhulikhel Hospital was a recommendation from a baseline study on SAP compliance. Compliance with this new guideline was enhanced through the establishment of a hospital committee, the establishment of an antibiotic stewardship program and the funding and training of healthcare professionals. Using the baseline and a follow-up study after introducing dedicated hospital SAP guidelines, we compared: (a) overall compliance with the SAP guidelines and (b) the proportion of eligible and non-eligible patients who received initial and redosing of SAP; (2) Methods: A before-and-after cohort study was conducted to compare SAP compliance between a baseline study (July 2019–December 2019) and a follow-up study (January 2023–April 2023); (3) Results: A total of 874 patients were in the baseline study and 751 in the follow-up study. Overall SAP compliance increased from 75% (baseline) to 85% in the follow-up study (p < 0.001). Over 90% of those eligible for the initial dose of SAP received it in both studies. Inappropriate use for those not eligible for an initial dose was reduced from 50% to 38% (p = 0.04). For those eligible for redosing, this increased from 14% to 22% but was not statistically significant (p = 0.272); (4) Conclusions: Although there is room for improvement, introduction of dedicated SAP guidelines was associated with improved overall SAP compliance. This study highlights the role of operational research in triggering favorable interventions in hospital clinical care. Full article

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14 pages, 250 KiB

Open AccessArticle

Improvement in the Surveillance System for Livestock Diseases and Antimicrobial Use Following Operational Research Studies in Sierra Leone January–March 2023

by Samuel Alie Konteh, Fatmata Isatu Bangura (Turay), Amara Leno, Srinath Satyanarayana, Divya Nair, Mohamed Alpha Bah, Salam Saidu, David Sellu-Sallu, Sahr Raymond Gborie, Sorie Mohamed Kamara, Amadu Tejan Jalloh, Joseph Sam Kanu, Kadijatu Nabie Kamara, Matilda Mattu Moiwo, Esther Dsani and Noelina Nantima

Trop. Med. Infect. Dis. 2023, 8(8), 408; https://doi.org/10.3390/tropicalmed8080408 - 10 Aug 2023

Viewed by 1234

Abstract

In Sierra Leone, two operational research (OR) studies in 2019 and 2021 showed deficiencies in the data being captured by the Integrated Animal Disease Surveillance and Reporting (IADSR) system. This third OR study was conducted in 2023 to assess whether the second OR study’s results and recommendations were disseminated with the key stakeholders, the uptake of the recommendations, improvements in data capture in the IADSR system, and to describe the data on livestock disease and antimicrobial use. In 2022, on seven occasions, the authors of the second OR study disseminated the study’s findings. Of the four recommendations, the one on improving laboratory infrastructure for confirmation of animal disease was not implemented. The district animal health weekly surveillance reports received through the IADSR system were sustained at 88% between the second (2021) and third (2023) studies. In both studies, the proportion of sick animals receiving antibiotics (25%) remained the same, but the use of “critically important antimicrobials for veterinary use” declined from 77% (in 2021) to 69% (in 2023). The IADSR system has improved considerably in providing information on animal health and antibiotic use, and sequential OR studies have played a key role in its improvement. Full article

13 pages, 929 KiB

Open AccessArticle

Has Data Quality of an Antimicrobial Resistance Surveillance System in a Province of Nepal Improved between 2019 and 2022?

by Sweety Upadhaya, Jyoti Acharya, Maria Zolfo, Divya Nair, Mahesh Kharel, Anjana Shrestha, Basudha Shrestha, Surendra Kumar Madhup, Bijendra Raj Raghubanshi, Hari Prasad Kattel, Piyush Rajbhandari, Parmananda Bhandari, Subhash Thakur, Gyani Singh, Lilee Shrestha and Runa Jha

Trop. Med. Infect. Dis. 2023, 8(8), 399; https://doi.org/10.3390/tropicalmed8080399 - 4 Aug 2023

Viewed by 1219

Abstract

An operational research study was conducted in 2019 to assess the quality of data submitted by antimicrobial resistance (AMR) surveillance sites in the Bagmati Province of Nepal to the National Public Health Laboratory for Global Antimicrobial Resistance and Use Surveillance System (GLASS). Measures were implemented to enhance the quality of AMR surveillance by strengthening capacity, improving infrastructure, implementing data sharing guidelines, and supervision. The current study examined reports submitted by surveillance sites in the same province in 2022 to assess whether the data quality had improved since 2019. The availability of infrastructure at the sites was assessed. Of the nine surveillance sites in the province, seven submitted reports in 2022 versus five in 2019. Completeness in reporting improved significantly from 19% in 2019 to 100% in 2022 (p < 0.001). Timely reports were received from two sites in 2019 and only one site in 2022. Specimen–pathogen consistency in accordance with the GLASS guidelines for urine, feces, and genital swab specimens improved, with ≥90% consistency at all sites. Overall, the pathogen–antibacterial consistency improved significantly for each GLASS priority pathogen. The study highlights the importance of dedicated infrastructure and institutional arrangements for AMR surveillance. Similar assessments covering all provinces of the country can provide a more complete country-wide picture. Full article

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14 pages, 702 KiB

Open AccessArticle

Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021

by Satta Sylvia Theresa Kumba Kpagoi, Kadijatu Nabie Kamara, Ronald Carshon-Marsh, Alexandre Delamou, Marcel Manzi, Rugiatu Z. Kamara, Matilda Mattu Moiwo, Matilda Kamara, Zikan Koroma, Sulaiman Lakoh, Bobson Derrick Fofanah, Ibrahim Franklyn Kamara, Alex Bumble John Kanu, Sartie Kenneh, Joseph Sam Kanu, Senesie Margao and Edward Mberu Kamau

Trop. Med. Infect. Dis. 2023, 8(8), 385; https://doi.org/10.3390/tropicalmed8080385 - 27 Jul 2023

Viewed by 1173

Abstract

Surgical site infections (SSIs) are a major public health threat to the success of surgery. This study assessed changes in SSIs and use of antibiotics among caesarean section (CS) and herniorrhaphy patients at a regional hospital in Sierra Leone following operational research. This was a comparative before and after study using routine hospital data. The study included all the CS and herniorrhaphy patients who underwent surgery between two time periods. Of the seven recommendations made in the first study, only one concerning improving the hospital’s records and information system was fully implemented. Three were partially implemented and three were not implemented. The study population in both studies showed similar socio-demographic characteristics. The use of postoperative antibiotics for herniorrhaphy in both studies remained the same, although a significant increase was found for both pre- and postoperative antibiotic use in the CS patients, 589/596 (98.8%) in 2023 and 417/599 (69.6%) in 2021 (p < 0.001). However, a significant decrease was observed in the overall incidence of SSIs, 22/777 (2.8%) in 2023 and 46/681 (6.7%) in 2021 (p < 0.001), and the incidence of SSIs among the CS patients, 15/596 (2.5%) in 2023 and 45/599 (7.5%) in 2021 (p < 0.001). The second study highlights the potential value of timely assessment of the implementation of recommendations following operational research. Full article

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12 pages, 905 KiB

Open AccessArticle

Improvement in Infection Prevention and Control Compliance at the Three Tertiary Hospitals of Sierra Leone following an Operational Research Study

by Rugiatu Z. Kamara, Ibrahim Franklyn Kamara, Francis Moses, Joseph Sam Kanu, Christiana Kallon, Mustapha Kabba, Daphne B. Moffett, Bobson Derrick Fofanah, Senesie Margao, Matilda N. Kamara, Matilda Mattu Moiwo, Satta S. T. K. Kpagoi, Hannock M. Tweya, Ajay M. V. Kumar and Robert F. Terry

Trop. Med. Infect. Dis. 2023, 8(7), 378; https://doi.org/10.3390/tropicalmed8070378 - 24 Jul 2023

Cited by 1 | Viewed by 1307

Abstract

Implementing infection prevention and control (IPC) programmes in line with the World Health Organization’s (WHO) eight core components has been challenging in Sierra Leone. In 2021, a baseline study found that IPC compliance in three tertiary hospitals was sub-optimal. We aimed to measure the change in IPC compliance and describe recommended actions at these hospitals in 2023. This was a ‘before and after’ observational study using two routine cross-sectional assessments of IPC compliance using the WHO IPC Assessment Framework tool. IPC compliance was graded as inadequate (0–200), basic (201–400), intermediate (401–600), and advanced (601–800). The overall compliance scores for each hospital showed an improvement from ‘Basic’ in 2021 to ‘Intermediate’ in 2023, with a percentage increase in scores of 16.9%, 18.7%, and 26.9% in these hospitals. There was improved compliance in all core components, with the majority in the ‘Intermediate’ level for each hospital IPC programme. Recommended actions including the training of healthcare workers and revision of IPC guidelines were undertaken, but a dedicated IPC budget and healthcare-associated infection surveillance remained as gaps in 2023. Operational research is valuable in monitoring and improving IPC programme implementation. To reach the ‘Advanced’ level, these hospitals should establish a dedicated IPC budget and develop long-term implementation plans. Full article

15 pages, 2199 KiB

Open AccessArticle

Improvement in Infection Prevention and Control Performance Following Operational Research in Sierra Leone: A Before (2021) and After (2023) Study

by Senesie Margao, Bobson Derrick Fofanah, Pruthu Thekkur, Christiana Kallon, Ramatu Elizabeth Ngauja, Ibrahim Franklyn Kamara, Rugiatu Zainab Kamara, Sia Morenike Tengbe, Matilda Moiwo, Robert Musoke, Mary Fullah, Joseph Sam Kanu, Sulaiman Lakoh, Satta Sylvia T. K. Kpagoi, Kadijatu Nabie Kamara, Fawzi Thomas, Margaret Titty Mannah, Victoria Katawera and Rony Zachariah

Trop. Med. Infect. Dis. 2023, 8(7), 376; https://doi.org/10.3390/tropicalmed8070376 - 23 Jul 2023

Viewed by 1439

Abstract

Introduction: Infection prevention and control (IPC) is crucial to limit health care-associated infections and antimicrobial resistance. An operational research study conducted in Sierra Leone in 2021 reported sub-optimal IPC performance and provided actionable recommendations for improvement. Methods: This was a before-and-after study involving the national IPC unit and all twelve district-level secondary public hospitals. IPC performance in 2021 (before) and in 2023 (after) was assessed using standardized World Health Organization checklists. IPC performance was graded as: inadequate (0–25%), basic (25.1–50%), intermediate (50.1–75%), and advanced (75.1–100%). Results: The overall IPC performance in the national IPC unit moved from intermediate (58%) to advanced (78%), with improvements in all six core components. Four out of six components achieved advanced levels when compared to the 2021 levels. The median score for hospitals moved from basic (50%) to intermediate (59%), with improvements in six of eight components. Three of four gaps identified in 2021 at the national IPC unit and four of seven at hospitals had been addressed by 2023. Conclusions: The study highlights the role of operational research in informing actions that improved IPC performance. There is a need to embed operational research as part of the routine monitoring of IPC programs. Full article

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9 pages, 251 KiB

Open AccessBrief Report

Quality of Reporting of Adverse Drug Reactions to Antimicrobials Improved Following Operational Research: A before-and-after Study in Sierra Leone (2017–2023)

by Thomas A. Conteh, Fawzi Thomas, Onome T. Abiri, James P. Komeh, Abdulai Kanu, Joseph Sam Kanu, Bobson Derrick Fofanah, Pruthu Thekkur and Rony Zachariah

Trop. Med. Infect. Dis. 2023, 8(10), 470; https://doi.org/10.3390/tropicalmed8100470 - 9 Oct 2023

Viewed by 1271

Abstract

Background: The quality of pharmacovigilance data is important for guiding medicine safety and clinical practice. In baseline and follow-up studies after introducing interventions to improve the quality of reporting of Individual Case Safety Reports (ICSRs) in Sierra Leone, we compared (a) timeliness and completeness of reporting and (b) patient outcomes classified as ‘recovering’. Methods: Baseline (January 2017–December 2021) and follow-up (June 2022–April 2023) studies of ICSRs in the national pharmacovigilance database. Interventions introduced following recommendations from the baseline study included: updating standard operating procedures and guidelines, setting performance targets follow-up of patient outcomes, and training. Results: There were 566 ICSRs in the baseline study and 59 in the follow-up study. Timelines (reporting < 30 days) improved by five-fold (10% at baseline to 47% in follow-up). For the completeness of variables in ICSRs (desired threshold ≥ 90%),this was 44% at baseline and increased to 80% in the follow-up study. ‘Recovering’ outcomes reduced from 36% (baseline study) to 3% (follow-up study, p < 0.001). Conclusions: Significant improvements in timeliness, completeness, and validation of ICSRs were observed following operational research in Sierra Leone. While enhancing pharmacovigilance and patient safety, this study highlights the important synergistic role operational research can play in improving monitoring and evaluation systems. Full article

9 pages, 449 KiB

Open AccessBrief Report

Assessing Changes in Bacterial Load and Antibiotic Resistance in the Legon Sewage Treatment Plant between 2018 and 2023 in Accra, Ghana

by Raymond Lovelace Adjei, Lady Asantewah Boamah Adomako, Appiah Korang-Labi, Franklin Kodzo Avornyo, Collins Timire, Rita Ohene Larbi, Cletus Kubasari, Stephen E. D. Ackon and Anthony Reid

Trop. Med. Infect. Dis. 2023, 8(9), 427; https://doi.org/10.3390/tropicalmed8090427 - 28 Aug 2023

Viewed by 1227

Abstract

Wastewater treatment plants are efficient in reducing bacterial loads but are also considered potential drivers of environmental antimicrobial resistance (AMR). In this study, we determined the effect of increased influent wastewater volume (from 40% to 66%) in the Legon sewage treatment plant (STP) on the removal of E. coli from sewage, along with changes in AMR profiles. This before and after study compared E. coli loads and AMR patterns in influent and effluent samples from a published baseline study (January–June 2018) with a follow-up study (March–May 2023). Extended-spectrum beta-lactamase (ESBL) E. coli were measured pre- and post-sewage treatment during the follow-up study. The follow-up study showed 7.4% and 24% ESBL E. coli proportions in influent and effluent, respectively. In both studies, the STP was 99% efficient in reducing E. coli loads in effluents, with no significant difference (p = 0.42) between the two periods. More E. coli resistance to antimicrobials was seen in effluents in the follow-up study versus the baseline study. The increased influent capacity did not reduce the efficiency of the STP in removing E. coli from influent wastewater but was associated with increased AMR patterns in effluent water. Further studies are required to determine whether these changes have significant effects on human health. Full article

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Impact of Operational Research in Tackling Antimicrobial Resistance through the Structured Operational Research Training Initiative in Ghana, Nepal and Sierra Leone

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