Redefining antimicrobial resistance surveillance in Africa

Last week, Fleming Fund regional grantee the African Society of Laboratory Medicine (ASLM) held its sixth biennial conference, returning to Cape Town, South Africa, from 12-15 December.

We speak to Project Manager Watipaso Kasambara at ASLM about their work across the continent to strengthen laboratory capacity and tackle antimicrobial resistance (AMR) head-on.

Africa has the highest mortality rate from antimicrobial-resistant infections in the world, with 27.3 deaths per 1,000 attributable to antimicrobial resistance (AMR). The continent faces a disproportionately high burden of most infectious diseases, including bacterial infections, and AMR is a growing and poorly quantified problem – with incomplete data in countries, limiting AMR analysis.

The ASLM Conference 2023 roundtable session on local manufacturing and African talent, Fleming Fund Health Specialist - Laboratory Services from Mott MacDonald , Emmanuel Azore, spoke on the Fleming Fund Fellowship Scheme outcomes and impacts in different regions and disciplines.

Images shows: The ASLM Conference 2023 roundtable session on local manufacturing and African talent, Fleming Fund Health Specialist - Laboratory Services from Mott MacDonald , Emmanuel Azore (centre-right), spoke on the Fleming Fund Fellowship Scheme outcomes and impacts in different regions and disciplines.

ASLM is a leading pan-African organisation addressing AMR in Africa by promoting improved laboratory practices for precise diagnosis and surveillance data, used within the countries to drive policy decisions.

The ASLM conference is a platform to share knowledge and best practices, discuss challenges, and foster collaboration within the AMR community – pushing coordinated efforts, innovative solutions, and policy changes to target disease resistance in Africa.

ASLM leads three regional grants from the Fleming Fund to enhance laboratory capacities in Africa, focusing on strengthening AMR surveillance which includes workforce development and formal qualifications for health professionals; strengthening quality assurance systems; encouraging data use to inform policy and investments towards addressing AMR.

Dr Watipaso Kasambara, Project Manager, ASLM.

Dr Watipaso Kasambara, Project Manager, ASLM - at MAAP training in 2020.

Mapping Antimicrobial Resistance and Antimicrobial use Partnership (MAAP)

In phase I of the Fleming Fund project, ASLM’s work revealed that only 1.3 % of labs surveyed in 14 African countries conduct bacteriological testing.

The quantity and quality of data for AMR, antimicrobial consumption, and use (AMC/U) is inadequate, limiting the ability to understand the efficacy of commonly used drugs and resistance drivers in Africa. Data estimates are often recorded manually and unfit for aggregated analytics, with limited AMU data in human health, agriculture, and food production systems.

For the first time, vast quantities of AMR and AMC data are being systematically collected, processed, and evaluated in Africa. The MAAP project measures data levels based on historical records to assess connections between AMR and AMC and provide policy recommendations to strengthen surveillance capacity and AMR containment.

MAAP has reviewed over 819.5k AMR records, spanning 2016-2019, from 205 laboratories across 14 countries, and 326 hospital and community pharmacies and 16 national-level datasets on AMC.

Qualifying the Workforce for Antimicrobial Resistance (QWArS)

The QWArS project addresses the skill shortage of laboratory and microbiology expertise needed for effective AMR management and data surveillance – across the human, animal, and environmental health sectors.

Implemented in 14 African and 3 Asian countries to date, QWArS has established a competency framework implementing standards across the One Health sectors that provide the knowledge and skill baseline for AMR surveillance training.

To bridge the skill gaps in AMR surveillance, ASLM has developed a recognised national qualification as part of the ASLM academy with members delivering the required training for sustainable and localised expertise.

External Quality Assessment (EQuAFRICA)

A critical roadblock to antimicrobial susceptibility testing on the continent is the lack of quality management systems (QMS), resources, and infrastructure to improve patient diagnostics and disease surveillance.

Despite the essential role of External Quality Assessment (EQA), this is often fragmented and underfunded, crippling efforts to build strong capacity for bacteriology and AMR testing.

An ASLM-led consortium has been increasing Africa-based capacity for more sustainable EQA practice. EQuAFRICA provides quality EQA proficiency testing panels for the AMR reference laboratories and surveillance sites across One Health sectors in 14 Fleming Fund-priority countries. This also includes improving QMS and assisting laboratories in attaining international standard accreditation.

Diagnostic revolution

As part of the ASLM conference, the Fleming Fund supported the 'Antimicrobial Resistance Surveillance Redefined; The Diagnostic Revolution' session, partnering with Africa CDC.

As part of the ASLM conference 2023, the Fleming Fund supported session: 'Antimicrobial Resistance Surveillance Redefined; The Diagnostic Revolution', partnering with Africa CDC.

Although gaps in AMR data have started to be addressed by the regional efforts of MAAP tracking and analysing in-country AMR data, QWArS achieving over 200 personnel to build the workforce, and EQuAFRICA bolstering training requirements, a significant gap remains.

The panel included the Fleming Fund’s Regional Africa Director, Dr Patrick Mubangizi and Laboratory Specialist Emmanuel Azore, speakers from the private and public sectors, covered clinical and microbiological stewardship, surveillance, diagnostics, frontline capacity building, and lab infrastructure - emphasising the importance of collaboration to address and reduce AMR and strengthen diagnostics.

Highlighting vital multisectoral action and country-based investments, participants discussed leveraging innovation to advance AMR diagnosis and surveillance, focusing on resilient and quality-assured systems.

The session was followed by a networking reception with posters from participant countries, including other Fleming Fund grantees.

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