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Antimicrobial Use and Resistance in Nigeria SITUATION ANALYSIS and RECOMMENDATIONS

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Antimicrobial Use and Resistance in Nigeria SITUATION ANALYSIS and RECOMMENDATIONS Antimicrobial Use and Resistance in Nigeria SITUATION ANALYSIS AND RECOMMENDATIONS Antimicrobial Use and Resistance in Nigeria SITUATION ANALYSIS AND RECOMMENDATIONS Contents Foreword................................................................................................................ 8 Acknowledgement................................................................................................... 10 Abbreviations and Acronyms...................................................................................... 11 Executive Summary................................................................................................... 16 1: Health and Economic Context............................................................................. 23 1.1 Geographic and Demographic Context............................................................. 23 1.2 Economic Context......................................................................................... 26 1.2.1 The Role of Economy on Health............................................................... 26 1.2.2 Health Financing.................................................................................. 28 1.3 Health Context.............................................................................................. 30 1.3.1 Health Indicators................................................................................... 30 1.4 Health Policy................................................................................................ 30 1.5 Nigeria’s Legal Framework for Antimicrobials and Resistance Control....................... 32 1.5.1 Laws/Regulations Governing Medicine Use in Human and Animals............... 32 1.5.2 Laws Establishing Councils and Regulatory Agencies.................................... 33 1.5.3 Laws/Regulations Governing Environment.................................................. 36 1.6 Organisation and Distribution of Services............................................................ 38 1.6.1 Human Health Workforce...................................................................... 39 1.6.2 Workforce in Agriculture......................................................................... 43 1.7 Access to Medicines...................................................................................... 43 1.8 Access to Health Care.................................................................................... 45 1.8.1 Access to Health Care in Aquatic and Terrestrial Animal Sector...................... 46 1.9 Laboratory Capacity...................................................................................... 46 2: Burden Of Disease And Antimicrobial Resistance..................................................... 53 2.1 National Burden of Disease............................................................................. 53 2.2 Bacterial Disease and Antimicrobial Resistance in Humans..................................... 55 2.2.1 Enteric Pathogens.................................................................................. 55 2.2.1.1 Escherichia Coli........................................................................ 56 2.2.1.2 Non-Typhoidal Salmonella.......................................................... 57 4 Antimicrobial Use and Resistance in Nigeria 2.2.1.3 Shigella Species....................................................................... 58 2.2.1.4 Vibrio Cholerae........................................................................ 59 2.2.2 Urinary Tract Infections.......................................................................... 62 2.2.3 Blood Stream Infections......................................................................... 63 2.2.3.1 Gram Positive Isolates................................................................ 64 2.2.3.2 Gram Negative Isolates............................................................. 65 2.2.4 Salmonella Typhi and Non-Typhoidal Salmonella (NTS)............................... 66 2.2.5 Meningitis and Pneumonia..................................................................... 66 2.2.6 Health care-Associated Infections............................................................. 70 2.3 Burden of Disease in Livestock......................................................................... 72 2.3.1 Antimicrobial Residue in Food of Animal Origin And Animal Feed................. 73 2.3.2 Antimicrobial Residue in Animal Feed....................................................... 73 2.3.3 Risks of Unintentional Presence of Antimicrobials in Feed.............................. 74 2.3.4 The Public Health Importance of Antimicrobial Residues in Foods................... 74 2.3.5 Resistance in Isolates from Animals........................................................... 75 2.3.6 Antimicrobial Resistance Studies.............................................................. 76 2.4 The Burden of AMR in the Nigerian Environment................................................. 76 3: Supply Chain and Implications for Antimicrobial Access and Appropriate Use............ 80 3.1 Size of the Pharmaceutical Market in Nigeria..................................................... 80 3.2 Antimicrobial Use in Livestock........................................................................... 80 3.3 Pharmaceutical Registration, Licensing and Inspection............................................ 82 3.3.1 Regulatory Framework: Responsible Institutions and Laws.............................. 82 3.3.2 Current Capacity to Regulate and Enforce Regulations................................. 83 3.4 Importation and Local Production of Medicines: Formal Drug Sales......................... 85 3.4.1 Quantity of Drugs Sold and Consumed.................................................... 85 3.4.2 Informal Drug Sales.............................................................................. 86 3.5 Used Pharmaceutical Chemicals/Health Care Waste (Pharmaceutical Waste)........... 86 3.6 Procurement and Distribution........................................................................... 88 Federal Ministries of Agriculture, Environment and Health; September 2017 5 Situation Analysis and Recommendations 3.7 Supply Chain and Implication for Antimicrobials Access and Appropriate Use in Agriculture................................................................................................... 90 3.8 Antimicrobial Use in Humans in Nigeria............................................................ 91 4: Infection Prevention and Control, Vaccination and Biosecurity.....W............. 97 4.1 Infection Prevention and Control (IPC) Capacity in Nigeria..................................... 97 4.2 organisational Framework for the Implementation of Ipc....................................... 99 4.3 Human Capacity Development for IPC and WaSH Services.................................. 99 4.4 Surveillance of Health care Associated Infections (Hcai)...................................... 100 4.5 Knowledge and Practice of IPC by Health Workers............................................. 100 4.6 Vaccination in Nigeria................................................................................... 102 4.6.1 Vaccination in Humans......................................................................... 102 4.6.1.1 Immunisation Plus Days (IPDs) 220............................................... 103 4.6.2 Vaccination in Animals......................................................................... 104 4.7 Water, Sanitation and Hygiene (WaSH)........................................................... 106 4.7.1 Community Level Access to Water........................................................... 106 4.7.2 Sanitation Services............................................................................... 107 4.8 Availability of Alternatives to Antimicrobials, Including Vaccines and Others.............. 107 4.9 Biosecurity Measures in Farms......................................................................... 109 Part 5: Antimicrobial Resistance Awareness and Training............................................. 113 5.1 AMR Awareness.......................................................................................... 113 5.2 Access to Information.................................................................................... 113 5.2.1 General Public.................................................................................... 113 5.2.2 Professionals and Policy Makers.............................................................. 115 5.3 AMR Curricula............................................................................................. 115 References............................................................................................................. 123 List of Contributors................................................................................................... 153 6 Antimicrobial Use and Resistance in Nigeria Appendices Appendix 1: Systematic Search Process (Example for Diarrhoeal Pathogens)...................... 120 Boxes Box 1: SWOT Analysis of Health and Economic Context in Nigeria................................ 49 Box 2: SWOT Analysis of Bacterial Resistance and Antimicrobial Use in Nigeria Based 78 on a One–Health Approach.......................................................................... Box 3: SWOT Analysis of Supply Chain and Implications for Antimicrobial Access and 94 Appropriate Use In Nigeria..........................................................................
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