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Global Burden of Fungal Infections and Antifungal Resistance from 1961 to 2024: Findings and Future Implications

Pharmacology & Pharmacy 2024年第4期15卷 81-112页

作者： steward mudenda Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia

Background: Antifungal resistance (AFR) is a global public health problem with devastating effects, especially among immunocompromised individuals. Addressing AFR requires a One Health approach including Antifungal stewardship (AFS). This study aimed to comprehensively review global studies published on fungal infections and AFR and to recommend solutions to address this growing problem. Materials and Methods: This was a narrative review that was conducted using published papers on fungal infections, AFR, and AFS between January 1961 and March 2024. The literature was searched using PubMed, Google Scholar, Web of Science, and EMBASE. Results: This found that there has been an increase in fungal infections globally, especially among immunocompromised patients. Due to this increase in fungal infections, there has been a proportionate increase in the use of antifungal agents to prevent and treat fungal infections. This increased use of antifungal agents has worsened the problem of AFR contributing to increased morbidity and mortality. Globally, fungal infections have contributed to 150 million infections annually and 1.7 million deaths per year. By the year 2023, over 3.8 million people died from fungal infections. Addressing AFR remains a challenge because the treatment of antifungal-resistant infections is difficult. Finally, the treatment of fungal infections is a global challenge exacerbated by the limited number of antifungal agents to treat invasive fungal infections. Conclusion: The results of this study indicated that fungal infections and AFR are prevalent across humans, animals, agriculture, and the environment. Addressing this problem requires the provision of solutions such as improving the awareness of AFR, conducting further research on the discovery of new antifungal agents, and implementing AFS programs. If this global problem is not addressed, the morbidity and mortality associated with AFR will continue to rise in the future.

关键词： Antifungal Resistance Antifungal stewardship Antimicrobial Resistance Fungal Infections Global Burden Immunocompromised Mycosis

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COVID-19 Vaccine Acceptance and Hesitancy among Pregnant Women: A Knowledge, Attitude, and Perceived Risks Survey in Lusaka, Zambia

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Pharmacology & Pharmacy 2024年第5期15卷 147-166页

作者： steward mudenda Ruth Mbewe Manal Hadi Ghaffoori Kanaan Shafiq Mohamed Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Agriculture Technical Institute of Suwaria Middle Technical University Baghdad Iraq Medicines Management and Pharmacy Services St. James University Hospital Leeds Teaching Hospitals NHS Trust Leeds United Kingdom

Introduction: The coronavirus disease 2019 (COVID-19) is an infectious disease of the respiratory tract caused by SARS-CoV-2. Since its emergence, there have been increased rates of transmission and spread, morbidity and mortality which led to the development of COVID-19 vaccines to address the pandemic. This study assessed acceptance, knowledge, attitude, and perceived risks regarding COVID-19 vaccines among pregnant women attending antenatal care at two First-Level Hospitals in Lusaka, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 241 pregnant women using a questionnaire from August 2023 to October 2023 in two First-Level Hospitals in Lusaka district, Zambia. The collected data were analyzed using IBM Statistical Package for Social Sciences (SPSS) version 22.0. Statistical analysis was performed using a Chi-square test. The statistical significance was set at a 95% confidence level. Results: Of the 241 participants, 107 (42.7%) were aged between 24 and 34 years. Overall, 64.3% accepted the COVID-19 vaccines, of which 122 (50.6%) were already vaccinated. Further, 203 (84.6%) of the pregnant women had good knowledge, and 199 (82.6%) had positive attitudes towards COVID-19 vaccines. However, 58.5% thought COVID-19 vaccines were not safe and could cause infertility. Alongside this, 70.1% thought that COVID-19 vaccines were harmful during pregnancy. Having good knowledge of COVID-19 vaccines was associated with age (p = 0.049), education status (p = 0.001), and employment status (p = 0.001). Having a positive attitude towards COVID-19 vaccines was associated with education status (p = 0.001) and employment status (p = 0.001). Conclusion: This study found that most pregnant women had good knowledge, and positive attitudes, and the majority accepted the COVID-19 vaccine. Encouragingly, most of the pregnant women who accepted the COVID-19 vaccines were already vaccinated. Most pregnant women thought that COVID-19 vaccines had sid

关键词： COVID-19 Vaccines Pregnant Women Vaccine Acceptance Vaccine Hesitancy Zambia

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Antimicrobial stewardship: Knowledge and Attitudes of Pharmacy Staff on Antibiotic Dispensing Patterns, Use and Resistance in Benin

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Pharmacology & Pharmacy 2023年第6期14卷 189-214页

作者： Aurel Constant Allabi Areine Gracidie Agbo Bawa Boya steward mudenda Laboratory of Pharmacology and Toxicology University of Abomey-Calavi and Teaching Hospital of Abomey-Calavi/S&#244-Ava Abomey-Calavi Benin Laboratory of Biology and Molecular Typing in Microbiology University of Abomey-Calavi Cotonou Benin Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia

Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.

关键词： Antibiotic Resistance Antimicrobial Resistance Antimicrobial stewardship Attitudes Benin Knowledge Perceptions Pharmacists West Africa

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Phytochemical Analysis of Leaf, Stem Bark, and Root Extracts of Cassia abbreviata Grown in Zambia

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Pharmacology & Pharmacy 2022年第5期13卷 119-128页

作者： Reagan Kabuka steward mudenda Martin Kampamba Martha Chulu Tadious Chimombe Christabel Nang’andu Hikaambo Department of Pharmacy School of Health Sciences Levy Mwanawasa Medical University Lusaka Zambia Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia

Background: Plants have for a long time been used as medicines to treat ailments. Cassia abbreviata (C. abbreviata) is one of the plants that has been widely used in the management of a range of ailments, including malaria, diarrhea, and abscesses. Aim: This study was conducted to investigate the phytochemical composition of crude extracts of the roots, leaves, and stem bark of C. abbreviata. Materials and Methods: This was a laboratory-based study in which the fresh leaves, stem bark, and roots of C. abbreviata were collected, thoroughly cleaned, chopped into small pieces, and kept at room temperature until fully dry. The dried plant parts were powdered separately and stored separately in airtight containers for the phytochemical investigation. Ethanol (96% v/v) or distilled water was used for the extraction of components of the coarse powder. The mixtures were separately filtered, and the filtrates were reduced to a concentrated semisolid mass by drying in a water bath at 40?C. Thereafter, phytochemical analysis for flavonoids, phenolics, tannins, saponins, alkaloids, terpenoids, glycosides, carbohydrates, and proteins was done. Results: The phytochemical analysis of the ethanolic extracts revealed the presence of high concentrations of tannins, reducing sugars, and sterols in the stem bark and roots. Flavonoids, phenolics, and proteins were present in high concentrations in the stem bark, while anthraquinone, glycosides, and alkaloids were present in the leaves and roots, respectively. Conclusion: C. abbreviata plant contains a wide range of phytochemical constituents. Depending on the solvent used for extraction, various compositions of phytochemicals are obtained in each part of the tree. However, extraction with ethanol showed a better concentration than with water for most of the phytochemicals.

关键词： Cassia abbreviata Flavonoids Phytochemicals Stem Bark Sterols Tannins

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Antibiotic Prescribing Patterns and Prevalence of Surgical Site Infections in Caesarean Section Deliveries at Two Tertiary Hospitals in Lusaka, Zambia

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Pharmacology & Pharmacy 2022年第8期13卷 313-330页

作者： Maisa Kasanga Misheck Chileshe steward mudenda Raphael Mukosha Maika Kasanga Victor Daka Tobela mudenda Maureen Chisembele John Musuku Benjamin Bisesa Solochi Jian Wu College of Public Health Zhengzhou University Zhengzhou China Department of Pathology and Microbiology University Teaching Hospitals Lusaka Zambia Mary Begg Health Services Ndola Zambia Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Disease Control School of Veterinary Medicine University of Zambia Lusaka Zambia Laboratory Department Levy Mwanawasa University Teaching Hospital Lusaka Zambia Department of Pharmacy University Teaching Hospitals Lusaka Zambia Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Department of Pathology Ndola Teaching Hospital Ndola Zambia Department of Obstetrics and Gynaecology University of Zambia-School of Medicine Lusaka Zambia Women and Newborn Hospital University Teaching Hospitals Lusaka Zambia Levy Mwanawasa University Teaching Hospital Lusaka Zambia

Introduction: A caesarean section (CS) is one of the most frequently performed obstetric surgeries in the world and its use has increased dramatically in recent years. The number of caesarean section cases worldwide has been increasing each year, and the World Health Organization (WHO) reported an excess of 10% - 15% of CS procedures for all births. However, some women experience surgical site infections (SSIs) after undergoing CS delivery. This study investigated the prescribing patterns of antibiotics in CS deliveries and the prevalence of SSIs at two tertiary hospitals in Lusaka, Zambia. Materials and Methods: A retrospective cross-sectional study was conducted from January 2020 to December 2020 at the Women and Newborn University Teaching Hospital (UTH) and the Levy Mwanawasa University Teaching Hospital, in Lusaka, Zambia. Results: Of a total of 838 women who delivered via CS, more than half were aged between 21 and 25 years (n = 461, 55.0%), 56.3% were from low-cost residential areas, and 57% had emergency CS delivery. The prevalence of SSIs was 6.0%, with the level of education (OR 0.377, 95% CI 0.150 - 0.946), type of caesarean section (OR 6.253, 95% CI 2.833 - 13.803), and oral antibiotics post-caesarean (OR 0.218, 95% CI 0.049 - 0.963). The duration of IV antibiotic treatment significantly predicted SSI (p Conclusion: This study found that the third-generation cephalosporin (cefotaxime) and triple combination therapy (benzylpenicillin, gentamicin, and metronidazole) were the most frequently prescribed antibiotics before and after CS. The level of education, type of CS, oral antibiotics post-CS, facility, and duration of administering IV antibiotics were all predictors of SSIs.

关键词： Antibiotic Prescribing Patterns Caesarean Section Post-Operative Antibiotics Prophylactic Antibiotics Surgical Site Infections

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Antimicrobial Activities of Solanum aculeastrum Fruit Extract against Escherichia coli, Staphylococcus aureus and Candida albicans: Significance of African Traditional Medicine in Combating Infections and Attaining Universal Health Coverage

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Pharmacology & Pharmacy 2023年第5期14卷 176-188页

作者： Christabel Nang’andu Hikaambo Phanuel Chilala Ferdinand Ndubi Godfrey Mayoka Martin Kampamba Reagan Kabuka Billy Chabalenge steward mudenda Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Pharmaceutical Chemistry and Pharmaceutics School of Pharmacy Kabarak University Nakuru Kenya Department of Pharmacology and Pharmacognosy School of Pharmacy Jomo Kenyatta University of Agriculture and Technology Nairobi Kenya Department of Pharmacy School of Health Sciences Levy Mwanawasa Medical University Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia

Solanum aculeastrum, a member of the Solanum genus, has a rich history of traditional use in various populations throughout tropical and southern Africa for treating different ailments. This study investigated the antimicrobial activities of S. aculeastrum fruit extracts grown in Zambia against Escherichia coli (E. coli) (ATCC 25922), Staphylococcus aureus (S. aureus) (ATCC 25923), and Candida albicans (C. albicans). After being dried in an oven at 50°C for eight days, the fruits of S. aculeastrum were pulverised and subjected to extraction using methanol and distilled water as solvents. The resulting crude extract was then filtered, concentrated using a water bath, and packed into airtight containers separately. The disc diffusion method was employed to evaluate the antimicrobial activity of the extracts. The results showed that both the methanolic and aqueous extracts demonstrated antimicrobial activity against S. aureus and C. albicans, but not against E. coli. The zone of inhibition was greater in S. aureus than in C. albicans. This study highlights the importance of researching plants for their medicinal properties, which can pave the way for discovering natural product-based drugs with potential antimicrobial properties. These findings recommend further studies on plants used in African traditional medicine.

关键词： African Traditional Medicine Solanum aculeastrum Phytochemicals Solanum Berries Antimicrobial Activity

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Prevalence and Antimicrobial Susceptibility Status of Gram-Negative and Gram-Positive Bacteria on Handheld Shopping Trolleys and Baskets in Supermarkets in Ndola, Zambia

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Open Journal of Epidemiology 2023年第4期13卷 235-249页

作者： Shivangi Patel Victor Daka steward mudenda Mulemba Samutela Misheck Chileshe Warren Chanda Imukusi Mutanekelwa Ephraim Chikwanda Titus Haakonde Tobela mudenda Scott Matafwali Samson Mwale Ruth Lindizyani Mfune Public Health Department School of Medicine Copperbelt University Ndola Zambia School of Health Sciences University of Zambia Lusaka Zambia Mary Begg Health Services Ndola Zambia School of Medicine and Health Sciences Mulungushi University Livingstone Zambia Tropical Disease Research Centre Ndola Zambia Environmental Health Section School of Applied and Health Sciences Evelyn Hone College of Applied Arts and Commerce Lusaka Zambia Pathology and Laboratory Department Ndola Teaching Hospital Ndola Zambia Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK

Background: Supermarkets are a place visited by individuals with different health conditions daily where microbiological contaminants through touch onto fomites such as trolleys and baskets can be passed on to other people hence potentially spreading infectious diseases. This study aimed to investigate the presence of Gram-negative and Gram-positive bacteria on handheld shopping trolleys and baskets and their antimicrobial susceptibility status against commonly used antibiotics in Zambia. Methods: A cross-sectional study was conducted. Trolleys and basket handles were swabbed and standard microbiological methods were used to identify the bacteria and disc diffusion to determine their antimicrobial susceptibility status. Data was collected from December 2021 to April 2022. Data was analysed using IBM Statistical Package for Social Sciences (SPSS) Version 22. Results: Twenty-eight percent of the 200 total samples were found to be culture-positive and predominant isolates were Staphylococcus aureus (17.3%), Pseudomonas species (4.5%), Escherichia coli (2%), Corynebacterium species (2%), Staphylococcus species (1.5%) and Enterobacter aerogenes (0.5%). Staphylococcus aureus showed the most resistance to azithromycin (17%) followed by ciprofloxacin (2.8%), nitrofurantoin (2.8%) and chloramphenicol (2.8%). Escherichia coli showed 100% resistance to amoxicillin, cloxacillin and ampicillin, 75% resistance to ciprofloxacin and the least resistance to azithromycin (25%) while it was susceptible to nitrofurantoin. Staphylococcus species, Corynebacterium species, Enterobacter aerogenes and Pseudomonas species showed no resistance to any antibiotics. Conclusion: The study showed the presence of microorganisms with considerable antimicrobial resistance to antibiotics in Zambia on trolley and basket handles indicating the need for more initiatives to address proper hygiene in public environmental sites for better infection prevention and control.

关键词： Antimicrobial Resistance Coliform Bacteria Staphylococcus aureus Escherichia coli Supermarket Shopping Trolleys and Baskets

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Assessment of Knowledge, Attitude and Practices towards the Disposal of Unused and Expired Medications among Students of Private Medical Universities in Lusaka, Zambia

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Pharmacology & Pharmacy 2022年第2期13卷 49-68页

作者： Martin Kampamba Vewoerd Maingaila Tumelo Muyenga Akapelwa steward mudenda Luke Biete Webrod Mufwambi Michelo Banda Margaret Phiri Christabel Nang’andu Hikaambo Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Physiological Sciences School of Medicine and Health Sciences Mulungushi University Livingstone Zambia Department of Clinical Pharmacy and Pharmacy Practice School of Pharmacy Eden University Lusaka Zambia Department of Pharmacy School of Medicine and Health Sciences Mulungushi University Kabwe Zambia

Background: The disposal of unused and expired medications has been a concern in many countries in that, the pharmaceutical waste enters the ecosystem and eventually causes a negative impact on human health and environment. Aim: To assess the knowledge, attitude and disposal practices of unused and expired medicines by students in the private medical universities in Lusaka of Zambia. Method: A cross-sectional survey was conducted over a period of 8 weeks among 391 respondents from three private universities in Lusaka. Respondents were polled using semi structured questions that focused on their knowledge, attitudes, and disposal practices for unused and expired drugs. In order to analyze data, the statistical package for social sciences (SPSS) version 20 was utilized. Results: The mean age of the participants was 23 years (SD: ±3). Out of the 391 participants, 320 (81.8%) knew about medicine waste and 391 (100.0%) responded that unsafe disposal of unused and expired medicine poses a threat to human health and can harm the environment. The drug-take-back system was unknown to a vast percentage of the respondent 371 (94.9%). The majority 274 (70.1%) of respondents had unused medicine stored at home, with antibiotics 215 (56.0%) and analgesia 111 (28.4%) being the most prevalent types of drugs kept in the households. The most commonly used disposal practice for unused 126 (32.2%) and expired medicines 274 (70.1%) was throwing them in household garbage. Only 27 (6.9%) and 30 (7.7%) reported returning unused and expired medicines to the nearest pharmacy respectively. The majority of respondents believed the risk stemmed from the presence of an undesired drug in the home, the potential for harm to children, a lack of proper information on safe disposal practices, and the necessity for a take-back program. Conclusions: The majority of the study participants used unsafe methods to dispose of unused and expired medicine. However, most of the participants acknowledged that un

关键词： Unused Medications Expired Medications Medicine Disposal Medicine Waste

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Knowledge, Attitudes, and Practices of Poultry Farmers on Antimicrobial Use and Resistance in Kitwe, Zambia: Implications on Antimicrobial stewardship

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Open Journal of Animal Sciences 2023年第1期13卷 60-81页

作者： Samuel Chilawa steward mudenda Victor Daka Misheck Chileshe Scott Matafwali Billy Chabalenge Prudence Mpundu Webrod Mufwambi Shafiq Mohamed Ruth Lindizyani Mfune Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Mary Begg Health Services Ndola Zambia Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Environmental and Occupational Health School of Health Sciences Levy Mwanawasa Medical University Lusaka Zambia Remedium Pharmaceuticals Limited Lusaka Zambia

Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.

关键词： Antibiotics Antimicrobials Antimicrobial Resistance Antimicrobial stewardship Attitudes Knowledge Livestock Poultry Farmers Practices

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Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective

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Pharmacology & Pharmacy 2023年第8期14卷 271-328页

作者： steward mudenda Billy Chabalenge Victor Daka Ruth Lindizyani Mfune Kyembe Ignitius Salachi Shafiq Mohamed Webrod Mufwambi Maisa Kasanga Scott Kaba Matafwali Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Medicines Management and Pharmacy Services St James University Hospital Leeds Teaching Hospitals NHS Trust Leeds UK Department of Epidemiology and Biostatistics School of Public Health Zhengzhou University Zhengzhou China Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK

Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevale

关键词： Antimicrobial Resistance Antimicrobial stewardship AWaRe Classification One Health Approach One Health Perspective Strategies Surveillance

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