“One Health” is a collaborative, multisectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment” (CDC.gov)

Bacterial infectious diseases are common medical problems in developing countries. Due to limited diagnostic facilities, the causative agents and sources of infection, as well as modes of transmission, often remain unidentified. Empiric treatment is a common practice, fostering the emergence of antibiotic resistance and leading to difficult-to-treat infections. Due to the absence of effective monitoring, knowledge of circulating bacterial strains, their reservoirs and how these change over time, is limited.

Because of our close connection with animals, particularly in developing countries, human infections are often zoonoses. Pathogens can be transmitted to humans through direct contact or through food, water or the environment. Overuse of antibiotics in animal husbandry has significantly contributed to the increase of multidrug resistant bacteria, found both in animals and humans.

Bacteria can also survive for extended periods in the environment. For example, in water, in soil, and of particular concern for human health, in the hospital environment. They are capable of adapting to different environments.

Our research interests cover the generation and comparison of bacteriological data from humans, animals and the environment in countries with limited resources. A special focus is on transmission and the identification of reservoirs of antibiotic resistant bacteria in rural areas of sub-Saharan African countries. Our activities will support and guide patient management and public health measures.

In resource-limited countries, broad-spectrum antibiotics are often prescribed empirically without microbiological diagnosis. This overuse of antibiotics in human medicine, significantly contributes to the emergence and the increase of multidrug-resistance. In addition, the use of antibiotics in animal husbandry as growth promoters and for prophylaxis and treatment of infection aggravates this problem. Often, in countries where resources are limited, animal farming is a common occupancy and people often live in close proximity to animals. Animals and meat products have been suggested as an important source for drug resistant enteric pathogens including Campylobacter spp., Arcobacter spp., Salmonella enterica, ESBL-producing Escherichia coli and Klebsiella pneumoniae in SSA countries. Transmission of these bacteria might occur by direct contact or consumption of contaminated meat products, leading to the colonization of the intestinal tract and eventually to infections. So far, the degree to which animals play a role as a reservoir for the transmission of multi drug resistant bacteria has not been studied on genotype level in rural areas of SSA. Within this project, Campylobacter spp., Arcobacter spp., Salmonella enterica, ESBL-producing E. coli and K. pneumoniae genomes collected from human and animals will be compared to examine transmission between human and animal in rural areas of Tanzania and Ghana.

Globally, one in ten child deaths during the first five years of life result from diarrhoeal disease. Due to limitations in diagnostic facilities in resource-constrained clinical settings, the aetiological agent of diarrhoeal disease is rarely laboratory confirmed. In the past years, clinical studies on diarrheal diseases in developing countries have shed more light on the predominating causes of infection. Campylobacter spp., Shigella spp., and diarrhoeagenic Escherichia coli and Salmonella enterica have been among the most common pathogens isolated from patients with diarrhoea. So far, studies on Arcobacter spp. are limited. Arcobacter spp. is an emerging pathogen with its role in diarrhoeal disease not well understood. In the past years, moderate associations with diarrhoea have been demonstrated for Shigella spp., Campylobacter spp. and diarrhoeagenic Escherichia coli but the associations on bacterial sub-type level have not been studied thoroughly. Data on sub-type specific burden of diarrhoea and antibiotic resistance is needed in order to identify populations at risk, to develop preventive measures and to adjust antibiotic usage when treatment is indicated.

Within this study we investigate and compare bacterial subtypes of children below 5 years of age and the association with diarrhoea in a rural hospital in Tanzania.

The spread of antimicrobial resistance (AMR) is a major challenge for health systems worldwide, also affecting many African countries. The majority of bacterial infections with resistant pathogens in sub-Saharan Africa still go undetected and empiric treatment of infections is common. The reason behind are lack of microbiology laboratories, that are capable of performing bacterial culture and antibiotic susceptibility testing, particularly in rural areas of sub-Saharan Africa. Therefore, the GHP funded project “development of standardized AMR laboratories” has so far built and set up three fully functioning AMR microbiology laboratories in three different geographical locations of Ghana, namely Agogo (Asante Akim North District), Assin Fosu (Assin Fosu Municipal) and Agroyesum (Amansie West District). The established laboratories are standardized and are able to process clinical specimens such as blood, urine and stool samples as well as perform antibiotic susceptibility testing according to the guidelines of the WHO Global Antimicrobial Resistance Surveillance System (GLASS). The established AMR surveillance systems will inform on circulation and emerging AMR bacterial strains and will eventually lead to improved patient care by allowing targeted antibiotic treatment. Currently, this work is expanded to three study sites in Tanzania including the island of Zanzibar. Work is carried out in collaboration with the National Institute for Medical Research (NIMR), the Zanzibar Livestock Research Institute (ZALRI) and the Health Improvement Project Zanibar (HIPZ).

Partners:

National Institute for Medical Research (NIMR), Tanga, Tanzania

Bombo Regional Referral Hospital, Tanga, Tanzania

Korogwe District Hospital, Korogwe, Tanzania

Health Improvement Project, Zanzibar, Tanzania

Makunduchi Health Centre, Zanzibar, Tanzania

Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana

Agogo Presbyterian Hospital, Agogo, Ghana

St. Francis Xavier Hospital, Assin Fosu, Ghana

St. Martin Catholic Hospital, Agroyesum, Ghana

Funding: Global Health Programme (GHP)-Bundesministerium für Gesundheit

Infections with antibiotic resistant bacteria are common medical problems in developing countries leading to significant morbidity and mortality in particular affecting vulnerable groups such as children under the age of five and neonates. Due to limited diagnostic facilities in countries with low resources, the causative agents and sources of infection, as well as modes of transmission, often remain unidentified. Due to the absence of effective monitoring and surveillance systems, knowledge of circulating bacterial strains, their reservoirs and how these change over time, is limited, however this is essential information for successful patient management and for the implementation of control strategies.

The WHO has developed a pathogen priority list divided into three categories according to the urgency of need for new antibiotics: critical, high and medium priority. The most critical group includes multi drug resistant bacteria that pose a particular threat in hospitals. They include Acinetobacter baumannii (carbapenem resistant) Pseudomonas aeruginosa (carbapenem resistant) and bacteria of the group Enterobacterales, including Klebsiella spp. and Escherichia coli (carbapenem resistant and ESBL-producing).

This study aims at generating data in the field of multidrug resistant bacteria (WHO prority pathogen), their reservoirs in community and hospital environments with a focus on maternal-neonatal transmission in order to improve hospital hygiene and prevention programs.

Partners:

National Institute for Medical Research (NIMR), Tanga, Tanzania

Bombo Regional Referral Hospital, Tanga, Tanzania

Korogwe District Hospital, Korogwe, Tanzania

Funding: Global Health Programme (GHP)-Bundesministerium für Gesundheit

Hospital partnership, Tanzania

In many African countries, in particular those of sub-Saharan Africa, fever is still mainly associated with malaria. Fortunately, malaria diagnostics such as microscopy and rapid test are largely available, even in resource limited clinical settings. This is less true for differential diagnosis of other febrile illnesses such as for example those caused by bacteria that are potentially severe and for which specific treatment is required. Most hospitals in Tanzania do not offer such differential diagnosis and antibiotic susceptibility testing is not routinely carried out. As a result, empiric treatment is typically applied. This leads to overuse of antibiotics and to treatment failures.

Partners: 

National Institute for Medical Research (NIMR), Tanga, Tanzania

Bombo Regional Referral Hospital, Tanga, Tanzania

Funder: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)