The African region is beset with multiple challenges which negatively impact the capacity to address antimicrobial resistance. Surveillance and laboratory data is sparse and there is concern that the National Action Plans on AMR are not founded on a strong evidence-base detailing the specifics of the problem nor on interventions proven to be effective in African contexts. Furthermore, there is concern that in the absence of robust evidence, interventions and policies will not make efficient and effective use of already scarce resources. This is why ReAct Africa hosted a research priority setting workshop end 2018.
Global trends show rapidly increasing rates of antimicrobial resistance. Sub-Saharan Africa, which already bears the largest proportion of the global burden of infectious disease, including HIV/AIDS, tuberculosis (TB) and malaria, is especially vulnerable in the context of antimicrobial resistance (AMR).
ReAct Africa hosts an AMR Research priority setting workshop
In response to concerns about the lack of comprehensive evidence on antimicrobial resistance in Africa, and pursuant of the One Health Approach, ReAct Africa – with support from the Swedish International Development Cooperation Agency (Sida) – convened an AMR research priority setting workshop with the aim of approaching the challenge of antimicrobial resistance coherently across sectors and at all levels of society.
Both ReAct Africa and Sida have a common interest in identifying priority areas for research and research capacity building related to antimicrobial resistance in Africa from African perspectives.
The two primary objectives of the workshop were:
- to determine AMR research priorities through consensus decision-making among key stakeholders and
- to explore AMR research capacity strengthening approaches in Africa.
The workshop attracted 70 participants from 31 countries in Africa. Participants included experts in human health, animal health, agriculture, environment, social sciences, research, academia and non-governmental organizations among others.
Today’s research priorities determine the agenda of tomorrow
Research priority setting is important to ensure that limited resources are allocated appropriately, efficiently and effectively to research focus areas that are significant, meaningful and where there is a need.
Ethical, appropriate and effective research priority setting ensures that local and regional priorities receive primacy:
- that research priorities work for equity in health
- that research focuses on the needs of the most vulnerable groups of the population and reinforces the links between research, action, policy and development.
Today’s research priorities determine the health agenda, practices and technologies of tomorrow.
AMR research priority setting methodology at the workshop
Generation of research questions
The approach for identifying AMR research priorities for Africa was broadly twofold: generation of AMR research questions or areas and priority ranking. Generation of AMR research questions targeted experts in AMR and AMR research in human, animal, veterinary and environment sectors based in Africa. Data collection was through desktop reviews of literature on AMR, an online survey and face-to-face discussions.
The criteria, against which research questions were rated to determine research priority scores, were identified from those suggested by COHRED amongst other sources. These were appropriateness, relevance, and usefulness. As such, workshop participants rated research focus areas /questions as to whether they should be done, why they should be done and the potential impact of the research in that area.
Sub-clustering of research questions
Research questions generated were classified into one of eight broad thematic clusters viz. governance mechanisms for AMR; awareness and understanding of AMR; knowledge and evidence base through surveillance; infection prevention measures including effective sanitation and hygiene; optimizing use of antimicrobial medicines; investment in new medicines, diagnostic tools, vaccines and other interventions; gender and inequities and the environment. During the workshop, participants were randomly assigned to groups and through a participatory process of consensus building, they identified key linking and overlapping questions within clusters, and to group questions into sub-clusters, developed by the groups. These sub-clusters were then added to a priority ranking tool and formed the items that would be rated against the previously specified criteria.
Ranking and scoring
Sub-cluster lists were entered into an electronic Google survey form that was emailed to all workshop participants. Participants ranked each sub-cluster according to the three criteria described above using a ranking guide handout to assist the process. Time was set aside during the workshop process for ranking to take place.
In accordance with the COHRED suggested approach, the average rating among participants for each question on each sub-criterion was computed. Relevant sub-criterion scores were added together to reach a criterion score out of a possible maximum of 6. An overall priority score, of a potential maximum of 18, was calculated for each question by summing the three criterion scores. Priority ranking scores were also calculated for each of the sub-clusters identified by the participants including the eight thematic clusters into which the original list of questions were sorted.
Results from the priority setting at the workshop
- A total of 324 antimicrobial resistance research questions were generated from the online survey, literature and face-to-face discussions.
- Eighty six stakeholders from thirty five countries responded to the online survey call to submit research questions.
- Twelve stakeholders based in Kenya participated in face-to-face discussions and a total of seventy participants from thirty one countries ultimately attended the workshop in Kenya.
Thematic cluster ranking
Priority scores calculated for each of the thematic areas are shown in Figure 1 below.
The priority ranking for each of the listed clusters were quite close to one another as depicted by a variance of 0.705 and a standard deviation of 0.839.
Coordinating team formed
At the end of the workshop, a coordinating team was formed to review the results of the AMR prioritization exercise and develop next steps.
Review on antimicrobial resistance. ReAct-Africa Proposal for “Workshop to identify AMR related research priorities in Africa.”
WHO – Antimicrobial Resistance
WHO report; Antimicrobial resistance in the African Region: Issues, challenges and actions proposed, 2013.
COHRED Working Group on Priority Setting (1997) Essential National Health Research and Priority Setting: Lessons Learned. COHRED Document 97.3. Geneva, Switzerland.
COHRED (2010) Priority Setting for Research for Health: a management process for countries. Montorzi G, de Haan S, IJsselmuiden C. Council on Health Research for Development; Council on Health Research for Development (2000) The ENHR Handbook, A Guide to Essential National Health Research. Geneva, Switzerland;
Viergever, R. F., Olifson, S., Ghaffar, A., & Terry, R. F. (2010). A checklist for health research priority setting: nine common themes of good practice. Health research policy and systems, 8(1), 36.
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