PubMed · 85930
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1979-03-24. Albert Joseph Hawe.. https://pubmed.ncbi.nlm.nih.gov/85930/
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BACKGROUND: Addressing antimicrobial resistance (AMR) poses a complex challenge, primarily because of the limited understanding of bacterial antibiotic resistance genes (ARGs) and the spread of these genes across different domains. To bridge this knowledge gap in Ghana, we undertook a comprehensive systematic review and meta-analysis to quantify and estimate the prevalence of circulating ARGs in bacteria isolated from human, animal, and environmental sources. METHODS: A thorough literature search was conducted across three major databases-Web of Science, PubMed, and Scopus-to retrieve all relevant articles related to ARGs in Ghana from the inception of the databases to February 25, 2024. A risk-of-bias evaluation was performed using the Newcastle-Ottawa Scale (NOS), and the data analysis involved descriptive statistics and proportional meta-analysis. RESULTS: Of the 371 articles initially obtained, 38 met the inclusion criteria. These studies adequately covered Ghana geographically. The most prevalent ESBL gene identified was blaCTX-M, with a prevalence of 31.6% (95% CI: 17.6-45.7), followed by blaTEM (19.5% [95% CI: 9.7-29.3]), and blaSHV (3.5% [95% CI: 0.3-6.6]). The pooled prevalence of carbapenemase genes ranged from 17.2% (95% CI: 6.9-27.6) for blaNDM to 10.3% (95% CI: 1.9-18.7) for blaOXA. Additionally, other ARGs, including sul1, qnrS, gyrA, erm(B), and mecA, were detected, with prevalence ranging from 3.9% (95% CI: 0.0-8.5) to 16.4% (95% CI: 3.1-29.8). Several ARGs were shared across human, animal, and environmental sources. CONCLUSION: This review revealed that bacteria obtained from human, animal, and environmental samples in Ghana shared genes associated with AMR. This finding provides evidence on the interconnection of AMR across these three domains. Horizontal gene transfer, which enables the dissemination of ARGs between genetically diverse bacteria, can occur, necessitating a multidisciplinary approach to addressing antimicrobial resistance in Ghana.
Debate over the equitable allocation of financial resources in the health sector has focused overwhelmingly on allocation from national to regional levels. More equitable allocation of such resources within regions has been virtually ignored, creating a vacuum in knowledge regarding how resources are allocated intra-regionally and their potential influence on promoting health equity. In this paper, we report an empirical study examining progress towards equity in intra-regional resource allocation in the Ashanti and Northern regions of Ghana. Relative deprivation across the 31 districts of the two regions was measured as a proxy of health needs. The result was used to develop an equity-adjusted share index (EAS) applied as a yardstick against which progress towards equity was assessed. The study found a significant correlation between districts' share of donor pooled funds (DPF) and the EAS in the Northern region for three of the 4 years investigated. In Ashanti region, a worsening trend in relation to equity in DPF allocation was discovered. The proportion of variance in the share of DPF that could be explained by the EAS reduced incrementally from 56% in 1999 to less than 1% in 2002. The study highlights the need for more emphasis on intra-regional equity in resource allocation in Ghana.
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