Community-Based Surveillance of Antibiotic Resistant Shigella spp. in Manhiça, Mozambique

ABSTRACTBackground: This project addresses the goals of the World Health Organization’s (WHO) Global Action Plan on Antimicrobial Resistance (AMR). One of the major objectives of the Global Action Plan is to strengthen the knowledge and evidence base through surveillance. However, AMR surveillance systems in low- and middle-income countries (LMICs) remain underdeveloped. To overcome the challenge of developing national AMR surveillance systems, it has been suggested that LMICs may benefit from establishing either sentinel- or community-based surveillance systems that build capacity around one site, followed by systematic expansion of AMR surveillance capacity to other sites over time. Herein, we propose to conduct a community-based AMR surveillance project on Shigellosis in Manhiça, Mozambique. Hypothesis:1.The distribution of Shigella ssp. isolates in the community of Manhiça, Mozambique is identical to the distribution of Shigella spp. isolates identified in hospital patient clinical samples from the same population. 2.The antimicrobial susceptibility patterns in Shigella ssp. isolates in the community of Manhiça, Mozambique are identical to the antimicrobial susceptibility patterns of Shigella spp. isolates identified in existing hospital records from the same population. Specific AimsI. Sampling: Households containing children under the age of five in Manhiça, Mozambique will be randomly sampled to acquire a robust sample of 100 Shigella spp. isolates.II. Shigella spp. speciation and susceptibility testing: Standard microbiological techniques will be used to determine Shigella spp. and antibiotic sensitivities. IV. Data analysis: Data will be analyzed descriptively and analytically. Study Design: This is a cross-sectional study. To address the two hypotheses, we will assume a 7% prevalence of Shigella infections in children aged 0-59 months. To isolate a robust sample of 100 isolates from the community, we will randomly sample households containing children 0-59 months of age. Within the household, we will take fecal samples from the children and the adult caretakers will answer a questionnaire to capture demographic data and assess AMR knowledge. We will then compare the distribution of Shigella spp. and respective antimicrobial sensitivities of community based-isolates with previous data on clinic-based isolates27,28, to assess whether or not the clinical-isolates are representative of Shigella spp. circulating in the community. Innovation and Impact: Successful completion of this study will allow characterization of the distribution of Shigella spp. in a well-studied clinical population where community-based estimates for the same population remains to be estimated. The public health importance of this information is that it will allow characterization the preclinical cases of Shigella that are not severe enough warrant a hospital visit. The direct benefit to the community is more evidence-based treatment. The benefit to the scientific community is that this data will allow researchers to characterize clinical and preclinical Shigellosis in this target population. Taken together, this study aims to overcome the limitations with laboratory-based surveillance systems, serve as a template for conducting community-based surveillance in other LMICs, and provide policy makers evidence useful for national, regional, and district level planning of AMR. Finally, the data generated will help stimulate a sense of urgency, help instill a sense of ownership, and raise community awareness of AMR.Master of Public Healt