Welcoming you for any type of article submission for the upcoming issue on/before February 26, 2021.


Opinion
Volume 1 Issue S1 - 2016
Low Microbial Isolation Rate in Developing Countries; Need for Urgent Global Attention and Action
Beckie N. TAGBO*
Chief Consultant Paediatrician & Vaccinologist, University of Nigeria Teaching Hospital, Nigeria
*Corresponding Author: Beckie N. TAGBO, Chief Consultant Paediatrician & Vaccinologist, University of Nigeria Teaching Hospital, Nigeria.
Received: January 07, 2016; Published: January 08, 2016
Citation: Beckie N. TAGBO. “Low Microbial Isolation Rate in Developing Countries; Need for Urgent Global Attention and Action”. EC Bacteriology and Virology Research 1.S1 (2016): S1-S4.
Abstract
This paper draws attention of the international community to a dire need to urgently address a long standing problem of poor microbial yield in the laboratories in developing countries. In view of persistent high disease burden in these countries, microbial detection in the laboratory is fundamental in addressing prevention, control, detection and management of infectious disease. If disease burden must be drastically reduced, low microbial isolation rates must be addressed and this is better addressed at a global scale.
Keywords: Microbial; Bacterial; Isolation rates; Developing countries; Infectious disease; +/- surveillance; Laboratory
Introduction
It is an established fact that the burden of infectious diseases is unacceptably high in developing countries [1-3]. This has been the case over many years now. With the advent of anti-microbial agents and environmental control, as well as introduction of many vaccines against vaccine preventable diseases, the burden of infectious diseases dropped throughout the globe. While a tremendous drop in global disease burden has been documented, disaggregating the drop into developing and developed countries shows that most of the difference occurred in developed countries with sub-optimal improvement in developing countries. Today, infectious diseases still remain a major cause of under-five mortality, accounting for more than 76% of under-five mortality [3]. The pivot on which control and elimination of infectious disease stands is detection/isolation of the microbial agents responsible for infectious disease. But the paucity of quality data on the burden of infectious diseases due to low microbial isolation rates slows down prevention and control measures [4,5].
Progress so far
Tremendous progress made in combating infectious diseases can be partly attributed to the following:
PRational use of antibiotics: Since the discovery of penicillin in 1928 by Alexander Fleming, Professor of Bacteriology at St. Mary’s Hospital in London, dramatic results have been achieved in terms of reduction of morbidity and mortality from microbial agents [6].
Many more antibiotics have continued to be discovered and added onto the global antibiotic armoury. Rational use of these drugs cannot happen without appropriate microbial isolation in the lab [7]. In addition to antibiotics, antifungals as well as antivirals have been introduced into the market
Environmental Control: This has been shown to significantly reduce disease burden by eliminating factors that enhance transmission. Environmental control such as good housing, good urban planning and development, portable water, electricity, elimination of air pollution and urban slums as well as over-crowding, all minimize transmission of communicable diseases [8].
Personal and Food Hygiene: Singular promotion of regular hand washing has been shown to reduce infectious disease burden [9,10]. Additionally proper observance of personal and food hygiene results in drop in infection transmission.
Vaccination: The advent of vaccination severally described as one of the most cost-effective interventions in human existence has undoubtedly had a tremendous impact on infectious disease burden globally [2,11].
Prompt and appropriate case management: While instituting preventive measures against infectious diseases, breakthrough cases require prompt and appropriate management measures. To achieve this, microbial isolation rate in the laboratory is very critical.
Disease Surveillance: This is fundamental for control of both vaccine and non-vaccine preventable diseases. Surveillance for communicable disease requires laboratory microbial isolation. It enhances disease burden estimation/trends, prompt detection of outbreaks, diseases control/elimination/eradication, vaccine impact assessment and detection of emergence of new strains.
The Problem
Laboratory microbial detection and isolation is monumentally fundamental to any meaningful progress in the diagnosis, management, control, elimination and eradication of infectious diseases. This is so because accurate microbial detection/isolation is necessary;
1. To correctly arrive at a definitive diagnosis
2. Determine antimicrobial susceptibility/resistance
3. To appropriately treat cases
4. Monitor response to treatment or treatment failure
5. Carry out surveillance to determine disease burden
6. Develop effective vaccines and antimicrobial agents
7. Detect outbreaks and plan outbreak response
8. Monitor vaccine impact, etc.
In my few years of experience in Bacteriology and Virology, the magnitude of the problem is becoming more glaring with passage of time. Disease surveillance to accurately determine the burden of diseases and antimicrobial resistance patterns has particularly been hampered by poor microbial isolation rates in Developing Countries.
For instance: a systematic review by Huynh., et al. [3] of burden of neonatal bacterial infections and antibiotic resistance in Developing Countries revealed that there is“insufficient data” to draw valid conclusions as isolation rates were low. Of the 20 countries that reported bacteremia rates, isolation rates ranged from 5.8% to 48% with median of 22.4% (This is excluding one study from Georgia with isolation rate of 67%). The only CSF culture study reported in literature from Developing Countries had 4% isolation rate. Also, “less than one-fifth of the studies reviewed were based on active surveillance”.
Several studies on isolates from suspected pneumonia and meningitis case in children ranged from zero isolation rates to 23% [12-15]. Majority of studies where moderate yields have been documented received a form of foreign support. These include technical assistance, capacity building, Laboratory equipment and reagents, External Quality Control and External Quality Assurance.
Recently WHO initiated a Global (and Regional) surveillance network for Paediatric bacterial meningitis and rotavirus diarrhoea. This is one major global move towards addressing the problem of near- absence quality locally generated data on disease burden in Developing Countries [16].
While the antigen based detection of rotavirus by ELISA in Developing Countries is high [17,18], it is the opposite in (paediatric bacterial meningitis) PBM. The PBM isolation rates have been reported to be as low as 7% [9]. This is in spite of technical and financial support from WHO and other organizations. Although, the target organisms in the surveillance are fastidious (Streptococcus pneumoniae, Haemophilus Influenzaeb, Neisseria meningitis), isolation rates from CSF is still at a low range. Attempts to increase the yield by use of antigen tests and PCR seem to have only marginally improved the detection rates and require much more to be done.
The WHO surveillance network has no doubt had a significant impact on improving laboratory capacity, clinical practice and generation of better quality data. For instance, before the commencement of the surveillance networks, most labs in Developing Countries used human blood for culture media preparation and Clinicians sent CSF to the lab for culture after several hours of delay. This has changed, at least in participating hospitals. However, non-participating hospitals and even some non-participating sections of the laboratory in participating hospitals have not improved their capacity.
Contributing factors
Factors that contribute to low microbial isolation rates in DCs are many some of which include:
Resistance: There is easy availability of over-the-counter (OTC) antimicrobials including anti-TB drugs due to weak regulatory systems. This has led to miss-use and even where prescribed, over prescription of antimicrobials. As a result, the proportion of patients whose blood cultures are done after antibiotic consumption is usually high. Poor access to health also encourages self-medication and indiscriminate use of antimicrobials. This is compounded by illiteracy, poverty and low awareness. The high rate of fake and substandard drugs, and poor prescription patterns all help to enhance development of antimicrobial resistance.
Poor access: The high burden of poverty and malnutrition [19], weak infrastructure and weak health systems are major contributors to low microbial yield in DCs. Many areas of the community are underserved with no health facilities, no electricity and where available, very expensive and unaffordable. Laboratories lack appropriate equipment, supplies, training and personnel; thereby resulting in poor physical and economic access [20].
Low lab Capacity: Where laboratories exist, the capacity in most hospitals for microbial isolation is low, even in some teaching hospitals. There is still wide-spread use of human blood, high level of contaminant yield, high level of no growth, poor lab supplies, lack of constant power supply, portable and distilled water, poor lab environment, near absence lab policies, non-availability of services during weekends and public holidays, poorly motivated staff without updated skills and training.
Weak political commitment: There appears to be poor ownership and government commitment towards investing in well-equipped and maintained health facilities with adequate laboratory capacity. This could be traced to poor awareness and perception of its importance.
Weak advocacy: Addressing poor ownership requires strong advocacy. But this is also low and there is lack of advocacy tools such as quality data.
Way Forward
This paper is an urgent call for a global attention and action towards addressing head-on, the perennial problem of low microbial isolation rates in DCs. It will enhance prompt detection and management of disuses, prompt detection and response to disease outbreaks, control and elimination/eradication of disease, help monitor and improve disease surveillance data.
There is need for strong coalition of World Health bodies, agencies and organizations together with governments to develop strategic and concerted effort, not just against antimicrobial resistance (which is only a small part of the whole), but against poor microbial isolation rates.
The efforts and strategies should include:
1. Global needs assessment
2. Setting of goals, targets and performance indicators
3. Adoption and ratification by governments (including ownership encouragement measures)
4. Periodic monitoring and evaluation by monitoring and evaluation bodies
5. Review of progress periodically
6. Operational research in areas of yield-enhancement of laboratory methods in developing country settings, integration of surveillance into health system, health information system studies, etc.
Conclusion
Antimicrobial isolation rates are unacceptably low in may developing countries. This has a global effect on development, morbidity, mortality, case detections and management, epidemics and outbreak detection, disease surveillance and quality of epidemiological data. There are many contributing factors. This paper is a strong call for urgent global attention and action. It is expected that if given global attention, the picture will change significantly within the next 5-10 years. Future operational research should focus at increasing laboratory antimicrobial isolation rates in a developing country setting.
Bibliography
  1. Dye C. “After 2015: Infectious diseases in a new era of health and development”. Philosophical Transactions B (2014).
  2. Curtiss R III. “The Impact of Vaccines and Vaccinations: Challenges and Opportunities for Modelers”. Mathematical Biosciences And Engineering 8.1 (2011): 77-93.
  3. Huymh B., et al. ““Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?”. BMC Infectious disease 15 (2015): 1-13.
  4. Lubell Y., et al. “Susceptibility of community-acquired pathogens to antibiotics in Africa and Asia in neonates–an alarmingly short review”. Tropical Medicine and International Health 16.2 (2011): 145–151.
  5. Berkley JA., et al. “Bacteremia among children admitted to a rural hospital in Kenya”. The New England Journal of Medicine 352.1 (2005): 39–47.
  6. American Chemical Society International Historic Chemical Landmarks. Discovery and Development of Penicillin.
  7. Banaji N and Oommen S. “Towards a rational antimicrobial testing policy in the laboratory”. Indian Journal of Medical Microbiology 29.3 (2011): 209-212.
  8. Prüss-Üstün A., et al. “Preventing disease through healthy environments. Towards an estimate of the environmental burden of disease”. World Health Organization 30.5 (2006): 1-106.
  9. Pittet D. “Clean hands reduce the burden of disease”. The Lancet 366.9481 (2005): 186-187.
  10. Fewtrell F., et al. “Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis”. The Lancet Infectious Diseases 5.1 (2005): 42–52.
  11. World Health Organization. State of the world’s vaccines and immunization Third edition. (2009):1-208.
  12. Falade AG., et al. “Invasive Pneumococcal disease in children aged > 5 years admitted to 3 urban hospitals in Ibadan, Nigeria”. Clinical Infectious Diseases 48.2 (2009): S190-196.
  13. Mulu A., et al. “Bacterial isolates from Cerebrospinal fluids and their antibiotive susceptibility patterns in Gondar University Teaching Hospital, Northwest Ethiopia”. The Ethiopian Journal of Health Development 19.2 (2005): 160-164.
  14. Begne G and Tsegaye W. “Bacterial Uno pathogens in urinary tract infection and antibiotic susceptibility pattern in Jimma University specialized hospital, Southwest Ethiopia”. Ethiopian Journal of Health Sciences 21.2 (2011): 141-146.
  15. Hamer DH., et al. “Etiology of Bacteremia in Young Infants in Six Countries”. Pediatric Infectious Disease Journal 34.1 (2015): e1–8.
  16. Centers for Disease Prevention and Control. “Pediatric Bacterial Meningitis Surveillance --- African Region, 2002—2008”. Morbidity and Mortality Weekly Report 58.18 (2009): 493-497.
  17. Tagbo BN., et al. “Epidemiology of rotavirus diarrhea among children younger than 5 years in Enugu, South East, Nigeria”. Pediatric Infectious Disease Journal 33.1 (2014): S19-22.
  18. Seheri LM., et al. “Report of the 7th African Rotavirus symposium, Cape Town, South Africa, 8th November 2012”. Vaccine 32.48 (2014): 6336-6341.
  19. Mahin T. “WASH Impacts on Maternal and Child Mortality, Malnutrition and Impaired Development”. Health & Medicine, Business, Technology Published on Apr 08, 2013.
  20. Tagbo BN. “Routine immunization in the change era: Targeting measles and other vaccine preventable diseases”. 2015 Theme lecture delivered at Nigerian Medical Association Physicians’ week opening ceremony, December 7 2015.
Copyright: © 2016 Beckie N. TAGBO. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events

June Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the June issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before July 12, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.