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Genetic diversity and risk factors for the transmission of antimicrobial resistance across human, animals and environmental compartments in East Africa: a review.

Katale, Bugwesa Z; Misinzo, Gerald; Mshana, Stephen E; Chiyangi, Harriet; Campino, Susana; Clark, Taane G; Good, Liam; Rweyemamu, Mark M; Matee, Mecky I


Bugwesa Z Katale

Gerald Misinzo

Stephen E Mshana

Harriet Chiyangi

Susana Campino

Taane G Clark

Liam Good

Mark M Rweyemamu

Mecky I Matee



The emergence and spread of antimicrobial resistance (AMR) present a challenge to disease control in East Africa. Resistance to beta-lactams, which are by far the most used antibiotics worldwide and include the penicillins, cephalosporins, monobactams and carbapenems, is reducing options for effective control of both Gram-positive and Gram-negative bacteria. The World Health Organization, Food and Agricultural Organization and the World Organization for Animal Health have all advocated surveillance of AMR using an integrated One Health approach. Regional consortia also have strengthened collaboration to address the AMR problem through surveillance, training and research in a holistic and multisectoral approach. This review paper contains collective information on risk factors for transmission, clinical relevance and diversity of resistance genes relating to extended-spectrum beta-lactamase-producing (ESBL) and carbapenemase-producing Enterobacteriaceae, and Methicillin-resistant Staphylococcus aureus (MRSA) across the human, animal and environmental compartments in East Africa.


The review of the AMR literature (years 2001 to 2019) was performed using search engines such as PubMed, Scopus, Science Direct, Google and Web of Science. The search terms included 'antimicrobial resistance and human-animal-environment', 'antimicrobial resistance, risk factors, genetic diversity, and human-animal-environment' combined with respective countries of East Africa. In general, the risk factors identified were associated with the transmission of AMR. The marked genetic diversity due to multiple sequence types among drug-resistant bacteria and their replicon plasmid types sourced from the animal, human and environment were reported. The main ESBL, MRSA and carbapenem related genes/plasmids were the CTX-Ms (45.7%), SCCmec type III (27.3%) and IMP types (23.8%), respectively.


The high diversity of the AMR genes suggests there may be multiple sources of resistance bacteria, or the possible exchange of strains or a flow of genes amongst different strains due to transfer by mobile genetic elements. Therefore, there should be harmonized One Health guidelines for the use of antibiotics, as well as regulations governing their importation and sale. Moreover, the trend of ESBLs, MRSA and carbapenem resistant (CAR) carriage rates is dynamic and are on rise over time period, posing a public health concern in East Africa. Collaborative surveillance of AMR in partnership with regional and external institutions using an integrated One Health approach is required for expert knowledge and technology transfer to facilitate information sharing for informed decision-making.


Katale, B. Z., Misinzo, G., Mshana, S. E., Chiyangi, H., Campino, S., Clark, T. G., …Matee, M. I. (2020). Genetic diversity and risk factors for the transmission of antimicrobial resistance across human, animals and environmental compartments in East Africa: a review. Antimicrobial Resistance and Infection Control, 9(1), 127

Journal Article Type Article
Acceptance Date Jul 21, 2020
Publication Date Aug 6, 2020
Deposit Date Aug 13, 2020
Publicly Available Date Aug 13, 2020
Journal Antimicrobial resistance and infection control
Print ISSN 2047-2994
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 9
Issue 1
Pages 127
Public URL


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