A Systematic Review on Antimicrobial Resistance in Ghana from a One Health Perspective

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Studying the interconnection among humans, animals, and the environment is crucial to preventing zoonotic disease outbreaks and maintaining ecosystem health, which impacts disease transmission and promotes a holistic approach to addressing health threats.

“Studying the interconnection among humans, animals, and the environment is crucial to preventing zoonotic disease outbreaks and maintaining ecosystem health, which impacts disease transmission and promotes a holistic approach to addressing health threats [14].”

• cites [14] Sharan, 2023, Surveillance and response strategies for zoonotic diseases: A comprehensive review, Sci. One Health sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

AMR limits the effectiveness of treatment options, leading to increased morbidity and treatment failure rates, longer hospital stays, elevated mortality rates, and higher healthcare costs.

“AMR limits the effectiveness of treatment options, leading to increased morbidity and treatment failure rates, longer hospital stays, elevated mortality rates, and higher healthcare costs [2].”

• cites [2] Salam, A., Al-Amin, Y., Salam, M.T., Pawar, J.S., Akhter, N., Rabaan, A.A., and Alqumber, M.A.A. (2023). Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare, 11. sourcePartly supported

  The Abstract (page unavailable) says microbes have acquired resistance to many drugs, supporting the claim that AMR limits treatment effectiveness. The available passages do not state that AMR increases morbidity, treatment failure, hospital stays, mortality, or healthcare costs; searches for those outcomes returned only references and other non-substantive text. (LLM, conf=0.72)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Ghana, a five-year National Action Plan on AMR was instituted in 2017, focusing on enhanced surveillance through a One Health approach.

“In Ghana, a five-year National Action Plan (NAP) on AMR was instituted in 2017, focusing on enhanced surveillance through a One Health approach [15].”

• cites [15] Koduah, 2021, Antimicrobial resistance national level dialogue and action in Ghana: Setting and sustaining the agenda and outcomes, One Health Outlook sourcePartly supported

  The Abstract (Result; page not provided) identifies a Ghanaian AMR national action plan for 2017–2021. The Results (Outcomes of sustained AMR agenda; page not provided) link the national policy to stronger surveillance, and the paper describes Ghana’s multisectoral One Health approach. But the Background explicitly says the policy and NAP were launched on 11 April 2018, not instituted in 2017. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Lower-middle-income countries are the most impacted by AMR.

“Although AMR affects countries across all regions and income levels, lower-middle-income countries are the most impacted [5].”

• cites [5] Pokharel, 2024, Tackling antimicrobial resistance in low-income and middle-income countries, BMJ Glob. Health sourcePartly supported

  The opening section says AMR affects all countries and that its burden is disproportionately higher in low-income and middle-income countries. It does not single out the narrower lower-middle-income group as the most impacted. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Most high-income countries have adopted guidelines for the rational use of antibiotics, but more efforts are needed in lower-middle-income countries.

“While most high-income countries have adopted guidelines for the rational use of antibiotics, more efforts are needed in lower-middle-income countries [9,10,11].”

• cites [9] Ahiabu, 2016, A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana, Health Policy Plan. sourcePartly supported

  The Conclusion (page unavailable) calls for interventions to promote rational antibiotic use in Ghana, supporting the need for more effort there. The Introduction (page unavailable) says Ghana has therapeutic guidelines, but the paper does not establish that most high-income countries have adopted such guidelines or extend its recommendation specifically to all lower-middle-income countries. (LLM, conf=0.88)

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• cites [10] Jimah, 2020, Antibiotics stewardship in Ghana: A cross-sectional study of public knowledge, attitudes, and practices among communities, One Health Outlook sourcePartly supported

  The Background (page unavailable) says Ghana has guidelines restricting excessive antibiotic dispensing, but poor enforcement has made them ineffective. The Conclusion (page unavailable) calls for sustained public education and further efforts in Ghana. The paper does not establish that most high-income countries have adopted rational-use guidelines, or extend its recommendation specifically to lower-middle-income countries as a group. (LLM, conf=0.84)

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• cites [11] Opoku, M.M., Bonful, H.A., and Koram, K.A. (2020). Antibiotic prescription for febrile outpatients: A health facility-based secondary data analysis for the Greater Accra region of Ghana. BMC Health Serv. Res., 20. sourcePartly supported

  The Background (page not provided) says Ghana has introduced treatment guidelines and an antimicrobial-use policy, but still needs targeted stewardship efforts to address inappropriate prescribing. It does not say that most high-income countries have adopted such guidelines, and its discussion of needed efforts concerns Ghana rather than lower-middle-income countries generally. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

In many sub-Saharan African countries such as Ghana, antimicrobial agents are easily obtained over the counter, facilitating their abuse.

“In many sub-Saharan African countries such as Ghana, antimicrobial agents are easily obtained over the counter, facilitating their abuse [7,8].”

• cites [7] Yevutsey, S.K., Buabeng, K.O., Aikins, M., Anto, B.P., Biritwum, R.B., Frimodt-Møller, N., and Gyansa-Lutterodt, M. (2017). Situational analysis of antibiotic use and resistance in Ghana: Policy and regulation. BMC Public Health, 17. sourceSupported
• cites [8] Duedu, K.O., Offei, G., Codjoe, F.S., and Donkor, E.S. (2017). Multidrug Resistant Enteric Bacterial Pathogens in a Psychiatric Hospital in Ghana: Implications for Control of Nosocomial Infections. Int. J. Microbiol., 2017. sourcePartly supported

  The Discussion (page unavailable) reports high rates of self-medication in Ghana and says long-used antibiotics contribute to the resistance observed. It does not say that antimicrobials are easily obtained over the counter or establish the claim for many sub-Saharan African countries. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

The One Health concept considers humans, animals, the environment, and the food chain as interconnected entities, owing to which resistance genes can be transferred from environmental bacteria to human pathogens.

“This concept considers humans, animals, the environment, and the food chain as interconnected entities, owing to which resistance genes can be transferred from environmental bacteria to human pathogens [13].”

• cites [13] Aslam, B., Khurshid, M., Arshad, M.I., Muzammil, S., Rasool, M., Yasmeen, N., Shah, T., Chaudhry, T.H., Rasool, M.H., and Shahid, A. (2021). Antibiotic Resistance: One Health One World Outlook. Front. Cell. Infect. Microbiol., 11. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The WHO Global Action Plan to address AMR emphasizes the application of the One Health approach.

“the WHO Global Action Plan to address AMR emphasizes the application of the “One Health” approach [12].”

• cites [12] Hailat, 2023, Strengthening the One Health Approach in the Eastern Mediterranean Region, Interact. J. Med. Res. sourcePartly supported

  The Roundtable Panel Discussion says a One Health approach is essential to tackling AMR, and the Conclusions identify WHO as part of the platform promoting One Health. Neither passage says that the WHO Global Action Plan to address AMR emphasizes that approach; searches for the plan found no such statement in our copy. (LLM, conf=0.78)

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May combine two claims.

Enterococcus showed high resistance prevalence of 100% to tetracycline and trimethoprim-sulfamethoxazole.

“Enterococcus showed high resistance prevalence of 100% to tetracycline [25,31], and trimethoprim-sulfamethoxazole [31].”

• cites [25] Krumkamp, R., Oppong, K., Hogan, B., Strauss, R., Frickmann, H., Wiafe-Akenten, C., Boahen, K.G., Rickerts, V., Smith, I.M., and Groß, U. (2020). Spectrum of antibiotic resistant bacteria and fungi isolated from chronically infected wounds in a rural district hospital in Ghana. PLoS ONE, 15. sourcePartly supported

  Table 2 (section labeled Conclusions; page unavailable) reports 12/12 (100%) tetracycline resistance in Enterococcus faecalis. Its trimethoprim-sulfamethoxazole (SXT) entry is internally inconsistent: it reads 12/12 (58%), so the stated 100% prevalence for that antibiotic is not unambiguously supported. (LLM, conf=0.87)

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• cites [31] Janssen, 2018, Antimicrobial-Resistant Bacteria in Infected Wounds, Ghana, 2014, Emerg. Infect. Dis. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In 2019, bacterial AMR directly caused 1.27 million deaths and contributed to 4.95 million deaths globally.

“In 2019, bacterial AMR directly caused 1.27 million deaths and contributed to 4.95 million deaths globally [3].”

• cites [3] Murray, 2022, Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis, Lancet sourceSupported

May combine two claims.

Campylobacter spp. had resistance prevalence of 44% to ciprofloxacin, 81% to tetracycline, 81% to ampicillin, 56% to trimethoprim-sulfamethoxazole, and 88% to chloramphenicol in another study.

“while another reported a resistance prevalence of 44% to ciprofloxacin, 81% to tetracycline, 81% to ampicillin, 56% to trimethoprim-sulfamethoxazole and 88% to chloramphenicol [52].”

• cites [52] Karikari, A.B., Obiri-Danso, K., Frimpong, E.H., and Krogfelt, K.A. (2017). Antibiotic Resistance of Campylobacter Recovered from Faeces and Carcasses of Healthy Livestock. BioMed Res. Int., 2017. sourcePartly supported

  Section 3.4 reports all five percentages, but specifically for Campylobacter isolates from cattle faeces. The citing sentence omits that restriction and could be read as giving prevalence across the study’s isolates. (LLM, conf=0.86)

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May combine two claims.

E. coli and K. pneumoniae can cause severe infections and have multiple resistance mechanisms, such as extended-spectrum beta-lactamase (ESBL) and carbapenemase production.

“MDR was commonly observed among members of the Enterobacteriaceae, including E. coli and K. pneumoniae, which can cause severe infections and have multiple resistance mechanisms, such as extended-spectrum beta-lactamase (ESBL) and carbapenemase production [28,66,67].”

• cites [28] Agyepong, 2018, Multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana, Antimicrob. Resist. Infect. Control. sourcePartly supported

  The Background identifies E. coli and K. pneumoniae as major causes of multidrug-resistant infections, and Results (Table 4) reports MDR in 89.9% and 94.7% of their isolates, respectively. The Discussion says cephalosporin resistance may suggest ESBL production among Gram-negative bacteria, but does not establish it for either species; it does not report carbapenemase production. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [66] Shaikh, 2015, Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment, Saudi J. Biol. Sci. sourcePartly supported

  The Introduction identifies E. coli and K. pneumoniae as multidrug-resistant pathogens, and Treatment describes serious infections caused by ESBL-producing strains of both. Epidemiology discusses the NDM-1 carbapenemase in Enterobacteriaceae, but does not specifically establish carbapenemase production in both named species. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [67] Alkofide, 2020, Multidrug-Resistant and Extensively Drug-Resistant Enterobacteriaceae: Prevalence, Treatments, and Outcomes—A Retrospective Cohort Study, Infect. Drug Resist. sourceSupported

May combine two claims.

In six human studies, E. coli exhibited MDR, with prevalence ranging from 41.5% to 99.6%.

“In six “human studies”, E. coli exhibited MDR, with the prevalence ranging from 41.5% to 99.6% [18,23,27,34,36,41].”

• cites [18] Inusah, 2021, Resistance Status of Bacteria from a Health Facility in Ghana: A Retrospective Study, J. Pathog. sourcePartly supported

  The Results report that E. coli was among the species with 100% multidrug resistance. The cited paper’s 99.6% figure is for all bacterial isolates, not E. coli specifically; it does not establish the 41.5%–99.6% range across six studies. (LLM, conf=0.88)

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• cites [23] Sah, 2022, Plasmid-mediated quinolone resistance determinants in clinical bacterial pathogens isolated from the Western Region of Ghana: A cross-sectional study, Pan Afr. Med. J. sourceCould not verify

  The Results report resistance to individual antibiotics among E. coli isolates, but do not give an E. coli multidrug-resistance (MDR) prevalence. Searches for MDR, 41.5%, and 99.6% found no passage establishing that this study contributes to the claimed range across six human studies. (LLM, conf=0.73)

  Experimental — accuracy not yet measured
• cites [27] Deku, 2021, Occurrence and distribution of extended-spectrum β-lactamase in clinical Escherichia coli isolates at Ho Teaching Hospital in Ghana, Ghana Med. J. sourcePartly supported

  The Results report 41.5% among clinical E. coli isolates, matching the lower endpoint of the cited range. But that figure is the prevalence of ESBL production, not a reported prevalence of multidrug resistance (MDR). This paper does not establish the 99.6% endpoint or the range across six studies. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [34] Asafo-Adjei, K., Mensah, J.E., Labi, A.-K., Dayie, N.T.K.D., and Donkor, E.S. (2018). Urinary Tract Infections among Bladder Outlet Obstruction Patients in Accra, Ghana: Aetiology, Antibiotic Resistance, and Risk Factors. Diseases, 6. sourceSupported
• cites [36] Karikari, A.B., Saba, C.K., and Yamik, D.Y. (2022). Reported Cases of Urinary Tract Infections and the Susceptibility of Uropathogens from Hospitals in Northern Ghana. Microbiol. Insights, 15. sourcePartly supported

  The Results section (Table 5) reports multidrug resistance in E. coli isolates from patients at two hospitals, supporting the claim that E. coli exhibited MDR in a human study. It reports 100% MDR at both hospitals, however, not a value within the cited 41.5%–99.6% range; this paper does not report findings from six human studies. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [41] Dwomoh, F.P., Kotey, F.C.N., Dayie, N.T.K.D., Osei, M.-M., Amoa-Owusu, F., Bannah, V., Alzahrani, F.M., Halawani, I.F., Alzahrani, K.J., and Egyir, B. (2022). Phenotypic and genotypic detection of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in Accra, Ghana. PLoS ONE, 17. sourcePartly supported

  The Methods (Study site, design, and sampling; page unavailable) describe a human clinical study that included MDR E. coli isolates, so this paper supports its inclusion as one of the cited studies. But the isolates were selected for being MDR, and the Results’ 69.4% is the proportion of selected MDR isolates that were E. coli—not the prevalence of MDR among E. coli. This paper does not establish the stated 41.5%–99.6% prevalence range. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

MDR prevalence was 17.6% for Shigella spp., 78.4% for Vibrio cholerae, 88% for K. pneumoniae, 89.5% for P. aeruginosa, and 100% for A. baumannii.

“MDR prevalence of 17.6%, 78.4%, 88%, 89.5% and 100% were reported for Shigella spp. [17], Vibrio cholerae [26], K. pneumoniae [35], P. aeruginosa [28], and A. baumannii [30], respectively.”

• cites [17] Afum, T., Asandem, D.A., Asare, P., Asante-Poku, A., Mensah, G.I., Musah, A.B., Opare, D., Taniguchi, K., Guinko, N.M., and Aphour, T. (2022). Diarrhea-Causing Bacteria and Their Antibiotic Resistance Patterns among Diarrhea Patients from Ghana. Front. Microbiol., 13. sourceSupported
• cites [26] Abana, D., Gyamfi, E., Dogbe, M., Opoku, G., Opare, D., Boateng, G., and Mosi, L. (2019). Investigating the virulence genes and antibiotic susceptibility patterns of Vibrio cholerae O1 in environmental and clinical isolates in Accra, Ghana. BMC Infect. Dis., 19. sourcePartly supported

  The Discussion reports the emergence of multidrug-resistant V. cholerae strains, and the Results describe resistance among the clinical and environmental isolates. Neither section reports the 78.4% MDR prevalence attributed to this paper. The other species and percentages in the citing sentence have separate citations and are not assessed here. (LLM, conf=0.80)

  Experimental — accuracy not yet measured
• cites [35] Donkor, E.S., Muhsen, K., Johnson, S.A.M., Kotey, F.C.N., Dayie, N.T.K.D., Tetteh-Quarcoo, P.B., Tette, E.M.A., Osei, M.-M., Egyir, B., and Nii-Trebi, N.I. (2023). Multicenter Surveillance of Antimicrobial Resistance among Gram-Negative Bacteria Isolated from Bloodstream Infections in Ghana. Antibiotics, 12. sourcePartly supported

  The Results (§2.3) report 88.0% multidrug resistance among all Gram-negative blood isolates and say that K. pneumoniae had a similar resistance pattern. They do not report 88% MDR prevalence specifically for K. pneumoniae, the only figure attributed to this source in the citing sentence. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

E. coli is a common colonizer of the gastrointestinal tract in humans and animals.

“E. coli, a common colonizer of the gastrointestinal tract in humans and animals [68,69], was the most studied bacterial species, followed by species of Klebsiella, Pseudomonas, and Salmonella.”

• cites [68] Loayza, F., Graham, J.P., and Trueba, G. (2020). Factors Obscuring the Role of E. coli from Domestic Animals in the Global Antimicrobial Resistance Crisis: An Evidence-Based Review. Int. J. Environ. Res. Public Health, 17. sourceSupported
• cites [69] Ramos, S., Silva, V., Dapkevicius, M.d.L.E., Caniça, M., Tejedor-Junco, M.T., Igrejas, G., and Poeta, P. (2020). Escherichia coli as Commensal and Pathogenic Bacteria among Food-Producing Animals: Health Implications of Extended Spectrum β-Lactamase (ESBL) Production. Animals, 10. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Klebsiella pneumoniae is naturally present in the respiratory and gastrointestinal tracts of humans and has a lower occurrence in animals, possibly due to diet, competition with other bacteria, or genetic virulence factors.

“Klebsiella pneumoniae is naturally present in the respiratory and gastrointestinal tracts of humans and has a lower occurrence in animals, possibly due to diet, competition with other bacteria, or genetic virulence factors [70,71,72].”

• cites [70] Khan, I., Bai, Y., Zha, L., Ullah, N., Ullah, H., Shah, S.R.H., Sun, H., and Zhang, C. (2021). Mechanism of the Gut Microbiota Colonization Resistance and Enteric Pathogen Infection. Front. Cell. Infect. Microbiol., 11. sourcePartly supported

  The Nutrient Competition section (page unavailable) identifies Klebsiella pneumoniae as a pathogen with a mechanism that gives it a growth advantage over gut commensals. The paper also discusses diet and microbial competition generally, but it does not establish that K. pneumoniae naturally inhabits both human respiratory and gastrointestinal tracts, occurs less often in animals, or that the proposed factors explain such a difference. (LLM, conf=0.78)

  Experimental — accuracy not yet measured
• cites [71] Wareth, 2021, The Animal-foods-environment interface of Klebsiella pneumoniae in Germany: An observational study on pathogenicity, resistance development and the current situation, Vet. Res. sourcePartly supported

  The Introduction (page unavailable) says K. pneumoniae has been found in the digestive and respiratory tracts of humans. It does not establish that occurrence is lower in animals or attribute any difference to diet, bacterial competition, or genetic virulence factors. The Discussion (page unavailable) says prevalence in animals has not been significantly investigated. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [72] Young, 2020, Animal Model To Study Klebsiella pneumoniae Gastrointestinal Colonization and Host-to-Host Transmission, Infect. Immun. sourcePartly supported

  The Introduction (page not provided) identifies the oropharynx and gastrointestinal tract as natural sites of colonization, and the Discussion reports gastrointestinal colonization in mice. The paper does not compare occurrence in humans and animals or attribute a lower occurrence in animals to diet, bacterial competition, or genetic virulence factors; it discusses microbiota and genetic variation in relation to colonization, not that comparison. (LLM, conf=0.86)

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Probably not a substantial claim: may not pass S3 (load-bearing).

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure a systematic and transparent approach to our literature search and review.

“We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [85] to ensure a systematic and transparent approach to our literature search and review.”

• cites [85] Page, 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews, BMJ sourcePartly supported

  The Abstract identifies PRISMA 2020 as a guideline for transparently reporting systematic reviews, including how studies were identified and selected. The Scope of the guideline section says it is not intended to guide review conduct, so it does not establish that following PRISMA ensured a systematic approach to the citing authors’ search and review. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

MDR bacteria can be transmitted from animals to humans through direct contact or the consumption of contaminated food products.

“MDR bacteria can be transmitted from animals to humans through direct contact or the consumption of contaminated food products [75].”

• cites [75] Pokharel, 2020, Antimicrobial use in food animals and human health: Time to implement ‘One Health’ approach, Antimicrob. Resist. Infect. Control sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The involvement of MDR organisms in meat contamination could exacerbate the already severe problem of AMR, which is projected to cause 10 million deaths annually, amidst other adverse impacts.

“The involvement of MDR organisms in meat contamination could exacerbate the already severe problem of AMR, which is projected to cause 10 million deaths annually, amidst other adverse impacts [81].”

• cites [81] Taneja, 2019, Antimicrobial resistance in the environment: The Indian scenario, Indian J. Med. Res. sourcePartly supported

  The Introduction projects 10 million AMR deaths by 2050 and describes economic and livestock impacts, but it does not explicitly say the projected 10 million deaths are annual. The sections on reported AMR and its drivers describe resistant organisms in broilers and antibiotic residues in chicken meat, supporting the concern about food animals without specifically establishing MDR-organism contamination of meat. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Cochrane risk-of-bias tool (ROB2) was used to assess the risk of bias in each study, and the results were visualized using the Robvis tool.

“The Cochrane risk-of-bias tool (ROB2) [87] was used to assess the risk of bias in each study, and the results were visualized using the Robvis tool [88].”

• cites [87] Sterne, 2019, RoB 2: A revised tool for assessing risk of bias in randomised trials, BMJ sourceSupported
• cites [88] McGuinness, 2021, Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments, Res. Synth. Methods sourceSupported

May combine two claims.

Pseudomonas spp. typically take advantage of weakened immune systems and cause infections that can be acquired in hospitals or the community, affecting both humans and animals.

“Pseudomonas spp., on the other hand, typically take advantage of weakened immune systems and causes infections that can be acquired in hospitals or the community, affecting both humans and animals [73].”

• cites [73] Verdial, C., Serrano, I., Tavares, L., Gil, S., and Oliveira, M. (2023). Mechanisms of Antibiotic and Biocide Resistance That Contribute to Pseudomonas aeruginosa Persistence in the Hospital Environment. Biomedicines, 11. sourcePartly supported

  The Abstract describes P. aeruginosa as an opportunistic pathogen causing hospital- and community-acquired infections in human and veterinary medicine. The Introduction also associates it with illness especially in immunocompromised individuals. The source discusses P. aeruginosa specifically, so it does not establish the claim for Pseudomonas species generally. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Salmonella spp. are foodborne pathogens that cause gastroenteritis and other serious illnesses in humans and animals.

“Salmonella spp. are foodborne pathogens that cause gastroenteritis and other serious illnesses in humans and animals [74].”

• cites [74] Ehuwa, O., Jaiswal, A.K., and Jaiswal, S. (2021). Salmonella, Food Safety and Food Handling Practices. Foods, 10. sourcePartly supported

  Section 2.2, Epidemiology and Pathogenicity, describes salmonellosis as gastroenteritis and reports serious complications, including potentially fatal septicemia or meningitis. Section 2.1, Occurrence of Salmonella, identifies infected animals and notes intermittent fevers in birds, but the copy does not establish that Salmonella causes gastroenteritis or other serious illnesses in animals. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Overall, the Greater Accra Region was the most frequent sampling location (35.4%, n = 17).

“Overall, the Greater Accra Region was the most frequent sampling location (35.4%, n = 17), followed by the Ashanti (18.6%, n = 9), Northern (13%, n = 6), Upper East (2%, n = 1), Volta (4%, n = 2), Western (4%, n = 2), and Central (4%, n = 2) Regions.”

May combine two claims.

Acinetobacter spp. resistance prevalence ranged from 35% to 67% for ciprofloxacin, tetracycline, gentamicin, and trimethoprim-sulfamethoxazole, while resistance to ampicillin and ceftriaxone was >80%.

“For instance, the prevalence of resistance in Acinetobacter spp. ranged from 35% to 67% for ciprofloxacin, tetracycline, gentamicin, and trimethoprim-sulfamethoxazole, while the prevalence of resistance to ampicillin and ceftriaxone was >80%.”

May combine two claims.

The most abundant human specimen was urine (46%, n = 13), followed by blood (43%, n = 12), wound swabs (36%, n = 10).

“For samples reported from “human studies”, the most abundant was urine (46%, n = 13), followed by blood (43%, n = 12), wound swabs (36%, n = 10), high vaginal swabs (21%, n = 6), ear swabs (18%, n = 5), urethral swabs (14%, n = 4), stool (14%, n = 4), sputum (11%, n = 3), aspirates (11%, n = 3), nasopharyngeal swabs (11%, n = 3), semen (7%, n = 2), cerebrospinal fluid (7%, n = 2), fecal sludge (4%”

Probably not a substantial claim: may not pass S3 (load-bearing).

The initial search of the online databases identified a total of 1789 publications.

“The initial search of the online databases identified a total of 1789 publications.”

May combine two claims.

The 48 included articles comprised 28 studies on humans, 14 studies on animals, and six studies on the environment.

“These 48 articles included 28 studies on humans, 14 studies on animals, and six studies on the environment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most studies (71.4%, n = 20) adopted CLSI and EUCAST (17.9%, n = 5) guidelines.

“Additionally, most studies (71.4%, n = 20) adopted the CLSI and EUCAST (17.9%, n = 5) guidelines (Table S3).”

May combine two claims.

E. coli was the most commonly reported organism for each of the three sectors: 19 human studies, eight animal studies, and five environmental studies.

“E. coli was the most commonly reported organism for each of the three sectors: 19 “human studies”, eight “animal studies”, and five “environmental studies”.”

Probably not a substantial claim: may not pass S3 (load-bearing).

68 full-text articles were assessed for eligibility.

“Subsequently, 68 full-text articles were assessed for eligibility, of which 48 [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63] met the inclusion criteria (Figure 1).”

May combine two claims.

The identification methods included culture-based techniques (92.9%, n = 26), standard biochemical tests (78.6%, n = 22), PCR (10.7%, n = 3), and MALDI-TOF assays (25%, n = 7).

“The identification methods utilized in these studies included culture-based techniques (92.9%, n = 26), standard biochemical tests (78.6%, n = 22), PCR (10.7%, n = 3), and MALDI-TOF assays (25%, n = 7).”

Probably not a substantial claim: may not pass S3 (load-bearing).

1460 articles were excluded because they did not meet the inclusion criteria.

“From these records, 1460 articles were excluded because they did not meet the inclusion criteria.”

Probably not a substantial claim: may not pass S3 (load-bearing).

After removing duplicates and inaccessible records, the titles and abstracts of 1528 records were screened.

“After removing duplicates and inaccessible records, the titles and abstracts of the remaining 1528 records were screened.”

Probably not a substantial claim: may not pass S3 (load-bearing).

18 studies (37.5%) did not specify the design used.

“However, 18 studies (37.5%) did not specify the design used.”

May combine two claims.

Forty-eight different bacterial agents were isolated across the human, animal, and environmental sectors, with approximately one-third belonging to the Enterobacteriaceae family.

“Forty-eight different bacterial agents were isolated across the “human”, “animal” and “environmental” sectors, with approximately one-third belonging to the Enterobacteriaceae family (Figure 2).”

May combine two claims.

E. coli was the most studied bacterial species, followed by species of Klebsiella, Pseudomonas, and Salmonella.

“E. coli, a common colonizer of the gastrointestinal tract in humans and animals [68,69], was the most studied bacterial species, followed by species of Klebsiella, Pseudomonas, and Salmonella.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In 2019, Ghana had 5900 attributable deaths and an additional 25,300 associated deaths related to AMR.

“In 2019, Ghana faced significant challenges related to AMR, with 5900 attributable deaths and an additional 25,300 associated deaths [6].”

• cites [6] (2024, July 11). Antimicrobial Resistance (AMR). Available online: https://www.healthdata.org/research-analysis/health-risks-issues/antimicrobial-resistance-amr.Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The economic costs of AMR are estimated to reach USD 1 trillion additional healthcare costs by 2050, along with significant GDP losses.

“The economic costs of AMR are substantial, estimated to reach USD 1 trillion additional healthcare costs by 2050, along with significant GDP losses [4].”

• cites [4] (2024, June 06). Antimicrobial Resistance. Available online: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Ghana ranked 36th globally in age-standardized mortality rates associated with AMR per 100,000 population.

“The country also ranked 36th globally in terms of age-standardized mortality rates associated with AMR per 100,000 population [6].”

• cites [6] (2024, July 11). Antimicrobial Resistance (AMR). Available online: https://www.healthdata.org/research-analysis/health-risks-issues/antimicrobial-resistance-amr.Not checked yet

  Not checked in the free run.

May combine two claims.

The overall low risk of bias across all evaluated domains indicates that the studies are methodologically sound and robust.

“The overall low risk of bias across all evaluated domains indicates that the studies are methodologically sound and robust.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The fewer studies in the Central, Volta, Western, Upper East, and Eastern Regions could be due to inadequate research infrastructure and funding.

“It is essential to note that the Central, Volta, Western, Upper East, and Eastern Regions had fewer studies conducted across all sectors, which could be due to various factors, such as inadequate research infrastructure and funding.”

May combine two claims.

AMR is a major concern across multiple bacterial species in Ghana, with significant levels of resistance in bacteria commonly associated with human infections, such as E. coli, Klebsiella spp., S. aureus, and Salmonella spp.

“The results indicate that AMR is a major concern across multiple bacterial species in Ghana; there are significant levels of resistance in bacteria commonly associated with human infections, such as E. coli, Klebsiella spp., S. aureus, and Salmonella spp.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The greater amount of animal research than clinical research in the Ashanti Region may be due to the high prevalence of agricultural activities in the region.

“Interestingly, the Ashanti Region had more animal research than clinical research, which may be due to the high prevalence of agricultural activities in the region.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two independent reviewers performed the screening process with fixed inclusion criteria.

“Two independent reviewers performed the screening process with fixed inclusion criteria.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A recent study in Romania found that pigs, and to some extent cattle, serve as significant natural reservoirs for zoonotic MDR Campylobacter strains.

“Similarly, a recent study in Romania found that pigs, and to some extent cattle, serve as significant natural reservoirs for zoonotic MDR Campylobacter strains [80].”

• cites [80] Popa, S.A., Morar, A., Ban-Cucerzan, A., Tîrziu, E., Herman, V., Imre, M., Florea, T., Morar, D., Pătrînjan, R.-T., and Imre, K. (2024). First study in the frequency of isolation and phenotypic antimicrobial resistance profiles of pig and cattle origin Campylobacter strains in Romania. Vet. Res. Commun., 1–7. Available online: https://link.springer.com/article/10.1007/s11259-024-10360-w. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Two authors worked independently using a data abstraction format prepared in Microsoft Excel 365 to extract data from the studies.

“Two authors worked independently using a data abstraction format prepared in Microsoft Excel 365 to extract data from the studies.”

May combine two claims.

The diverse range of bacterial contaminants found reflects the various infections that consumers may be exposed to, particularly if the meat is not cooked thoroughly before consumption, leading to foodborne illnesses and the transmission of zoonotic diseases.

“The diverse range of bacterial contaminants found reflects the various infections that consumers may be exposed to, particularly if the meat is not cooked thoroughly before consumption, leading to foodborne illnesses and the transmission of zoonotic diseases.”

Probably not a substantial claim: may not pass S2 (checkable).

Given the ability of these pathogens to infect multiple host types, it is crucial to adopt a One Health approach that recognizes the interdependence of human, animal, and environmental health in addressing antibiotic resistance.

“Given the ability of these pathogens to infect multiple host types, it is crucial to adopt a One Health approach that recognizes the interdependence of human, animal, and environmental health in addressing antibiotic resistance.”