Frontline healthcare workers' experiences of providing care during the COVID-19 pandemic at a COVID-19 centre in Bulawayo, Zimbabwe: A phenomenological study

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching, negative impact on healthcare systems worldwide. Healthcare workers play a critical role in the country's healthcare delivery system, as they facilitate a continuum of care and containment of diseases such as the COVID-19 pandemic.Objectives: The aim of this study was to explore and describe the experiences of healthcare workers who provided care to COVID-19 patients at a central hospital in Zimbabwe.Method: The researchers used an interpretative phenomenological analysis design. In-depth interviews were conducted virtually with 10 frontline healthcare workers working at a COVID-19 centre in Zimbabwe. Data collection was guided by an interview guide. All audio-recorded interview data were transcribed verbatim into written text. Data analysis was conducted using an interpretative phenomenological analysis framework. An expert in qualitative research acted as an independent co-coder and conducted the open coding of each transcript. Results: Findings reveal inadequate preparation and training of healthcare providers before the commencement of duty, resources-related challenges and a lack of support as significant experiences of healthcare providers. Moreover, healthcare providers have been subjected to stigma and discrimination attached to COVID-19, resulting in psychological effects on frontline healthcare providers. Conclusion: The COVID-19 pandemic brings unique and challenging experiences for frontline healthcare workers, resulting in a physically and emotionally drained workforce. This study calls for comprehensive support in the form of counselling, reasonable work schedules, training and adequate provision of personal protective equipment.

Covid-19 pandemic: chronicle of responses and experiences of the infection prevention and control committee at a tertiary hospital in southwest Nigeria

Since the advent of 2019-Corona virus Disease (COVID-19) in Nigeria in February 2020, the number of confirmed cases has risen astronomically to over 61,307 cases within 8 months with more than 812 healthcare workers infected and some recorded deaths within their ranks. Infection prevention and control is a key component in ensuring safety of healthcare workers in the hospital as healthcare- associated infection is one of the most common complications of healthcare management. Unbridled transmission of infection can lead to shortage of healthcare personnel, reduced system efficiency, increased morbidity and mortality among patients and in some instances, total collapse of healthcare delivery services. The Infection Prevention and Control Committee is a recognised group by the Centre for Disease Control and Prevention with their core programmes including drawing up activities, procedures and policies designed to achieve above-stated objectives before, during and after any disease outbreak, especially emerging and re-emerging ones such as the 2019 Coronavirus Disease. In this report, we highlight the roles played by the Infection Prevention and Control Committee of the University of Medical Sciences Teaching Hospital to prevent the spread of COVID-19 within and outside the hospital community and the lessons learned to date

Ebola virus disease preparedness in countries bordering Democratic Republic of Congo: lessons from west African outbreak: Ebola virus disease preparedness

Background: Ebola virus disease ravaged three West African countries in the wake of 2014 which was seen as the deadliest Ebola Virus Disease (EVD) outbreak in history. Several lessons were taken out of the West African outbreak one of which is the lack of preparedness by countries in the region.Materials and Methods: This paper looked at the mistakes of the West African outbreak and reports how such mistakes were corrected in the current outbreak going on in the Democratic Republic of Congo (DRC). Preparedness efforts are currently taking place in countries bordering DRC which included quick detection and response to an eventual EVD event.Results: This paid off on several occasions when cases from DRC to Uganda were quickly detected and response was as quick as possible. Preparedness carried out in Countries bordering DRC included setting up of Rapid Response Team (RRT) and training of these teams both at country and regional level. All members of the RRT were trained in all areas of readiness which included community engagement, laboratory, logistics, surveillance, case management, sample collection, packaging and shipment as well as Infection Prevention and Control (IPC).Conclusion: These trainings have led to readiness to an eventual EVD event. Countries now have the ability to respond quickly with better Emergency Operation Centre (EOC) for EVD

Infection control recommendations for radiology departments in Malawi

Background: Guidelines for radiographers contain recommendations related to standard infection control precautions for healthcare-associated infections (HAIs) which are a major cause of mortality and morbidity in hospital settings. However, the implementation of these recommendations has proven to be a challenge in the Malawian radiology departments, as there are no national guidelines or radiology policies for infection control.Aim: This article outlines the development of infection control recommendations that could facilitate sound knowledge and practices of radiographers regarding infection control.Setting: Radiology departments in hospitals in Malawi.Methods: The recommendations were developed based on data from a questionnaire that measured the knowledge and practices of 62 radiographers regarding infection control as well as data from the literature. The Florence Nightingale environmental theory was used as the conceptual framework for the recommendations, while its development was based on steps of the National Institute for Health and Care Excellence. For the format of the draft recommendations, an adapted version of the Appraisal of Guidelines for Research and Evaluation II tool was used.Results: Issues identified from the responses to the questionnaire and literature resulted in seven sets of recommendations: hand hygiene, personal hygiene, personal protective gear and the use of appropriate equipment, safe handling of sharps and sharp containers, decontamination and cleaning, housekeeping and routine infection control practices.Conclusions: The recommendations can be further reviewed and implemented to improve the implementation of infection control and to reduce HAIs in resource-constrained settings

The strengths, weaknesses, opportunities, and threats (swots) analyses of the Ebola virus

Background: Owing to the extreme virulence and case fatality rate of ebola virus disease (EVD); there had been so much furore; panic and public health emergency about the possible pandemic from the recent West African outbreak of the disease; with attendant handful research; both in the past and most recently. The magnitude of the epidemic of ebola virus disease has prompted global interest and urgency in the discovery of measures to mitigate the impact of the disease. Researchers in the academia and the industry were pressured to only focus on the development of effective and safe ebola virus vaccines; without consideration of the other aspects to this virus; which may influence the success or otherwise of a potential vaccine. The objective of this review was to adopt the SWOT concept to elucidate the biological Strengths;Weaknesses; Opportunities; and Threats to Ebola virus as a pathogen; with a view to understanding and devising holistic strategies at combating and overcoming the scourge of EVD.Method: This systematic review and narrative synthesis utilized Medline; PubMed; Google and other databases to select about 150 publications on ebola and ebola virus disease using text word searches to generate the specific terms. Relevant publications were reviewed and compared; findings were synthesized using a narrative method and summarized qualitatively.Results: Some of the identified strengths of ebola virus include: Ebola virus is an RNA virus with inherent capability to mutate; reassort and recombine to generate mutant or reassortant virulent strains; Ebola virus has a broad cellular tropism; Natural Reservoir of ebola virus is unconfirmed but fruit bats; arthropods; and plants are hypothesized; Ebola virus primarily targets and selectively destroys the immune system; Ebola viruses possess accessory proteins that inhibits the host' immune responses; Secreted glycoprotein (sGP); a truncated soluble protein that triggers immune activation and increased vascular permeability is uniquely associated with Ebola virus only; Ability to effectively cross the species barrier and establish productive infection in humans; non human primates; and other mammals; Ebola virus attacks every part of the human body; The Weaknesses include: Ebola virus transmission and persistence is severely limited by its virulence; Ebola virus essentially requires host encoded protein Niemann-Pick C1 (NPC1) for host's cell' entry; Ebola virus essentially requires host encoded proteins (TIM-1) for cell' entry; Relative abundance of Ebolavirus Nucleoprotein than the other virion components; The Opportunities harnessed by ebola virus include: Lack of infection control practices in African health-care facilities and paucity of health infrastructures; especially in the endemic zones; Permissiveness of circulating Monocytes; Macrophages and dendritic cells in virus mobilization and dissemination; Collection; consumption and trade of wild games (bushmeats); Pertubation and drastic changes in forest ecosystems present opportunities for Ebola virus; Use of dogs in hunting predisposes man and animals to inter-species contact; Poverty; malnutrition; crowding; social disorder; mobility and political instability; Ease of travel and aviation as potentials for global spread; Possible mechanical transmission by arthropod vectors; No vaccines or therapeutics are yet approved for human treatment; The Threats to ebola virus include: Avoidance of direct contact with infected blood and other bodily fluids of infected patient; Appropriate and correct burial practices; Adoption of barrier Nursing; Improved surveillance to prevent potential spread of epidemic; Making Available Rapid laboratory equipment and procedures for prompt detection (ELISA; Western Blot; PCR); Sterilization or disinfection of equipment and safe disposal of instrument; Prompt hospitalization; isolation and quarantine of infected individual; Active contact tracing and monitoring; among others.Conclusion: The identified capacities and gaps presented in this study are inexhaustive framework to combat the ebola virus. To undermine and overcome the virus; focus should be aimed at strategically decreasing the identified strengths and opportunities; while increasing on the weaknesses of; and threats to the virus

Active Surveillance of Hospital-Acquired Infections in South Africa: Implementation; Impact and Challenges

BACKGROUND:Hospital-acquired infections (HAIs) are a significant although unquantified burden in South Africa. Lack of adequate surveillance compounds this problem.OBJECTIVE:To report on the establishment and outcomes of a unit-specific surveillance system for hospital-acquired infections; based on international standards; in a private academic hospital. METHODS: Active unit-specific surveillance of device-associated infections (DAIs) was introduced over a 2-year period. The surveillance system was based on the US National Healthcare Safety Network (NHSN) utilising standardised definitions. Analysis of DAI rates and device utilisation was done according to Centers for Disease Control and Prevention methods. Comparative analysis using study-derived annualised data and existing NHSN data was done.RESULTS:Surveillance results of DAI rates showed significant reductions in intensive care unit-related ventilator-associated pneumonia (42%) and central line-associated bloodstream infections (100%) over a 3-year period. Substantial variations in DAI rates and utilisation ratios between wards highlight the importance of unit-specific surveillance.CONCLUSIONS:Active surveillance requires a significant investment in resources and is a sustained operational challenge; although equally significant benefits are derived from a better understanding of HAIs with more targeted interventions and efficient use of resources. A robust surveillance system is an essential component of any healthcare infection prevention and control programme and is a prerequisite to contextualising the HAI burden of hospitals

Oral Health Care Habits and its Role in Preventing Adverse Prenancy Outucomes in Rwanda

More than 20 million infants in the world (15.5 of all births) are born preterm with low birth weight (PLBW). Ninety-five of them are in developing countries and the rate of PLBW in developing countries is more than double (16.5) that in developed countries. It has been suggested that oral infection can act as the site of origin for dissemination of periodontopathogens and their toxins as well as induce inflammatory mechanisms to distant body sites; thus linking periodontal diseases to pre-term delivery of low birth weight (PLBW) infants. The objective of this study was to assess the general oral health care habit of pregnant mothers in order to determine its association with premature delivering of low birth weight infants.Methods: Study participants were asked to complete a questionnaire to obtain information regarding their oral health care habits and the responses linked to their gestation term and time of delivery. In addition; their mouths were examined for gingival inflammation and / or bleeding which might be attributed to lack of oral health care. Results and conclusion: Although in this study oral health care habits of the mothers did not appear to directly influence the gestation period and birth weight of the infants; the resulting gingival inflammation and bleeding showed a significant correlation with PLBW (p = 0.004). Therefore maternal dental care during pregnancy and good oral hygiene habits could be highly recommended. Also more detailed examination and assessment of the oral health status of mothers with particular emphasis on periodontal disease and its association with adverse pregnancy outcomes are needed

Exposure to Blood among Mortuary Workers in Teaching Hospitals in South-West Nigeria

Background: Mortuary workers like other health workers are exposed to blood borne pathogens at work. A baseline assessment is important to plan for programmes to safeguard the health of workers. The aim of this study is to determine exposure rates to blood among mortuary workers in teaching hospitals in South West Nigeria. Methods: A descriptive cross sectional study was carried out between March and May 2008. All mortuary workers working in six (6) teaching hospitals; 80 in total were included in the study. Data was collected with the aid of a 15- item self administered questionnaire. Data was analysed with the aid of EPI-INFO 2002. Statistical associations were explored using odds ratio and confidence intervals. Results: A total of 76 respondents completed questionnaire giving a response rate of 95; 3 males and 1 female declined to participate; the mean age of respondents was 38.2 years; 48(72.6); 53(85.5) and 50(73.5) of the workers had been exposed to blood through cuts; blood splash and needle stick injury. Duration at work was significantly associated with blood splash. Workers who had worked 5years and above were 0.10 times (95confidence interval 0.00-.0.78) as likely to experience blood splash compared to those who had worked under 5 years. Only 5(10.4) of workers with needle stick injury had completed three doses of Hepatitis B vaccine. The specific confirmation by antibody titre was however not done in this study. Conclusion: Exposure to blood was very common with blood splash emerging as the most common route of exposure. There is a need for vaccination of all mortuary workers with three doses of Hepatitis B Vaccine to protect their health. In addition; education of workers on risks and institution of standard operating procedure are crucial to safeguard the health of mortuary workers

Evidence of long term benefit of morbidity reduction due to praziquantel treatment against schistosoma mansoni in Kigungu fishing village in Entebbe, Uganda

Praziquantel (PZQ) is efficacious against Schistosoma mansoni. This was prospective cohort study. This study was carried out at Kigungu fishing village, Entebbe, Uganda. The goal of the study was to establish cost effective regiment for mass drug administration (MDA) of Praziquentel in the morbidity reduction of S.mansoni infection. In January 2004, nine hundred and forty five (945) participants were registered in this study. Our analysis was based on examining microscopically three slides prepared from each of 945 stool specimens delivered by each of the participant using modified Kato/Katz method. These included male and female, children and adults living in Kigungu fishing village in Entebbe Uganda. In total 901, cohorts were re-examined for infections clearance six months later in July 2004 and 18 months later in June 2005, 625 cohorts were again re-evaluated for S.mansoni infections after the baseline study. At baseline, (448) of 945 (47.5%) cohorts were S. mansoni positive. All these participants were treatment with a single oral dose of praziquantel at 40mg/kg. At the same time, 495 (52.5%) were S. mansoni negative. Of the 625 (66.3%) cohorts who came back for final review, 80 (12.8%) were still positive for S. mansoni while 210 (33.6%) remained negative after the base line treatment with praziquantel. On the other hand 103 (16.3%) of cohorts who were initially negative at the base line became S.mansoni positive after 18 months and 213(34.1%) remained negative for S.mansoni. The force of re-infection after six months was significant {(P=0.0001),(OR 0.47) CI at 95% (0.31-0.71)}. Nevertheless the force of reinfection was not significant after 18 months {(P=0.766), (OR 0.95) CI at 95% (0.68-1.34)}.The geometric mean eggs excretion of the 80 cohorts who were S.mansoni positive at 18 months was 151.967.This did not reach the geometric mean egg excreted by the same cohorts at baseline which was 285.05. The egg excretion was reduced by 46.8%. Similarly there was marked decrease in clinical symptoms amongst the cohorts. Our study suggests evidence of long-term benefit of praziquantel in Kigungu and that a yearly administration of praziquantel to the community could be a regiment for mass drug administration (MAD) for this community to control schistosomiasis morbidity

Assessment of Existing Practices in the Operating Theatre in the Khartoum North Teaching Hospital; Sudan

This study; assessing existing practices in the operating theatre regarding hand washing; disinfection and sterilisation; was conducted at Khartoum North Teaching Hospital. As far as we know; this is the first study of its kind since the inauguration of the hospital in 1950. A total of 55 health personnel working in the operating theatre participated in the study. These included nurses and environmental service personnel (housekeepers and sterilisation and disinfection personnel). Knowledge and practice were evaluated using multiple choice and direct interview questions. Operation theatre sterilisation and disinfection practices were monitored using checklists modified from World Health Organization recommendations. A marked lack of knowledge and defective attitudes and practices were observed among a large number of personnel. It was observed that 51 of the nurses were 46 years of age or older and that two-thirds had only a primary and intermediate school level education. The study recommends the upgrading of the operating theatres and additional training and education of staff. Theatres should be provided with facilities for proper disinfection and waste disposal. Qualified nurses should be employed. We also recommend the establishment of an infection control committee. The role of the committee would include the planning and execution of hygiene policies. In addition; planning and organising training courses in infection control should be seen as a priority

Addressing HIV/AIDS Challenges in Uganda: does Social Capital Generation by NGOs Matter?

HIV/AIDS has had devastating impacts in many countries; Uganda in particular. However; Uganda is depicted as one of the most successful countries in fighting HIV/AIDS. Among others; Uganda's success story is attributed to the open general environment which allows open discussions surrounding HIV/AIDS when other countries such as South Africa and Kenya denied the existence of the disease in their countries. In addition; the success is attributed to the policy which allowed many actors to participate in the fight against the disease. The primary focus of this article is to map the process of social capital generation by NGOs and how social capital benefits enhance mitigation of HIV/AIDS challenges in Uganda. The key to social capital is nurturing relationships. In this regard; HIV/AIDS NGOs play a central role in the way individuals; groups and communities interact; and how various kinds of social relations are forged with people living with HIV/AIDS and especially for those who are HIV infected. NGOs' success in reducing the number of HIV/AIDS cases in Uganda is based on their abilities to generate social capital. This involves inclusion and building social networks and empowerment at the individual and community levels; and disseminating information to reduce social stigma as well as discrimination. We used a mixed-method strategy to collect data for this study. We used a structured questionnaire having quantitative and qualitative question sets which focused on different social capital measurement indicators. We used observations and in-depth face-to-face interviews. A major finding of the study is that the ways individuals and groups are connected and interact with each other are important mechanisms for alleviating HIV/AIDS challenges in Uganda

Changing Trends and the Impact of Alcohol on the HIV/AIDS Epidemic in South Africa: Review

The association between increased HIV infection and alcohol use has been extensively studied and is established. South Africa is among one of the sub-Saharan African countries with the highest prevalence and number of people living with HIV/AIDS in the world. Although recent evidence suggests that the epidemic has stabilised; infection rates remain unacceptably high. Alcohol use is on the increase; particularly in the groups most susceptible to HIV infection; namely women and young adults; and informs poor choices with respect to safer sexual practices. This paper reviews the association between alcohol and HIV. More specifically; however; it aims to explore the potential socio-politico-biological and cultural explanations as to the factors that intersect to drive these two epidemic diseases: alcoholism and HIV/AIDS in South Africa. Understanding some of the underlying factors will provide a framework to implement public health measures to curb HIV

Appraisal of the inherent socio-demographic dynamics of HIV/AIDS epidemic in four districts of South-Western Uganda

Although HIV prevalence in Uganda is much lower than it once was; AIDS is still claiming many lives each year with clear signs of escalating rural epidemics. The objective of this study was to appraise the socio-economic and demographic dynamics of HIV/AIDS epidemic in South-Western Uganda. Data were collected with standard closed ended semi-structured questionnaires self-administered to consenting; 605 HIV/AIDS patients; selected using the multistage random sampling technique; logistic linear regression; randomized block design and Pearson's Chi square test (a=0.01) were used to analyse the data obtained. The duration of carriage was inversely proportional (r=-0.94) to population of HIV/AIDS patients surveyed. There were 98.2 Bantu (55.5 Banyankole and 22.6 Baganda); 77.5 females and 22.5 males; more widows (38.0) than married (35.5). HIV/AIDS prevalence generally decreased with increasing level of education. The highest (66.7). HIV/AIDS prevalence generally decreased with increasing level of education. The highest (66.7) HIV/AIDS prevalence was recorded in Bushenyi; followed by 58.4 in Masaka; 57.9 in Mbarara and 53.3 in Rukungiri. Rukungiri patients above 60 years of age harboured 57.1 HIV/AIDS followed by 45.5 among Masaka patients aged 11 - 20 years and 40 among Mbarara patients less than 10 years of age. HIV/AIDS prevalence was significantly (p0.05) dependent on socio-economic and demographic factors of surveyed population. Therefore socio-economic and demographic factors underlie HIV/AIDS prevalence in this region. Observed differences in prevalence of HIV/AIDS between the surveyed districts wereremarkable and warrant regular surveillance for updated disease epidemiology. Education can debunk the generally misconstrued rolesof social; economic and demographic factors in the spread of HIV/AIDS

Hospital acquired infection in Obafemi Awolowo University Teaching Hospital, Ile-Ife, Southwest, Nigeria: a ten year review (2000-2009)

Surveillance and proper hygiene have been identified as key components in the fight against HAIs and antimicrobial resistance in hospital setting. This study assesses the pattern of hospital acquired infections (HAIs) and state of hygiene in a tertiary hospital in southwest; Nigeria. Data collected routinely between January 2000 and December 2009 by the infection control committee on HAI and primary data generated on hygiene in the wards were analysed using appropriate statistical techniques. A total of 37;957 patients were admitted during the period under review and 1129 cases (3.0) of HAI were reported. The highest prevalence of 9.0 was reported in 2006. The Intensive Care Unit (ICU) had the highest period prevalence of 14.7 followed by Orthopaedics ward (7.7). Surgical ward contributed the highest number of cases with 433. Gram negative organisms were the most implicated (78) of which Klebsiella species was 38 while Staphylococcus aureus was the only Gram positive organism identified (28). Hand washing was practised universally by health workers but facilities for proper hand washing were inadequate. The pattern of HAI has not changed significantly in the past 10 years and Klebsiella was the most implicated organism in HAIs and ICU. Facilities for proper hand washing are suboptimal. We recommend the introduction of hand washing policy for the hospital and the provision of an environment conducive for its implementation by the hospital management as well as adequate support for the infection control committee in the discharge of her duties

Percutaneous Injuries in Doctors in the School of Medicine; University of the Free State: Prevalence; Reporting and Adherence to Precautionary and Management Procedures

"Background: Despite the official precautionary measures against percutaneous injuries; incidents still occur. Consequently; it is possible that healthcare workers could contract infections like HBV; HCV; HGV (hepatitis B; C and G viruses) and HIV (human immune deficiency virus). The most serious problem lies in the fact that percutaneous injuries are often underestimated; resulting in non-reporting of the incident. The aim of this study was to determine the incidence of percutaneous injuries in doctors in the School of Medicine at the University of the Free State (UFS); whether the incidents were reported; and the reasons for non-reporting. The use of gloves during procedures was also evaluated. Methods: A mainly descriptive study design was used. Questionnaires were administered from October 2006 through January 2007 to collect information. Participants were selected randomly; and the respondents were divided into surgical and non-surgical groups. Results: The respondents fulfilled the following roles and/or functions in their respective departments of employment: 35 (67.3) were registrars; 12 (23.1) were specialists/consultants; four (7.7) were medical officers; and one (1.9) was exclusively involved in student training. Two of the respondents did not indicate their roles and functions in their respective departments. A total of 82 incidents of percutaneous injuries occurred. Although the surgical groups handled sharp objects more frequently per week than the non-surgical groups (p-value = 0.04); more incidents occurred in the non- surgical groups (p-value = 0.02). Only 39 (47.6) of the incidents were reported; while 44.4of the respondents were aware of the correct reporting procedures. The reasons given for the non-reporting of these incidents were ""too busy"" (58.1); ""did not think it was serious"" (48.8); and ""was not aware of the reporting procedures"" (7). Only 13.7of the respondents indicated that they always used gloves when drawing blood; 17.4used them when injections were administered; and 22.4used gloves during intravenous cannulation. However; 86.8of the respondents wore gloves when they used a scalpel or any other incision object. The respondents (n = 51) suggested that the three most important precautionary measures to take into consideration when working with sharp objects were (i) the use of gloves (23/51; 45.1); (ii) never recapping a needle (9/51; 17.6); and (iii) keeping the container for disposing of sharp objects close at hand (6/51; 11.8). Conclusions: Despite the risk of percutaneous injuries; non-reporting still occurs. Although the rate of reporting these incidents could be compared with international findings published in the literature; it remains too low. Drastic measures should be taken to ensure that physicians are informed of the hazards of percutaneous injuries; as well as of the appropriate mechanisms of reporting these incidents."

Life-threatening oro-facial infections

Four cases of oro-facial infection leading to life-threatening complications are reported. Although all had been treated with antibiotics prior to con-sultation; lack of surgical intervention had allowed the infection to progress. These cases are a re-minder that acute spreading odontogenic infection can be life-threatening. Definitive treatment in-cludes airway management; adequate resuscitation and optimization of pre-existing medical condi-tions prior to removal of the source of infection and drainage of pus. High dose intravenous antibi-otics should be administered; with the initial choice of antibiotics modified in the light of sub-sequent bacteriological reports. The treatment of all odontogenic infections must include removal of the focus of infection; and drainage of pus

Strategies for the Prevention and Containment of Antibiotic Resistance

Antibiotic resistance may emerge by antibiotic selection pressure but is perpetuated by diverse risk factors and maintained within environments as a result of poor infection control. Population-specific drug pharmacokinetics and pharmacodynamics also play a role. The WHO; US; UK and EU have initiated strategies for the containment of resistance; with surveillance and delineation of the cause(s) cited as essential. Surveillance of antibiotic efficacy should be disease-based; establishing sensitivity profiles of common causative organisms to inform the development of or amendment to standard treatment guidelines and essential drugs lists adopted within the national drug policy. The manner of antimicrobial use (overuse; underuse; inadequate dosing) associated with resistance should be established for appropriate intervention in terms of rational drug use; a reduction in use and dosing regimens based on population-specific pharmacokinetics and pharmacodynamics. Risk factors unique to South African communities (poverty; HIV) and hospitals (duration of hospitalisation; location within the hospital; intensive care unit stay; surgery; wounds; previous and current antimicrobial therapy; mechanical ventilation; urinary catherterisation; nasogastric intubation; central venous and peripheral catheters; previous hospitalisation and transfer from another unit or hospital) must be determined and due vigilance exercised in patients exhibiting classical risk factors for the acquisition of or colonisation with resistant pathogens. Hygiene and sanitation (in communities) and infection control (in hospitals) status must be determined and interventions initiated to prevent the spread of resistance. Pharmacokinetics and pharmacodynamics specific to diverse populations must be devised to optimise antimicrobial therapy. South Africa has unique needs in the antimicrobial resistance arena; needs to be addressed in the context of sev ere financial; human resources and technological challenges