Lessons from the field: Supporting infection prevention and control and antimicrobial stewardship in Amman, Jordan.

BACKGROUND: To reduce antimicrobial resistance (AMR), appropriate antimicrobial prescribing is critical. In conjunction with Infection Prevention & Control (IPC) programs, Antimicrobial Stewardship Programs (ASP) have been shown to improve prescribing practices and patient outcomes. Low- and middle-income countries (LMIC) face challenges related to inadequate ASP policies and guidelines at both the national and healthcare facility (HCF) levels. METHODS: To address this challenge, the World Health Organization (WHO) created a policy guidance and practical toolkit for implementation of ASPs in LMIC. We utilized this document to support a situational analysis and two-day ASP-focused workshop. In follow-up, we invited these attendees, additional HCF and hospital directors to attend a workshop focused on the benefits of supporting these programs. RESULTS: Over the course of a total three days, we recruited hospital directors, ASP team members, and IPC officers from fifteen different healthcare facilities in Jordan. We describe the courses and coordination, feedback from participants, and lessons learned for future implementation. CONCLUSIONS: Future efforts will include more time for panel-type discussion. which will assist in further delineating enablers and barriers. Also planned is a total three-day workshop; with the first two days being with ASP/IPC teams, and the final third day being with hospital directors and leadership. The WHO policy guidance and toolkit are useful tools to address overuse of antimicrobial agents. Strong leadership support is needed for successful implementation of ASP and IPC. Discussions on quality/safety, as well as cost analyses, are important to generate interest of stakeholders.

Risk as catalyst for positive change: lessons learnt from public health readiness for cholera in Jordan.

This case study highlights how a looming health crisis was leveraged as drivers for positive change for the health sector, in line with the health security agenda. In Jordan, several authorities are mandated by law to manage health emergencies. Following the declaration of outbreaks of cholera in Iraq, Lebanon and Syria, health authorities in Jordan called for a series of emergency meetings during September 2022 to discuss implications around travel and trade as well as shared waters. WHO was part of the consultations and provided guidance on the application of the International Health Regulations 2005. As the risk for cholera importation persisted, the Ministry of Health assumed its leadership role for the overall health sector response while the Jordanian Center for Disease Control assumed a coordinating function. Roles and responsibilities were enshrined in the National Cholera Preparedness and Response Plan. In consideration of the vulnerability of refugee camps and settlements towards Cholera, the existing Jordan humanitarian coordination platforms such as the Health Sector Working Group were used to share information and to coordinate activities. A whole-of-government risk assessment during December 2022 was complemented by a field visit at Zaatari refugee camp. This helped assess the risk and readiness for a cholera outbreak in Jordan and informed priority activities, such as the establishment of a national risk communication and community engagement working group as well as training on case management.

Implementation of one health approach in Jordan: Joint risk assessment of rabies and avian influenza utilizing the tripartite operational tool.

Background Health challenges at the human-animal-environment interface vary and include zoonotic and food-borne diseases as well as antimicrobial resistance. These are serious threats to animal and public health, and account for the majority of emerging and re-emerging conditions or infectious diseases. Reducing zoonotic disease threats requires an understanding of where and why risks exist. To support countries in building multi-sectoral mechanisms to jointly assess the risks at the human-animal-environment interface, a new operational tool is available to complement the existing tripartite guide to addressing zoonotic diseases in countries. The aim of this study is to conduct joint risk assessment (JRA) of rabies and avian influenza in Jordan utilizing the tripartite Joint Risk Assessment Operational Tool (JRA OT). Methods Representatives of sectors that are involved in zoonotic diseases outbreak investigation, control, surveillance and risk assessment, were trained on JRA OT. The operational tool of tripartite guide to addressing zoonotic diseases in countries that was developed by WHO (World Health Organization), FAO (Food and Agriculture Organization of the United Nations) and WOAH (World Organization for Animal Health) was utilized to conduct risk assessment for rabies and H5N1 avian influenza in Jordan. Results The risk assessment outcome for rabies were as follows: Likelihood is high; impact is moderate with moderate level of uncertainty. The impact of the disease is moderate because the virus transmitted only by animal bite in Jordan. The level of uncertainty is moderate due to existence of some gaps in data available from the ministries regarding the surveillance and collection areas of wild animals with feral dogs. The risk assessment outcome for H5N1 AI indicated a low likelihood estimate with moderate uncertainty level. The impact estimate for H5N1 AI in Jordan is moderate with a low level of uncertainty. Conclusions The tripartite JRA OT provides a helpful and easy to follow guide to bring together expertise and information from all relevant sectors to jointly assess risks from zoonotic diseases and contributes to the understanding and management of shared threats at the human-animal-environment interface.