Field Impact of the SORT IT Initiative on Combating Antimicrobial Resistance Through a One Health Approach in Ghana

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: 30 September 2025 | Viewed by 1990

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1. College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar P.O. Box 1996, Ethiopia
2. Collaborative Research and Training Center for Neglected Tropical Diseases, Arba Minch University, Arba Minch P.O. Box 21, Ethiopia
Interests: neglected tropical diseases; antimicrobial resistance; clinical trials
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Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya
Interests: maternal health; HIV/AIDS; data science operational researh
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Guest Editor
Protect Humanitarians, 1000 Brussels, Belgium
Interests: protection; conflict; migration; water, sanitation and hygiene (WASH); infectious disease

Special Issue Information

Dear Colleagues,

The World Health Organization has identified Antimicrobial Resistance (AMR) as one of the top 10 threats to global public health. A key strategy in addressing AMR is strengthening the capacity of countries to conduct operational research, generating evidence that informs national responses and drives action on the ground.

The Structured Operational Research and Training InitiaTive (SORT IT), led by TDR and its partners, is an effective, output-driven model utilized to build such capacity. With a strong focus on sustainable national leadership and field-level results, SORT IT delivers real-world evidence of “value for money”—a crucial asset in an era of shrinking global health support.

This Special Issue features operational research studies that evaluate the real-world impact of earlier SORT IT research—essentially, “operational research on operational research”. These studies are led by researchers from Ghana and span the Environment, Agriculture, and Human Health sectors.

Implemented through an integrated Training-of-Trainers model, the initiative pairs experienced researchers with new trainees, fostering ongoing capacity development and enabling the impact of research to be assessed. These studies are aligned with Ghana’s national research priorities and involve nine Ghanaian institutions, along with several international partners—demonstrating a “think global, act local” approach to tackling AMR.

We invite you to contribute to this unique Special Issue evaluating the evolving role of operational research in shaping national policy and global learning in the implementation of effective and sustainable responses to AMR.

Prof. Dr. Wendemagegn Enbiale Yeshanesh
Dr. Rose J. Kosgei
Dr. Rafael Van Den Bergh
Guest Editors

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As stated above, the central purpose of this Special Issue is to present research from the Structured Operational Research and Training InitiaTive (SORT IT). Given this purpose, the Guest Editors’ contribution to this Special Issue may be greater than standard Special Issues published by MDPI. Further details on MDPI's Special Issue guidelines can be found here: https://www.mdpi.com/special_issues_guidelines. The Editorial Office and Editor-in-Chief of TropicalMed has approved this and MDPI’s standard manuscript editorial processing procedure (https://www.mdpi.com/editorial_process) will be applied to all submissions. As per our standard procedure, Guest Editors are excluded from participating in the editorial process for their submission and/or for submissions from persons with whom a potential conflict of interest may exist. More details on MDPI’s Conflict of Interest policy for reviewers and editors can be found here: https://www.mdpi.com/ethics#_bookmark22.

Keywords

  • operational reearch
  • SORT IT
  • health systems
  • AMR
  • impact
  • universal health coverage (UHC)

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Published Papers (4 papers)

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Research

16 pages, 461 KB  
Article
Improved Utilisation and Quality of Blood Culture Services Following Operational Research in a Tertiary Hospital in Ghana
by Rita Sewornu, Emily Boakye-Yiadom, Emmanuel Ativi, Precious Kwablah Kwadzokpui, Bismark Senahey, Helena Owusu, Pruthu Thekkur, Ajay M. V. Kumar and Cornelius C. Dodoo
Trop. Med. Infect. Dis. 2025, 10(9), 270; https://doi.org/10.3390/tropicalmed10090270 - 18 Sep 2025
Viewed by 153
Abstract
Operational research (OR) published in 2023 revealed low utilisation and suboptimal quality of blood culture services at a tertiary hospital in Ghana. To address these, several interventions were implemented, including sensitisation of physicians, training of laboratory staff, use of automated incubation systems, and [...] Read more.
Operational research (OR) published in 2023 revealed low utilisation and suboptimal quality of blood culture services at a tertiary hospital in Ghana. To address these, several interventions were implemented, including sensitisation of physicians, training of laboratory staff, use of automated incubation systems, and improved availability of laboratory consumables. To assess the impact of these interventions, we conducted a follow-up study in a cross-section of inpatients (n = 1080) with suspected bloodstream infections (BSI) admitted in 2024. There were three key changes. First, there was a five-fold increase in requests for blood culture from 8% pre-OR to 40% post-OR. Culture requests were more frequent from child health department (63%) and intensive care units (53%) compared to surgery department (15%). Second, there was a reduction in delays: time from hospital admission to culture request was reduced from 2 days to 1 day, and the laboratory turn-around time was reduced from 7 days to 5 days. Third, there was a marginal improvement (p = 0.692) in the quality of blood cultures: diagnostic yield improved from 7% to 10%, and the contamination rate was reduced from 16% to 14%. Achieving universal culture utilisation among eligible patients and lowering contamination rates will require a detailed gap analysis and targeted interventions. Full article
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17 pages, 787 KB  
Article
Prevalence of Antimicrobial and Colistin Resistance in Enterobacterales in Healthy Pigs in Ghana Before and After Farmer Education
by Elvis Fiam Amegayibor, Rita Ohene Larbi, Matilda Ayim-Akonor, Ebenezer D. O. Ansa, Pruthu Thekkur, Helena Owusu, Robert Fraser Terry, Anthony D. Harries, Benjamin Kissi Sasu, George Kwesi Hedidor and Richael Odarkor Mills
Trop. Med. Infect. Dis. 2025, 10(9), 266; https://doi.org/10.3390/tropicalmed10090266 - 17 Sep 2025
Viewed by 226
Abstract
High levels of antimicrobial resistance (AMR) were found in healthy pigs in the Greater Accra region of Ghana in 2022; this led to awareness creation and education of pig farmers about how to improve antimicrobial practices and biosecurity. To assess changes in AMR [...] Read more.
High levels of antimicrobial resistance (AMR) were found in healthy pigs in the Greater Accra region of Ghana in 2022; this led to awareness creation and education of pig farmers about how to improve antimicrobial practices and biosecurity. To assess changes in AMR after the intervention, we compared AMR, multi-drug resistance (MDR), and determined colistin resistance levels in healthy pigs in the region before (2022) and after (2024) the education of farmers. Rectal swabs (n = 140) from pigs in 14 farms were cultured for isolation of Enterobacterales (Escherichia coli and Enterobacter spp.) and subjected to antimicrobial susceptibility testing. A selective culture method was employed to isolate colistin-resistant Enterobacterales, which were further screened for the mcr-1 gene. AMR and MDR findings were compared with those from 140 pigs from the same farms in 2022. Enterobacterales were found in 137 (2022) and 138 (2024) rectal swabs, with Escherichia coli predominating. There was a marked increase in AMR prevalence for eight of the nine tested antibiotics in 2024. Notable increases in resistance were for tetracycline (58–82%), ampicillin (33–49%), and ciprofloxacin (3–33%). MDR prevalence was highest in Escherichia coli, increasing from 20% to 44%. Phenotypic colistin resistance was found in 44% of Escherichia coli isolates in 2024 (in 2022, using different methodology, phenotypic colistin resistance was 8%)—in 2024, the mcr-1 gene was found in 51% of these isolates. There were no relevant associations between farm and pig characteristics and prevalence of MDR and phenotypic colistin resistance. Although education is an important aspect of AMR control, the findings highlight that education alone cannot curb the rise of AMR. Further interventions including continuous surveillance, stronger regulatory policy on antimicrobial use, and behavioral interventions will be needed to mitigate the situation. Full article
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15 pages, 506 KB  
Article
Operational Research Improves Compliance with Treatment Guidelines for Empirical Management of Urinary Tract Infection: A Before-and-After Study from a Primary Health Facility in Ghana
by Elizabeth Boateng, Helena Owusu, Pruthu Thekkur, George Kwesi Hedidor, Oksana Corquaye, Mercy N. A. Opare-Addo, Florence Amah Nkansah, Priscilla Vandyck-Sey, Daniel Ankrah and Charles Nii Kwadee Ofei-Palm
Trop. Med. Infect. Dis. 2025, 10(9), 259; https://doi.org/10.3390/tropicalmed10090259 - 11 Sep 2025
Viewed by 466
Abstract
Compliance with standard treatment guidelines (STGs) for the empirical management of uncomplicated urinary tract infections (UTIs) ensures the rational use of antibiotics and mitigates antimicrobial resistance. Operational research (OR) at Korle Bu Polyclinic in Ghana (2022) showed suboptimal STG compliance (prescription of recommended [...] Read more.
Compliance with standard treatment guidelines (STGs) for the empirical management of uncomplicated urinary tract infections (UTIs) ensures the rational use of antibiotics and mitigates antimicrobial resistance. Operational research (OR) at Korle Bu Polyclinic in Ghana (2022) showed suboptimal STG compliance (prescription of recommended antibiotics in the correct dose, route, frequency, and duration). Some of the recommendations from the OR, including training of medical residents, implementation of an antimicrobial stewardship team, and an audit–feedback system, were implemented. This before-and-after study compared the changes in empirical prescribing practices for patients diagnosed with uncomplicated UTIs before (October 2019–October 2021) and after (January 2023–December 2024) the OR. Of the 3717 and 3457 UTI patients in the before and after cohorts, 83% and 86% received empirical antibiotics, respectively. Among those who received empirical antibiotics, STG compliance increased from 60% to 66% (p-value < 0.001). However, STG compliance remained significantly lower among males (18%) compared to females (85%) in the after cohort, as 80% of males were prescribed antibiotics for a shorter period than the recommended 10–14 days. Moving forward, the training and audit–feedback system should emphasize longer antibiotic durations for males with UTI. Given its positive impact, the OR’s approach warrants replication for other disease conditions. Full article
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15 pages, 455 KB  
Article
Enterobacterales and Antimicrobial Resistance in Feed, Water, and Slurry in Pig Production Farms in the Greater Accra Region of Ghana, 2024
by Elvis Fiam Amegayibor, Rita Ohene Larbi, Matilda Ayim-Akonor, Richael Odarkor Mills, Helena Owusu, Benjamin Kissi Sasu, Robert Fraser Terry, Anthony D. Harries and Florence S. Kuukyi
Trop. Med. Infect. Dis. 2025, 10(9), 239; https://doi.org/10.3390/tropicalmed10090239 - 27 Aug 2025
Viewed by 605
Abstract
Increasing antimicrobial resistance (AMR) levels in Enterobacterales from pigs in Ghana prompted us to investigate farm feed, pig slurry, and farm water for Enterobacterales isolates, their antimicrobial resistance patterns, and antimicrobial residues. Between August and November 2024, we collected one sample each of [...] Read more.
Increasing antimicrobial resistance (AMR) levels in Enterobacterales from pigs in Ghana prompted us to investigate farm feed, pig slurry, and farm water for Enterobacterales isolates, their antimicrobial resistance patterns, and antimicrobial residues. Between August and November 2024, we collected one sample each of feed, slurry, and water from 14 pig farms for microbiological analysis. Out of 42 samples, Enterobacterales (E. coli and Enterobacter spp.) were isolated from 30 (71.4%) samples, with the highest prevalence found in feed (85.7%), followed by slurry (78.6%) and water (50.0%). The prevalence of AMR to tetracyclines, trimethoprim-sulfamethoxazole, and ampicillin was high, with over 50% of isolates from slurry and water and 40% from feed exhibiting tetracycline resistance. Multi-drug resistance (MDR) was identified in nine (27.3%) isolates of Enterobacterales, with the highest prevalence found in feed (38.5%), then slurry (23.1%), and water (14.3%). Among 42 farm samples screened for colistin-resistant Enterobacterales, 10 (23.8%) exhibited phenotypic colistin resistance. No antimicrobial residues were detected. Risk factors associated with MDR included large farms with high pig turnover (p < 0.05) and the channelling of slurry into both covered and uncovered pits on the farm (p < 0.05). These high resistance levels underscore the urgent need for improved hygiene in feed, water, and slurry management, stricter antibiotic stewardship with veterinary oversight, and better enforcement of existing antibiotic use regulations on pig farms. Full article
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