A Scoping Review of Antibiotic Resistance through a One Health Lens. Insights from The Nile Valley: Egypt, Sudan, and Ethiopia

Leena Al-Hassan^1,2Anya A Nowbuth³Getachew Tesfaye Beyene⁴Biruk Yeshitela⁴Derbew Fikadu Berhe⁵Kassu Desta⁶Mistire Wolde⁶Thamarai Schneiders⁷Amira Hussein⁸Mai Zafer⁹Rana Elshimy^10,9Hadir El-Mahallawy¹¹Nagwa El- Amin¹²Anne Roemer-Mahler¹³Sarra Aizzeldin¹⁴Paul G Higgins^15,16Aalaa Moghith¹⁷Papreen Nahar¹Einas Osman^18*Maowia Mukhtar¹⁹

• ¹Brighton and Sussex Medical School, Brighton, United Kingdom
• ²Centre for Infection and Antimicrobial Research, Brighton, United Kingdom
• ³The Norwegian University of Science and Technology, Trondheim, Norway
• ⁴The Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
• ⁵University of Global Health Equity, Kigali, Rwanda
• ⁶Addis Ababa University, Addis Ababa, Ethiopia
• ⁷University of Edinburgh, Edinburgh, United Kingdom
• ⁸Galala University, Suez, Egypt
• ⁹Ahram Canadian University, Cairo, Egypt
• ¹⁰Egyptian Drug Authority, Cairo, Egypt
• ¹¹National Cancer Institute, Cairo University, Cairo, Egypt
• ¹²Qassim University, Qassim, Saudi Arabia
• ¹³University of Sussex, Brighton, United Kingdom
• ¹⁴Federal Ministry of Health, Khartoum, Sudan
• ¹⁵University of Cologne, Cologne, Germany
• ¹⁶German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
• ¹⁷The American University in Cairo, Cairo, Egypt
• ¹⁸A'Sharqiyah University, Ibra, Oman
• ¹⁹Bioscience Research Institute, Khartoum, Sudan

Antibiotic resistance (ABR) is a global issue that requires a One Health approach, addressing human, animal, and environmental health sectors together. The PRESAR network, which aims to reduce the emergence and spread of ABR in the Nile Valley, seeks to fill research gaps in ABR. This scoping review (ScR) focuses on mapping the existing literature and data on ABR in Egypt, Ethiopia, and Sudan, specifically examining the application of the One Health approach and reviewing the national action plans (NAPs) of these countries. The ScR was conducted using the PCC framework (population, concept, and context) and incorporated relevant keywords and MeSH terms in: Medline, Scopus, and Web of Knowledge. Two reviewers per sector (animal, environment/agriculture, human) screened articles, including peer-reviewed studies published in English across all years. Studies on non-bacterial or mycobacterial infections, and systematic reviews, were excluded. Data such as infection type, sample source, and observed resistance were recorded. The NAPs were compared with the WHO Global Action Plan (GAP) to assess similarities and differences. The review included 492 articles from Ethiopia, 331 from Egypt, and 31 from Sudan. Preliminary findings show that multidrug-resistant (MDR) S. aureus and K. pneumoniae dominate human infections, while Staphylococcus spp. and ESBL-producing Enterobacterales are more prevalent in animal and environmental sectors. There was large variability in diagnostic methodologies used across the sectors and countries, which in turn may lead to discrepancies in identification of bacteria at the species level and thereby inaccurate epidemiological data on prevalence and burden. The review revealed that wWhile NAPs are generally aligned with the GAP, variations exist in areas like process ownership, research capacity, and funding. The review underscores the need for more research in non-human sectors and highlights the importance of One Health in tackling ABR. We strongly advocate for a unified and strategic approach among local stakeholders, scientists, and international agencies to prioritize and fund research, aiming for a sustainable reduction in antibiotic resistance.