Strengthening pathogen and antimicrobial resistance surveillance through environmental monitoring in sub-Saharan Africa: stakeholder perspectives.

Wastewater and environmental surveillance (WES) is an emerging tool for monitoring emergence and trends of waterborne, respiratory, and antimicrobial-resistant (AMR) pathogens. In many developing countries with limited pathogen surveillance systems, WES can complement and support existing monitoring efforts and strengthen pathogen surveillance capacity. This study explored priority pathogens for WES and assessed existing surveillance practices, including WES, in Tanzania, Burkina Faso, and the Democratic Republic of the Congo (DRC). National hybrid workshops were held in each country, engaging stakeholders from diverse fields, including academia, research, policy, environmental health, and healthcare. Two structured surveys, administered via Webropol platform and Mentimeter. com, were conducted during each workshop to gather information on existing clinical and environmental surveillance systems and potential WES targets. Survey responses were analysed thematically, with each theme thoroughly evaluated using scientific evidence from the literature. Key pathogens identified for WES included waterborne pathogens, such as poliovirus, Salmonella Typhi, Vibrio cholerae, and non-waterborne pathogens, such as influenza A&B, SARS-CoV-2, measles, rubella. High-priority AMR targets for WES included multidrug-resistant Mycobacterium tuberculosis, Salmonella spp., and ESBL-producing E. coli. All three countries were found to use centralised electronic systems for clinical data collection, while WES was still limited and largely confined to project-based applications. Respondents highlighted that adopting WES could enhance surveillance systems, track circulating pathogens, and safeguard human, animal, and environmental health. Thus, WES could play a pivotal role in preventing waterborne outbreaks, protecting drinking water sources, and supporting integrated risk management, contributing to achieving various UN Sustainable Development Goals (SDGs).