Mapping One Health antimicrobial resistance policy and implementation in Bangladesh: A scoping review.

BACKGROUND

Implementation of policies and regulations on antimicrobial resistance (AMR) against global and national action plans is important to assess. We conducted a scoping review to map One Health AMR policies in Bangladesh against strategic objectives of the global and national action plans on AMR and examine evidence of implementation and compliance.

METHODS

We searched PubMed (Medline), Embase and Scopus databases, Google scholar and government websites. Records were screened against eligibility criteria for reports (policies and studies) addressing AMR in humans, animals/plants, and the environment in Bangladesh with no restriction on language or year. We synthesised data narratively and mapped against the AMR Global Action Plan and National Action Plan (NAP) objectives.

RESULTS

Of 889 identified citations, 91 items met inclusion criteria (n = 40 policy documents; n = 51 studies). The proportion of AMR policy documents from the human and animal sectors were similar (32.5% (n = 13) and 30% (n = 12) respectively) with 22.5% (n = 9) employing a One Health approach. Fewer policies (15%, n = 6) solely addressed the environmental sector. Studies assessing AMR policy implementation or compliance were predominantly from the human (57%, n = 29), and animal sectors (24%, n = 12). One fifth (20%, n = 10) described a One Health approach. None was from the environmental sector. Antimicrobial stewardship was the most frequently addressed global and national strategic action, followed by infection prevention and control. Gaps in knowledge on policy effectiveness and implementation were evident for antimicrobial stewardship monitoring, adequate provision of qualified health practitioners and regulation of informal food production systems.

CONCLUSIONS

One Health and multisectoral approaches are increasingly evident in policy, indicating progress towards Bangladesh NAP objectives. However, environmental AMR policies lag behind the animal and human sectors. We identified a significant gap in studies of policy effectiveness with most focussing on compliance. Low cost and sustainable ways to implement AMR policies and regulations are needed.