Surveillance of multidrug-resistant tuberculosis in sub-Saharan Africa through wastewater-based epidemiology
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Department of Environmental Science, The University of ArizonaIssue Date
2023-07-21Keywords
Molecular surveillanceMulti-drug resistant tuberculosis
One-health approach
Wastewater-based epidemiology
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Elsevier LtdCitation
Mtetwa, H. N., Amoah, I. D., Kumari, S., Bux, F., & Reddy, P. (2023). Surveillance of multidrug-resistant tuberculosis in sub-Saharan Africa through wastewater-based epidemiology. Heliyon, 9(8).Journal
HeliyonRights
© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
The spread of multidrug-resistant tuberculosis (MDR-TB) is a serious public health issue, particularly in developing nations. The current methods of monitoring drug-resistant TB (DR-TB) using clinical diagnoses and hospital records are insufficient due to limited healthcare access and underreporting. This study proposes using Wastewater-Based Epidemiology (WBE) to monitor DR-TB in six African countries (Ghana, Nigeria, Kenya, Uganda, Cameroon, and South Africa) and examines the impact of treated wastewater on the spread of TB drug-resistant genes in the environment. Using droplet-digital polymerase chain reaction (ddPCR), the study evaluated untreated and treated wastewater samples in selected African countries for TB surveillance. There was a statistically significant difference in concentrations of genes conferring resistance to TB drugs in wastewater samples from the selected countries (p-value<0.05); South African samples exhibited the highest concentrations of 4.3(±2,77), 4.8(±2.96), 4.4(±3,10) and 4.7(±3,39) log copies/ml for genes conferring resistance to first-line TB drugs (katG, rpoB, embB and pncA respectively) in untreated wastewater. This may be attributed to the higher prevalence of TB/MDR-TB in SA compared to other African countries. Interestingly, genes conferring resistance to second-line TB drugs such as delamanid (ddn gene) and bedaquiline (atpE gene) were detected in relatively high concentrations (4.8(±3,67 and 3.2(±2,31 log copies/ml for ddn and atpE respectively) in countries, such as Cameroon, where these drugs are not part of the MDR-TB treatment regimens, perhaps due to migration or the unapproved use of these drugs in the country. The gene encoding resistance to streptomycin (rrs gene) was abundant in all countries, perhaps due to the common use of this antibiotic for infections other than TB. These results highlight the need for additional surveillance and monitoring, such as WBE, to gather data at a community level. Combining WBE with the One Health strategy and current TB surveillance systems can help prevent the spread of DR-TB in populations. © 2023 The AuthorsNote
Open access journalISSN
2405-8440Version
Final Published Versionae974a485f413a2113503eed53cd6c53
10.1016/j.heliyon.2023.e18302
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Except where otherwise noted, this item's license is described as © 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license.