related to environment

1. Literature Review
Utilizing the latest literature reviews (Weitao Wang, 2023) summarized that the
relationship between antimicrobial resistance and their residues in the
environment. Their review highlights the occurrence, spread, and ecological and
human health impacts of antimicrobials and antimicrobial resistance. They also
identifies various environmental factors that contribute to antimicrobial
contamination and the spread of antimicrobial resistance. They suggests that
antimicrobial pollution has serious effects on the ecological environment, while
antimicrobial resistance poses greater potential harm to human health. They
emphasizes the role of pollutants like heavy metals and micro plastics in the
occurrence and spread of antimicrobial pollution and resistance. Hence, they
concluded that despite the implementation of regulations and strategies on
antimicrobial use in several countries, little progress has been made, particularly
in developing countries.
Ayako Wendy Fujita (2022) focuses on AMR in humans, animals, and the
environment in Ethiopia. Their review identifies a gap in the literature regarding
integrated surveillance approaches using a One Health approach. They notes that
only a few studies in Ethiopia describe AMR across all three sectors. The study
highlights the high rates of resistance among several antibiotics in both humans
and animals, emphasizing the need for AMR surveillance and antibiotic
stewardship programs. Inconsistencies in antimicrobial susceptibility testing and
a lack of data on AMR in the animal and environmental sectors are also identified.
They concludes that a One Health approach is necessary to address the growing
problem of AMR in Ethiopia.
Dejen Nureye (2020) focuses on AMR in Ethiopia and the importance of a One
Health approach to address it. They discusses the status of AMR in Ethiopia, the
limitations to effective AMR response, and Ethiopia's commitment to global
efforts in detecting and preventing AMR. They highlights the importance of

2. laboratory-based surveillance, knowledge and practices of healthcare workers,
and antimicrobial stewardship in limiting AMR. Their review advocates for a
national approach to preventing the development of AMR in Ethiopia,
highlighting the importance of laboratory-based surveillance and a
comprehensive national AMR surveillance system. They also mentions the
commitment of Ethiopia to global efforts in detecting and preventing AMR.
According to the Tracking AMR Country Self-Assessment Survey (TrACSS),
it reveals challenges faced by countries, including limited resources, technical
capacity, and inconsistent political commitment for implementing their AMR
National Action Plans (NAPs). This analysis also shows a lack of programmatic
approach to NAP implementation, with some indicators making progress while
others have seen little to no progress
The Ethiopian Antimicrobial Resistance Surveillance report document provides
information on Ethiopia's AMR Surveillance System and the establishment of a
Laboratory-Based Antimicrobial Resistance Surveillance Network. However, it
does not discuss the environmental sector.
According to the strategic document of Antibacterial Resistance Prevention and
containment strategic plan, even though the Government has undertaken various
efforts to prevent and contain antimicrobial resistance, the human and animal
health sector strategies as well as environmental sector strategies have not
comprehensively addressed antimicrobial resistance prevention and containment.
It explained that, the Ethiopian Government fears the country remains behind in
controlling the antimicrobial resistance threats and risks. The reason of this
lagging is attributed to an inadequate multi-sectorial approach, insufficient and
poor-quality antimicrobial resistance and antimicrobial data and use, lack of
sustainable financing, suboptimal practices, inadequate number of trained
professionals and insufficient laboratories and supplies.

3. Overall, these reviews highlight the critical challenges of AMR implementation
and the lack of coordinated activities to combat AMR prevalence. They also
discussed the need for a comprehensive approach to address AMR, particularly
through one health and coordinated sectorial approach across humans, animals,
and the environment. However, further research and examination are still needed,
particularly regarding the role of the environmental sector and the engagement of
organizations like the Environmental Protection Agency (EPA) in reducing AMR
prevalence. This thesis addresses the Role and implementation of AMR activities
in Environmental Protection Authority.

4. The literature reviews by Weitao Wang (2023), Ayako Wendy Fujita (2022), and Dejen Nureye
(2020) shed light on the relationship between antimicrobial resistance (AMR) and its residues
in the environment, particularly focusing on the situation in Ethiopia. Wang's review
emphasizes the occurrence, spread, and impacts of antimicrobials and AMR on ecological and
human health. They identify various environmental factors contributing to antimicrobial
contamination and AMR spread, highlighting the role of pollutants like heavy metals and
microplastics. Wang concludes that despite regulations and strategies, little progress has been
made, particularly in developing countries.
Fujita's review highlights the need for integrated surveillance approaches using a One Health
approach in Ethiopia, where limited studies cover AMR in humans, animals, and the
environment. The study emphasizes the high rates of resistance and calls for AMR surveillance
and antibiotic stewardship programs, as well as consistent antimicrobial susceptibility testing
and data availability.
Nureye's review also underscores the importance of a One Health approach to address AMR in
Ethiopia, discussing the status of AMR, limitations, and the country's commitment to global
efforts. They stress the significance of laboratory-based surveillance, healthcare worker
knowledge, and antimicrobial stewardship, advocating for a national approach and
comprehensive surveillance system.
The reviews collectively point out the challenges in implementing AMR National Action Plans
(NAPs), including limited resources, technical capacity, and inconsistent political
commitment. They also highlight the lack of a coordinated and programmatic approach to NAP
implementation.
While the Ethiopian Antimicrobial Resistance Surveillance report focuses on AMR
surveillance and laboratory networks, it neglects the environmental sector. The strategic
document on Antibacterial Resistance Prevention and Containment emphasizes the insufficient
focus on AMR prevention and containment in human, animal, and environmental sectors,
attributing the lag to various factors such as inadequate multi-sectorial approaches and lack of
resources.
Overall, these reviews stress the need for a comprehensive, coordinated, and multi-sectorial
approach to address AMR, involving humans, animals, and the environment. They call for
further research, particularly on the role of the environmental sector and the engagement of
organizations like the Environmental Protection Agency (EPA) in reducing AMR prevalence.

5. This thesis aims to address the role and implementation of AMR activities in the Environmental
Protection Authority.
Regenerate response
1. Antimicrobial pollution has serious effects on the ecological environment, while
antimicrobial resistance poses greater potential harm to human health.
2. The occurrence, spread, and ecological and human health impacts of antimicrobials and
antimicrobial resistance are highlighted.
3. Heavy metals and microplastics contribute to antimicrobial contamination and the spread of
antimicrobial resistance.
4. Little progress has been made in implementing regulations and strategies on antimicrobial
use, particularly in developing countries.
5. Integrated surveillance approaches using a One Health approach are needed to address
antimicrobial resistance (AMR) in Ethiopia.
6. High rates of resistance among several antibiotics in humans and animals in Ethiopia
emphasize the need for AMR surveillance and antibiotic stewardship programs.
7. Inconsistencies in antimicrobial susceptibility testing and a lack of data on AMR in the animal
and environmental sectors are identified as issues.
8. A national approach to preventing the development of AMR in Ethiopia, including
laboratory-based surveillance and a comprehensive national AMR surveillance system, is
advocated.
9. Limited resources, technical capacity, and inconsistent political commitment are challenges
faced by countries in implementing AMR National Action Plans.
10. The lack of a programmatic approach to NAP implementation results in uneven progress
across different indicators.
11. The Ethiopian government's efforts to prevent and contain antimicrobial resistance have not
comprehensively addressed the human, animal, and environmental sectors.
12. Inadequate multi-sectorial approach, poor-quality antimicrobial resistance and antimicrobial
data, lack of sustainable financing, suboptimal practices, and insufficient resources are
identified as reasons for lagging behind in controlling antimicrobial resistance threats and
risks.