A descriptive analysis of the effects of widespread armed conflict on antibiotic resistance rates Public Deposited

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  • February 27, 2019
  • Zalimeni, Emily
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
  • This paper posits a theoretical framework by which armed conflict may selectively pressure bacterial to become more resistant and identifies measurements by which to longitudinally measure the level of conflict and resultant state fragility within nations. The primary aims of this work were to determine (1) whether there is sufficient literature to examine whether the introduction and propagation of statewide conflict and resultant government fragility correlates with the rate of antibiotic resistance within a country, (2) whether such a correlation exists, and (3) whether measurements of state peace or stability are predictive measures of resistance patterns. A secondary aim of this paper was to present the current state of the research regarding antibiotic resistant rates in countries afflicted by large-scale conflict. Using the Global Peace Index (GPI) and Fragile State Index (FSI), Libya, Mali, and Syria were identified as the optimal contexts with which to test the hypothesis. Because no national data were reported for any of the states during the study period (2007-2017), all data used in this analysis were identified through a systematic review of the literature. Data from each country were visualized in three ways: by study year and pathogen classification, by bacterial-antibiotic or antibiotic class pairings highlighted in the WHO’s 2014 Report “Antimicrobial Resistance: Global Report on Surveillance”, and by resistance to antibiotics in the Reserve Group of the WHO’s List of Essential Medications. Unfortunately, the data available in the published literature were of poor amount, quality, substance, and detail both prior to and following the outbreak of conflict. It was thus not possible to thoroughly examine the effect, if any, of conflict on resistance or the predictive value of measurements of peace and state fragility. Concerning rates of resistance were identified with multiple antibiotics, including many listed in the Reserve Group by the WHO. Perhaps most alarmingly, there were multiple antibiotics in the Reserve Group and otherwise with no data on resistance. More research in this area is needed.
Date of publication
Resource type
  • Paper type: Research or research design
  • Track: HC&P
  • Tolleson-Rinehart, Sue
  • Jaff, Dilshad
  • Master of Public Health
Academic concentration
  • Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2018
Deposit record
  • 5d388072-84b4-431b-ac9d-c165f5adfbb6

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