Antimicrobial resistance in Somalia: Proposal for a One Health scoping review

Background: Escalating levels of antimicrobial resistance (AMR) present a pressing and evolving threat to public health, accounting for ~5,000,000 deaths globally. This threat is particularly pronounced in settings with weak health systems, such as Somalia, a country devastated chronically by frequent and prolonged instabilities and natural disasters[1-4]. In public health thinking, the interaction between humans, animals and plants in their shared environment is increasingly considered across an interconnected spectrum termed “One Health”[5, 6]. Recognition of this interconnection is crucial for addressing emerging threats such as AMR, which are exacerbated by prolonged crises that devastate health and health systems functioning across sectors[7-10]. While studies shed light on the current challenges of AMR in Somalia, strong evidence on the prevalence, burden, and economic impact of AMR on country's human, animal, and plant health has not been systemically mapped or investigated from One Health perspective [11-13].
Aim: To undertake a scoping review—through a transdisciplinary One Health lens—of published evidence on AMR in Somalia, delineating gaps in knowledge. The findings will (i) hone the focus of our own planned research on AMR in this setting; and (ii) provide a robust evidential basis—as an element of our nationwide One Health program-in-development in Somalia—for the upskilling and training of in-country personnel, institutional capacity building and policy required to deal with the problem.
Methods: The study will be conducted in accordance with the PRISMA Extension for Scoping Reviews, encompass all accessible relevant research published in peer-reviewed or ‘grey’ literature during the last 40 years, and submitted for publication in a peer-reviewed journal. Our international research team will facilitate incorporation of Somali- and English-language material.
Conclusion: Addressing health outcomes at the human-animal-plant interface is critical, particularly in a country like Somalia, where health system challenges are pronounced. Our review will delineate evidence and knowledge gaps surrounding the current impact of AMR in this context, providing a timely foundation for research development and capacity building.