Date of Award

January 2020

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kaveh Khoshnood


Introduction: Although control strategies for antimicrobial resistance (AMR) have been described in high-income settings, interventions to curb the emergence and spread of AMR in conflict-afflicted low- and middle-income countries (LMICs) have not been systematically explored.

Objective: The objective of this review was to identify and assess the effectiveness of various control strategies in curbing the emergence and spread of AMR in conflict-afflicted LMICs.

Methods: A systematic scoping review of the literature was conducted using Embase, PubMed, and Scopus to identify primary literature reporting on AMR in Pakistan, Lebanon, Jordan, or Turkey published in the last decade (Jan. 2010 – Jan. 2020). Papers were eligible for inclusion if they discussed conflict or the effects thereof, AMR, and control strategies for AMR. Summary and reporting of the findings were informed by guidelines presented by Tricco et al. 2018 and the JBI Reviewer’s Manual for scoping reviews. Semi-structured interviews with experts were conducted to substantiate review findings. All interviews were audio-recorded and transcribed in full using the website OTranscribe and the software Descript V.3.3.2.

Results: Sixteen articles were deemed eligible for inclusion. Control strategies discussed in these articles fell into five categories: infection prevention and control (n=4); antibiotic stewardship programs (n=3); diagnostics and surveillance (n=7); education (n=2); and other (n=2).

Conclusion: The challenges associated with controlling the emergence and spread of AMR are exacerbated by violent conflict and displacement. Conflict-afflicted LMICs not only face resource limitations, but must also find ways to care for and treat injured individuals carrying increasingly-resistant pathogens. The literature and expert opinions suggest that improved lab diagnostics, implementation of surveillance programs, and infection prevention and control should be prioritized as AMR control strategies in conflict-afflicted LMICs. However, there is limited research on the effectiveness of these interventions in such settings. Future research is needed before adequate interventions can be designed and implemented.


This is an Open Access Thesis.

Open Access

This Article is Open Access