{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:29:14Z","timestamp":1792466954391,"version":"4.5.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UK Department of Health and Social Care"},{"name":"Fleming Fund","award":["R52354 CN001"],"award-info":[{"award-number":["R52354 CN001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kenya has moved from fragmented, pilot-based antimicrobial resistance (AMR) surveillance toward a coordinated One Health system, and its experience, pathways of change, and remaining gaps are relevant for other low- and middle-income settings working to operationalize One Health AMR surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Here, we report a narrative overview of programmatic learning using 2018 as the pre-Fleming Fund baseline, drawing on national and global surveillance reports, monitoring frameworks from the Quadripartite indicators, qualitative evidence on governance, implementation and policy evolution across the One Health sectors, and Fleming Fund documentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Since 2018, AMR surveillance expanded from 2 human health sites to 30 human, animal, and environmental sites by 2025. National reports evolved to integrate AMR, antimicrobial consumption, and antimicrobial use data; routine reporting to global platforms matured; and outputs such as dashboards, reports, and policy briefs informing stewardship, Infection Prevention and Control, regulatory action, and policy decisions. External benchmarks showed improvement in AMR-related capacity, with World Health Organization Joint External Evaluation scores moving from limited to demonstrated capacity for surveillance and multisectoral coordination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Kenya's experience suggests that sustainable progress depends on embedding AMR surveillance within government-led governance structures, technical systems, and coordinated partner support, but sustaining gains will require predictable financing and routine data use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag500","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:29:47Z","timestamp":1792423787000},"page":"S48-S59","source":"Crossref","is-referenced-by-count":4,"title":["Fleming Fund Implementation in Kenya: What Have We Learned About Strengthening One Health Antimicrobial Resistance Surveillance for Decision-making?"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1467-3631","authenticated-orcid":false,"given":"Evelyn","family":"Wesangula","sequence":"first","affiliation":[{"name":"East Central and Southern Africa Health Community Family Health and Infectious Diseases, , Arusha ,","place":["Tanzania"]},{"name":"Itad ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8628-0167","authenticated-orcid":false,"given":"Nkatha","family":"Gitonga","sequence":"additional","affiliation":[{"name":"Global Health\u2014AMR , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5214-7395","authenticated-orcid":false,"given":"Emmanuel","family":"Tanui","sequence":"additional","affiliation":[{"name":"Kenya National Public Health Institute, Nairobi, Kenya Division of Quality Improvement, Infection Prevention and Control and Antimicrobial Resistance,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romona","family":"Ndanyi","sequence":"additional","affiliation":[{"name":"State Department of Livestock Development, Directorate of Veterinary Services, Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Githii","sequence":"additional","affiliation":[{"name":"National Laboratory Science and Biosecurity, Kenya National Public Health Institute, Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridgit Syombua","family":"Muasa","sequence":"additional","affiliation":[{"name":"State Department of Livestock Development, Directorate of Veterinary Services , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice","family":"Omondi","sequence":"additional","affiliation":[{"name":"State Department of Livestock Development, Directorate of Veterinary Services , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M","family":"F\u00e8vre","sequence":"additional","affiliation":[{"name":"International Livestock Research Institute (ILRI), Nairobi \u00a0","place":["Kenya"]},{"name":"University of Liverpool, Liverpool, United Kingdom Institute of Infection, Veterinary and Ecological Sciences,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dishon M","family":"Muloi","sequence":"additional","affiliation":[{"name":"International Livestock Research Institute (ILRI), Nairobi \u00a0","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Kassim","sequence":"additional","affiliation":[{"name":"Kenyatta National Hospital, Nairobi, Kenya Department of Laboratory Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3151-2036","authenticated-orcid":false,"given":"Josiah","family":"Mwenda","sequence":"additional","affiliation":[{"name":"Department of Veterinary Pathology, Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine Minoo","family":"Mbindyo","sequence":"additional","affiliation":[{"name":"Department of Veterinary Pathology, Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9776-6967","authenticated-orcid":false,"given":"Irungu John","family":"Kamau","sequence":"additional","affiliation":[{"name":"Division of Quality Improvement, Infection Prevention and Control and Antimicrobial Resistance, Kenya National Public Health Institute, Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4632-8792","authenticated-orcid":false,"given":"Loice Achieng","family":"Ombajo","sequence":"additional","affiliation":[{"name":"University of Nairobi, Nairobi, Kenya Department of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunturu","family":"Revathi","sequence":"additional","affiliation":[{"name":"Aga Khan University Hospital , Nairobi ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Chuchu","sequence":"additional","affiliation":[{"name":"Commonwealth Pharmacists Association, London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anafi","family":"Mataka","sequence":"additional","affiliation":[{"name":"African Society for Laboratory Medicine, Addis Ababa ,","place":["Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moctar M M","family":"Mouiche","sequence":"additional","affiliation":[{"name":"African Society for Laboratory Medicine, Addis Ababa ,","place":["Ethiopia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6469-3948","authenticated-orcid":false,"given":"Arshnee","family":"Moodley","sequence":"additional","affiliation":[{"name":"International Livestock Research Institute (ILRI), Nairobi \u00a0","place":["Kenya"]},{"name":"University of Copenhagen, Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Fenwick","sequence":"additional","affiliation":[{"name":"Mott MacDonald"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Nanjebe","sequence":"additional","affiliation":[{"name":"Mott 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Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"2026101911294128300_ciag500-B1","author":"World Health Organization"},{"key":"2026101911294128300_ciag500-B2","author":"World Bank"},{"key":"2026101911294128300_ciag500-B3","author":"FAO, UNEP, WHO, WOAH"},{"key":"2026101911294128300_ciag500-B4","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050","volume":"404","author":"Naghavi","year":"2024","journal-title":"Lancet"},{"key":"2026101911294128300_ciag500-B5","author":"World Health Organization"},{"key":"2026101911294128300_ciag500-B6","doi-asserted-by":"crossref","first-page":"S883","DOI":"10.1093\/infdis\/jiab457","article-title":"Antimicrobial resistance in endemic enteric infections in Kenya and the region, and efforts 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countries","volume":"83","author":"Drake","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026101911294128300_ciag500-B19","first-page":"S60","article-title":"Reflections for the future of AMR Surveillance and AMR action","volume":"83","author":"Chandler","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026101911294128300_ciag500-B20","doi-asserted-by":"crossref","first-page":"S13","DOI":"10.1093\/cid\/ciag497","article-title":"Generating actionable data from Antimicrobial Resistance Surveillance: insights from the Fleming Fund's international experience","volume":"83","author":"Gupta-Wright","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026101911294128300_ciag500-B21","author":"The Fleming Fund"},{"key":"2026101911294128300_ciag500-B22","author":"Parry"},{"key":"2026101911294128300_ciag500-B23","author":"The Fleming Fund"},{"key":"2026101911294128300_ciag500-B24","author":"Government of Kenya"},{"key":"2026101911294128300_ciag500-B25","author":"Government 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