By Mosope Ososanya. Freelance Health Writer and DLHA volunteer. With medical review and editorial support by the DLHA Team
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Imagine that you have to spend months in the hospital to treat malaria. Or you have to go abroad to treat “typhoid” because the medicines you are taking are not effective.
Imagine people dying from diarrhoea as if it were a pandemic.
It all sounds ridiculous, right? Antimicrobial Resistance (AMR) can lead to many absurd situations like these.
In this article, we will learn about Antimicrobial Resistance, its causes, impact, and practical solutions to address it within the context of Africa.
Antimicrobial Resistance is the state where disease-causing organisms – bacteria, fungi, viruses, and other pathogens – evolve and no longer respond to drugs (antimicrobials) that treated them before.
Antimicrobials include antimalarials, antivirals, antibiotics, anti-parasitics, and antifungals.
Microbes that become resistant to treatments are known as superbugs. Superbugs are everywhere. They can be found in the soil, water, and air.
Antimicrobial Resistance makes it difficult to treat common illnesses and may lead to death.
According to the World Health Organization, AMR is one of the top 10 global health threats facing humanity. [1]
Amongst all antimicrobials, antibiotics are losing their potency more. In 2019, about 5 million people died from antimicrobial resistance and 1.3 million were due to antibiotic resistance. [2]
For example, Streptococcus pneumoniae bacteria, germs which are responsible for pneumonia, and other respiratory infections have developed resistance to common antibiotics like penicillin.
N. gonorrhoeae - germs that commonly cause sexually transmitted diseases called gonorrhoea, has developed resistance to multiple antibiotics, making the treatment of this sexually transmitted infection more difficult.
Illnesses like tuberculosis, certain skin infections, blood poisoning, and urinary tract infections (UTIs) have also become resistant to antibiotics. [3]
Antimicrobial resistance affects animals too. This becomes a concern in animals used for food production because resistant microbes can be transmitted to humans through consumption.
Antimicrobial resistance is even more alarming in Africa. It is estimated to cause 27.3 deaths per 100,000 with Western Sub-Saharan Africa recording the most deaths. [4]
According to the Africa Center for Disease Control (CDC), 4.1 million people across Africa could be dead by 2050 because of AMR. [5]
Antimicrobial Resistance is said to happen naturally over time. As microbes evolve, they naturally become resistant to treatment. However, certain factors may speed up the rate at which these microbes develop resistance.
Here are a few of these factors:
This has been a major cause of the rise of AMR in the world and in Africa. When a person uses a medication wrongly, either shorter or longer than the prescribed period, microbes tend to adapt and become resistant to the drug. [6, 10]
Many times, people don't finish the whole course of a medication because they feel better after using it for a few days. This habit also contributes to antimicrobial resistance. The microbes that survive, develop resistance to that treatment and multiply. In the future, when the person falls ill, that medication may not work well as a treatment anymore. [7]
It is estimated that only 52% of Africans have access to healthcare when they need it. [8] Many Africans lack access to quality drugs, modern healthcare facilities, professional healthcare services, and proper diagnostic techniques. All these contribute to the rise of AMR in Africa.
Limited access to professional healthcare can lead to cases of wrong use of antimicrobials and irresponsible self-medication. People who receive a wrong diagnosis from unprofessional medical staff end up taking the wrong antimicrobial.
When a person uses a low-quality antimicrobial, it causes the microbe to become resistant to the authentic drugs. [9] Fake drugs are not just harmful to the health but also make microbes resistant to treatment.
Inappropriate self-medication is one of the primary causes of antimicrobial resistance. Using a drug you don't need may make it ineffective when you actually need it. That is because microbes will develop resistance to that medication.
Lack of access to Safe Water, Sanitation, and Hygiene (WASH) is a leading cause of AMR in Africa.
In low and middle-income African countries, poor hygiene has made infection prevention measures difficult. This increases the rate of the spread of pathogens, including "superbugs"
Poor environmental health makes resistant microbes to be in higher circulation in Africa. [11]
Poor access to WASH is responsible for the common occurrence of most poor hygiene and water-borne illnesses like cholera, dysentery, diarrhoea, hepatitis A, and typhoid [23] leading to an increase in the overuse of antimicrobials.
Lack of WASH has been estimated to cause 827,000 deaths annually including deaths due to antimicrobial resistance. [2]
Research has shown that the use of antimicrobials could be reduced by 60% if there is more access to WASH. [13]
Another study showed that proper access to WASH is an effective means to reduce antimicrobial resistance. [12]
The use of antimicrobials in agriculture for productivity is largely due to the high demand for food from both plants and animals from an ever-growing African population.
In animal production, antimicrobials are used to treat and prevent infection in animals. In crop production, Antimicrobials are used largely as pesticides and to prevent plant diseases.
Misuse or overuse of these antimicrobials may cause microbes to develop resistance and they can be transmitted to humans through consumption. [15]
A study showed that cattle and poultry are the largest consumers of antimicrobials in Africa. [14]
The wrong and excessive use of antimicrobials in animal production may increase antimicrobial resistance in Africa.
During the Coronavirus pandemic, the use of antimicrobials increased. A study revealed that 72% of COVID-19 patients were given medications they didn't need. [16] The broad-spectrum use of antimicrobials heightened antimicrobial resistance during and after the pandemic.
However, the increase in hygiene and hand washing; [17] and reduced travelling were said to reduce the spread of microbes and superbugs significantly. Notwithstanding, the excessive use of hand sanitizers, disinfectants, [18] and antimicrobials made microbes evolve rapidly and develop resistance to treatments. [19]
Antimicrobial resistance (AMR) poses a serious risk to lives in Africa. It threatens our ability to treat common infections.
Antimicrobial resistance increases the cost of healthcare, as we may require new and expensive treatments. It may lead to frequent hospital appointments, prolonged hospital stays, and reduced quality of life for many individuals.
AMR makes surgical and post-surgical care more challenging to perform especially in low and middle-income countries. [1]
AMR increases the rate of mortality and morbidity across the continent. [4]
Antimicrobial resistance could increase healthcare costs from $300 billion to more than $1 trillion by 2050 and increase extreme poverty in Africa. Over 28.3 million people in the world may fall into poverty by 2050 because of AMR. [20]
Antimicrobial resistance can impact national security by potentially hindering the readiness of armed and security forces in African countries, making it difficult to secure borders against foreign enemies and safeguard the safety and security of citizens and interests from threats within those borders.
Multiple health stakeholders in Africa need to work together to take urgent and consistent action to reduce the abuse and misuse of antimicrobials for greater effectiveness in treating illnesses.
Antimicrobial resistance (AMR) is a public health threat and it is killing thousands in Africa annually.
Powerful medicines are becoming ineffective rapidly because the disease-causing organisms have developed resistance to them.
The misuse and abuse of both prescription and over-the-counter drugs is a leading cause of antimicrobial resistance.
The rise of AMR in Africa can be reduced and possibly eradicated by practising safe hygiene, using drugs correctly, and getting vaccinated.
African governments should engage consistently with multiple stakeholders in health in the region to raise community awareness and slow down the rate of antimicrobial resistance.
More country-specific research is needed to provide evidence for effective public policy-making that will address the problems and challenges of AMR in Africa.
AMR is a threat to African nation’s security. Spread the awareness. Save lives.
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2. Moyo P, Moyo E, Mangoya D, Mhango M, Mashe T, Imran M, and Tafadzwa Dzinamarira T. Prevention of antimicrobial resistance in sub-Saharan Africa: What has worked? What still needs to be done? Journal of Infection and Public Health, Volume 16, Issue 4, 2023, p. 632-639. https://doi.org/10.1016/j.jiph.2023.02.020.
3. World Health Organization Antibiotics resistance; Fact Sheet 31 July 2020 Accessed October 17, 2023.
4. The Lancet. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. 12 February 2022. Accessed October 17, 2023.
5. Africa CDC Press release. International and African organizations partner to fight antimicrobial resistance in Africa. Handle antimicrobials with care. 18 November 2020. Accessed October 17, 2023.
6. Holmes AH, Moore LS, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, Guerin PJ, Piddock LJ. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016 Jan 9;387(10014):176-87. doi: 10.1016/S0140-6736(15)00473-0. Accessed October 17, 2023.
7. Michael CA, Dominey-Howes D, Labbate M. The antimicrobial resistance crisis: causes, consequences, and management. Front Public Health. 2014 Sep 16;2:145. doi: 10.3389/fpubh.2014.00145.
8. Cullinan K. Universal Health Coverage: Only Half of Africans Have Access to Health Care. Health Policy Watch. March 8, 2021. Accessed October 17, 2023.
9. Gulumbe BH, Adesola RO. Revisiting the blind spot of substandard and fake drugs as drivers of antimicrobial resistance in LMICs. Ann Med Surg (Lond). 2023 Feb 7;85(2):122-123. doi: 10.1097/MS9.0000000000000113.
10. Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014 Dec;5(6):229-41. doi: 10.1177/2042098614554919. Accessed October 17, 2023.
11. Musoke D, Namata C, Lubega GB, Niyongabo F, Gonza J, Chidziwisano K, Nalinya S, Nuwematsiko R, Morse T. The role of Environmental Health in preventing antimicrobial resistance in low- and middle-income countries. Environ Health Prev Med. 2021 Oct 5;26(1):100. doi: 10.1186/s12199-021-01023-2
12. Fuhrmeister ER, Harvey AP, Nadimpalli ML, Gallandat,K, Ambelu A, Arnold BF, et al. Evaluating the relationship between community water and sanitation access and the global burden of antibiotic resistance: an ecological study. The Lancet Microbe. 2023. 4(8), E591-600.
13. O'Neill J. Infection prevention, control and surveillance: limiting the development and spread of drug resistance: the review on antimicrobial resistance. 2016. Accessed October 17, 2023.
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15. Feiyang Ma, Shixin Xu, Zhaoxin Tang, Zekun Li, Lu Zhang, Use of antimicrobials in food animals and impact of transmission of antimicrobial resistance on humans. Biosafety and Health, Volume 3, Issue 1, 2021, Pages 32-38, https://doi.org/10.1016/j.bsheal.2020.09.004
16. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, Satta G, Cooke G, Holmes A. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing, Clinical Infectious Diseases, Volume 71, Issue 9, 1 November 2020, Pages 2459–2468, https://doi.org/10.1093/cid/ciaa530
17. Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, Fuller NM, Willcocks SJ, Hasan R, van Kleef E, Chandler CI. Antimicrobial resistance and COVID-19: Intersections and implications. Elife. 2021 Feb 16;10:e64139. doi: 10.7554/eLife.64139.
18. Lobie TA, Roba AA, Booth JA, Kristiansen KI, Aseffa A, Skarstad K, Bjørås M. Antimicrobial resistance: A challenge awaiting the post-COVID-19 era. Int J Infect Dis. 2021 Oct;111:322-325. doi: 10.1016/j.ijid.2021.09.003.
19. Clancy CJ, Buehrle DJ, Nguyen MH. PRO: The COVID-19 pandemic will result in increased antimicrobial resistance rates. JAC Antimicrob Resist. 2020 Sep;2(3):dlaa049. doi: 10.1093/jacamr/dlaa049.
20. The World Bank By 2050, drug-resistant infections could cause global economic damage on par with 2008 financial crisis. September 2016. Accessed October 17, 2023.
21. Food Standards Agency, UK. Antimicrobial resistance (AMR) Last updated: 8 January 2018. Accessed October 17, 2023.
22. Kim C, Holm M, Frost I, Hasso-Agopsowicz M, Abass K. Global and regional burden of attributable and associated bacterial antimicrobial resistance avertable by vaccination: modelling study. BMJ Global Health 2023;8:e011341. http://dx.doi.org/10.1136/bmjgh-2022-011341
23. Center For Disease Control And Prevention (CDC). Disease Threats and Global WASH Killers. Last reviewed: March 2020. Accessed, October 17, 2020
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