Lack of access, erratic use magnify antimicrobial infections in Africa

Only five of the 15 antibiotic-resistant bacteria listed by the WHO as priority pathogens are being tested in the continent

By Susan Chacko
Published: Monday 19 September 2022

Limited access to resources and erratic use of antimicrobials have magnified the antimicrobial resistance (AMR) infections in Africa, according to a new study by the African Union.

AMR accelerates due to the misuse and overuse of antimicrobials in humans, animals and crops.

Only five of the 15 antibiotic-resistant bacteria listed by the World Health Organization (WHO) as priority pathogens are being tested in the continent, stated the study published September 15 2022.

Some 34 uncategorised antibiotics were also found to be in circulation in 14 African countries, increasing the risk of AMR infections.

Only 1.3 per cent of the 50,000 laboratories across sub-Saharan Africa perform bacteriological testing. Failure to test priority resistant pathogens translates to substandard healthcare, where antimicrobials are irrationally used to treat infections.

Some 12 African countries have high drug resistance index scores, indicating the impact of rising AMR. A score higher than 25 per cent is of significant concern, while 12 countries scored at least 50 per cent.

Only four drugs — amoxicillin, doxycycline and combinations of sulfamethoxazole or trimethoprim and ciprofloxacin — comprised more than two-thirds of all the antibiotics used, according to the data from the 14 Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP) countries.

More potent medicines to treat more resistant infections such as — severe pneumonia, sepsis and complicated intra-abdominal infections — were unavailable. It suggests limited access to some groups of life-saving antibiotics.

Erratic consumption of unrecommended combinations of antibiotics was also sighted by the researchers. Some 3.4 per cent of the total antibiotic consumption across the 14 countries is from the combinations which are not recommended by the WHO. The bulk of the medicines used in this case was a mixture of ampicillin and cloxacillin.

The antibiotics listed on the national essential medicine lists were not in line with the WHO’s list, the researchers noted. The medicines used in these countries were often not aligned with the national essential medicine lists. Some 34 uncategorised antibiotics in circulation are not included in the national essential medicine lists.

Some 88 per cent of the 180,000 samples tested had no information on patients’ clinical profiles, while the remaining 12 per cent had incomplete information.

“Across Africa, even where data on antimicrobial resistance is collected, it is not always accessible. As a result, health experts cannot develop and deploy policies that would limit AMR,” said Nqobile Ndlovu, CEO of the African Society for Laboratory Medicine.

Three pathogens — Enterobacterales, Staphylococcus Aureus and Pseudomonas Aeruginosa — are of immediate concern in sub-Saharan Africa.

Enterobacterales are a large order of different bacteria that commonly cause infections in healthcare settings. Staphylococcus Aureus is the leading cause of skin and soft tissue infections such as — abscesses (boils), furuncles and cellulitis. Pseudomonas is a type of bacteria found in soil and water.

Africa has the highest mortality rate from AMR infections globally, with 27.3 deaths per 100,000 attributable to AMR, according to a Lancet study.

Antimicrobial resistance is one of humanity’s top 10 global public health threats. Some 4.1 million people across Africa could be dead by 2050 if action is not taken to resist the resistance, according to the WHO.

The MAAP carried out a multi-year, multi-country study. MAAP is the first initiative to systematically collect, process and evaluate large quantities of antimicrobial resistance and antimicrobial consumption data in Africa.

MAAP reviewed 819,584 AMR records of 205 laboratories from 2016-2019. They belong to Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Kenya, Tanzania, Uganda, Malawi, Eswatini, Zambia, Zimbabwe, Gabon and Cameroon.

MAAP also reviewed data from 327 hospitals and community pharmacies and 16 national-level datasets on antimicrobial consumption in 14 African countries.

Centre for Science and Environment, a non-profit, in March 2021, organised an Asia-Africa meet on antimicrobial resistance AMR as catastrophic as COVID-19 and climate change.

The need for broader adoption of the ‘One Health’ approach to deal with AMR was reiterated by experts. The One Health approach implies greater synergy between the human, animal and environmental health sectors.

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