Antibiotic resistance: AMR in Ghana, huge public health threat under cover

Health dept steps may fall short due to inadequate funding by government, donors

By Prosper K Kuorsoh
Published: Thursday 23 January 2020

Ibrahim Ahmed mixes honey with Penicillin V and administers it if any family member suffers from cough and cold. “The kids don’t like to take antibiotics straight; when you mixed it with sweet honey, they eagerly take it,” the father of three said.

Ahmed, from Napogbakole community at Wa municipality in the country’s Upper West region, grinds the penicillin into powder, pour it into a small container of honey and stirs until the two mixes well.

Misuse of antibiotics is one of leading cause of antimicrobial resistance (AMR) — a point when microorganisms (bacteria, viruses, fungi and some parasites) withstand therapeutic effects of antimicrobials, rendering treatment of infectious diseases ineffective.

Ghana and the world risk losing a life every three seconds to an infectious disease by 2050 if AMR is not vigorously tackled, studies have suggested.

Ahmed, though, is ignorant of such negative effects. He considered administering antibiotics the way he does a regular practice, especially during the peak of dry harmattan winds that make children cough a lot.

Impact of resistance 

Globally, 150,000 of nearly 440,000 patients suffering from drug-resistant tuberculosis dies every year, according to the World Health Organization (WHO).

Ghana continues to record multi-drug resistant TB cases. This is a concern for the country’s health ministry, according to Angela Ama Ackon, deputy director of pharmaceutical services at the ministry.

“Given the current state, if we do not tackle AMR with the seriousness it deserves, soon we may not be able to boast of fully treated tuberculosis, gonorrhea, pneumonia and other infectious diseases,” she said.

Various studies proved the existence of antibiotic-resistant microbes in Ghana. Common microbes such as Streptococci, Salmonella, and E coli showed very high levels of multiple drug resistance — up to 78.7 per cent in some cases.

Resistance to common and affordable antimicrobials such as tetracycline, co-trimoxazole, ampicillin and nalidixic acid are significantly high (largely above 70 per cent), according to the National Action Plan (NAP) on AMR.

“The commonest medicines to treat such infections no longer work. Those who can, spend more on expensive medicines; those who can’t afford are most likely to die,” Ackon said.

AMR wasn’t new but has now advanced to a precarious state, said Alex Owusu-Ofori, who heads the clinical microbiology unit of the Komfo Anokye Teaching Hospital (KATH) of Kumasi in the Ashanti Region.

Patients who have infections that could previously be treated with common and inexpensive antibiotics —amoxycillin, tetracyclin, chloramphenicol and septrin — cannot be treated with them any more due to resistance, said Owusu-Ofori who is also a lecturer at the School of Medicine and Dentistry – Kwame Nkrumah University of Science and Technology (KNUST).

“Rather, we have to use newer, more expensive antibiotics that are not readily available,” he said.

Patients with such infections subsequently fall sick for longer periods, stay longer in hospitals, spend more on treatments and are more likely to develop complications and die, he added.  

About 70 per cent of the most common bacteria that cause urinary tract infections are resistant to commonly used antibiotics, Owusu-Ofori pointed out. Lower resistance rates were observed in sexually transmitted diseases such as gonorrhoea.

Abuse of antibiotics

Owusu-Ofori flagged:

  • The purchase of non-prescribed antibiotics at pharmacies
  • Non-completion of the full course of a prescribed antibiotic
  • Passing on an antibiotic effective on one individual to another, without clinical advice
  • Opening an antibiotic capsule and pouring its contents over a wound
  • Using antibiotics for common cold
  • Purchase of antibiotics from drug peddlers
  • Carrying antibiotics on heads and selling in open markets without appropriate literature on dosage, side effect and indications

There was also some abuse by doctors and health personnel. Doctors should send the patients or their samples for investigation to a laboratory to identify the bacteria causing any disease and know the antibiotic that would suit best. This wasn’t always done, Owusu-Ofori said.

“Giving antibiotics without investigations may not fully work but expose the bacteria in the body to that antibiotic,” the clinical microbiologist stressed.

There were things beyond the control of doctors — like fake drugs or the use of antibiotics in agriculture, which contribute to the rapid spread of antibiotic resistance.

WHO has provided some interventions to contain AMR, including creating a national task force, developing indicators to monitor and evaluate the impact of antimicrobial resistance and designing reference microbiological facilities that will coordinate effective surveillance of the phenomenon among common pathogens.

However, the lack of resources constrained implementation in many developing countries where treatment options also tend to be relatively limited. Thus, although a global problem, AMR tends to be more significant in developing countries than in the developed world.

Ghana’s case

In Ghana, antimicrobial therapy constitutes a major form of treatment. It is mainly empirical due to a relative lack of appropriate laboratory facilities for culture and susceptibility testing of bacteria in several health facilities according to studies.

Even where laboratory facilities are available, culture and susceptibility tests may not be requested due to the fact that this is an extra cost to be paid by the patient.

Studies also has it that in Ghana, drug resistance has mainly been reported from the Korle-Bu Teaching Hospital (KBTH) and KATH in Accra and Kumasi respectively, and hardly any from regional and district hospitals.

Thus, there is inadequate information on the susceptibility of microorganisms to antimicrobial agents used for treatment in several areas in Ghana. Without surveillance records of antimicrobial susceptibility, empirical treatment could be ineffective and expensive according to health professionals.

Many Ghanaians don’t realise the danger. Antibiotics are still popular among health officials, policy makers, academicians and some activists, despite several efforts by the health ministry.

There’s evidence of lifestyle abuse of antibiotics: they are mixed in various alcoholic beverages, energy drinks and honey. They are also haphazardly mixed with animal feed to either treat ailments or to make animals grow bigger.

The government, in collaboration with the United Nation’s Food and Agriculture Organization, WHO and the World Organization for Animal Health (OIE), launched an AMR policy and the NAP in 2017.

The policy was put together in collaboration with ministries, including those for health, food and agriculture, environment, science and technology innovation as well as fisheries and aquaculture.

It dwelled on:

  1. Improving awareness and knowledge of AMR
  2. Providing evidence-based knowledge to reduce AMR burden
  3. Reducing the occurrence of infections in establishments
  4. Optimising the use of antimicrobials in animal and human health
  5. Creating an enabling environment for sustainable investment in AMR reduction

To back its implementation with functional regulatory framework, President Nana Addo Dankwa Akufo-Addo tasked the Ministry of Health and the attorney-general’s department to take necessary steps to move select aspects into legislation to ensure public health and safety.

Such aspects may include the responsible use of medicines like rules regarding prescription and good laboratory practices and curbs on the use of antibiotics in animal husbandry.

Funding commitments from both the government and donors, however, were low, according to Cecilia Lodonu-Senoo an AMR activist and the executive director of Hope for the Future Generations.

The health ministry was doing well, but the inadequate funding was thwarting its effort to take the campaign to the ordinary person, she said.

Antibiotics abuse due to ignorance would reduce if people were aware and informed about the potential health threat, she pointed out.

“The current snail’s pace of tackling the issue cannot win the AMR threat. We need real political commitment that comes with resources for a vigorous campaign — that’s how we can win the fight,” Lodonou-Senoo said passionately.

Subscribe to Daily Newsletter :

Comments are moderated and will be published only after the site moderator’s approval. Please use a genuine email ID and provide your name. Selected comments may also be used in the ‘Letters’ section of the Down To Earth print edition.