Shortfalls in fighting antibiotic resistance

According to the multi-year study carried out by the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership, most laboratories across Africa are not ready for AMR testing. MAAP reviewed 819,584 AMR records spanning from 2016 to 2019, from 205 laboratories across Malawi, Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Kenya, Tanzania, Uganda,…

New data released Thursday on antimicrobial resistance (AMR) from 14 sub-Saharan countries indicates that only five out of the 15 antibiotic-resistant pathogens designated by the World Health Organisation (WHO) as priority pathogens are being consistently tested and that all five demonstrated high resistance.

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat.

On the other hand, antibiotic resistance occurs when bacteria change in response to the use of respective medicines.

According to the multi-year study carried out by the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP), most laboratories across Africa are not ready for AMR testing.

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

MAAP also analysed data from 327 hospital and community pharmacies and 16 national-level antimicrobial consumption (AMC) datasets.

The results of the study, which was supported by the Fleming Fund, were released Thursday at a meeting held at the African Union (AU) headquarters in Addis Ababa, Ethiopia.

“Africa is struggling to fight drug-resistant pathogens, just like the rest of the world,” Dr Pascale Ondoa, director of science and new initiatives of the African Society for Laboratory Medicine (ASLM), said.

Ondoa added that Africa’s struggle is compounded by the fact that the continent does not have an accurate picture of how AMR is impacting its citizens and health systems.

The study results are said to have provided insight into the AMR burden and antimicrobial consumption in the 14 countries where most available data on AMR is only based on statistical modelling.

And the efforts by MAAP are said to be the first of their kind to systematically collect, process and evaluate large quantities of antimicrobial resistance and AMC data in Africa.

The WHO has constantly stated that AMR is a global health priority and that it is fact one of the leading public health threats of the 21st century.

A recent study estimated that, in 2019, nearly 1.3 million deaths globally were attributed to antimicrobial resistant bacterial infections.

Africa was found to have the highest mortality rate from AMR infections in the world, with 24 deaths per 100,000 attributable to AMR.

“Across Africa, even where data on antimicrobial resistance is collected, it is not always accessible, often recorded by hand and rarely consolidated or shared with policy makers.

“As a result, health experts are flying blind and cannot develop and deploy policies that would limit or curtail antimicrobial resistance,” ASLM Chief Executive Officer Nqobile Ndlovu said.

The researchers on AMR found that only 1.3 percent of the 50,000 medical laboratories forming the laboratory networks of the 14 participating countries conduct bacteriology testing.

And of those, only a fraction can handle the scientific processes needed to evaluate AMR, according to the study findings.

“The paucity of antimicrobial resistance testing services for 10 out of 15 of the priority pathogens identified by the WHO for causing the greatest threat to human health indicates that AMR levels are likely underestimated, which may directly impact patient care,” said Dr Geetanjali Kapoor, head of One Health Trust, an organisation that was part of the consortium that carried out the study.

The other partners in the consortium spearheaded by ASLM are the Africa Centres for Disease Control and Prevention, the West African Health Organisation, the East, Central and Southern Africa Health Community, Innovative Support to Emergencies, Diseases and Disasters and IQVIA.

According to the study’s findings, across the 14 countries, clinical and treatment data are not being linked to laboratory results, making it hard to understand what is driving AMR.

Out of almost 187,000 samples tested for antimicrobial resistance, around 88 percent had no information on patients’ clinical profile, including diagnosis or origin of infection, among others.

The remaining 12 percent had incomplete information.

The research also found that only four drugs comprised more than two-thirds (67 percent) of all the antibiotics used in healthcare settings.

Stronger medicines to treat more resistant infections, such as severe pneumonia, sepsis and complicated intra-abdominal infections were not available, suggesting limited access to some groups of antibiotics.

“Collectively, the data highlights a dual problem of limited access to antibiotics and irrational use of those that are available.

“As a result, people don’t get the right treatment for severe infections and irrational use of antibiotics drives antimicrobial resistance for existing available treatment options.

“Routine monitoring of antimicrobial consumption could help monitor the limited access and irrational use,” said Deepak Batra, head of Public Health (Africa and Middle East) and head of Real World Evidence (Middle East) at IQVIA.

MAAP has since called for a drastic increase in the quality and quantity of AMR and AMC data being collected across the continent, along with revised AMR control strategies and research priorities.

“The future of modern medicine and our ability to treat infectious diseases reliably hinges on our ability to control antimicrobial resistance,” Dr Ramanan Laxminarayan, director and president of One Health Trust, said.

He added that the study is an important step forward for Africa’s health systems and the health of people across the continent.

At the back of the threat of the rise of resistant organisms, the World Health Assembly at its 68th gathering in May 2015, adopted the Global Action Plan on AMR and established the Global Antimicrobial Resistance Surveillance System.

In February 2020, AU Heads of State and Government committed to addressing the threat of AMR across multiple sectors, especially human health, animal health and agriculture.

Studies show that nearly 1.3 million deaths globally are attributed to AMR every year, and that sub-Saharan Africa has the highest mortality rate in the world.

In March 2020, researchers Kathryn Haigh and four others published a paper that concluded that in Malawi, 20 years of surveillance data had captured “a recent and concerning rise in antimicrobial resistance among invasive bacterial infections in patients of all ages”.

Antimicrobial Resistance Coordinator at the Ministry of Health, Dr Watipaso Kasambara, said that time that in Malawi, patients take antibiotics anyhow leading to resistance.

“They self-medicate themselves when they feel sick or have a fever. All of us are to blame. We have in one way or the other accelerated the problem and we have contributed to increasing rates of antibiotic resistance,” Kasambara said.

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