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ANTIMICROBIAL RESISTANCE; A GLOBAL HEALTH CHALLENGE

Antimicrobial Resistance

Antimicrobial resistance is recognized as one of the greatest threats to human health worldwide. The world Health Organization (WHO, 2017) defined antimicrobial resistance (AMR) as the ability of microorganisms (like bacteria, fungi, viruses and some parasites) to stop an antimicrobial (such as antibiotics, antifungals, antivirals and antiparasitics) from working against it. These results in making the antimicrobial which is designed for treatment to become ineffective thereby make the infection to persist in human population.


The use of antimicrobials in an abusive manner without medical supervision, poor hygiene especially in rural communities, poor administration as well as inadequate therapy are reported as the main causes of this global problem (Tanko et al., 2020). AMR has the potential to affect people at any stage of life and can also occur in healthcare set up, environment, food, veterinary and agricultural industries. Currently, it is considered as one of the top ten global health challenges (CDC, 2018).


Deaths resulting from drug-resistant infections are projected to increase from 700, 000 to 10 million annually and the cost may reach as high as US$100 trillion worldwide by 2050 (Osman et al., 2019). Developing countries could contribute more to the disease burden due a weak health care system and poor hygiene, brought about by low public awareness and weak coordination of AMR campaign by government and partners.



AMR in Nigeria

In Nigeria, AMR has resulted in reduced efficacy or treatment failures of antimicrobials making the disease burden higher, treatment expensive, difficult or impossible. Impoverished and vulnerable individuals who are unable to bear the associated high cost of medication ultimately suffer considerably and increases mobility and mortality in the entire disease episode (Nigerian National Action Plan on Antimicrobial Resistance (2017).


According to some reports, antimicrobial resistances due to non- communicable diseases such as malaria, acute respiratory infections, measles, diarrhoea, tuberculosis, HIV and neglected tropical diseases (NTDs) accounted for 66% of total morbidity in 2015. Some studies confirm that susceptibility pattern of local isolates found many of the organisms resistant to first- line drugs. A data confirmed that 46.7 % to 71.1 % of children aged 0-5 years within the project area were given antibiotics without prescription.


Dearth of information regarding AMR is hampered by inadequate data (Tanko et al., 2020). This is because surveillance of drug resistance is limited to a few countries, thereby resulting in incomplete data on the true nature of this problem. This is further compounded by poor educational background and weak health care system of the inhabitants. This could lead to an increasing number of treatment failures in patients with infections caused by multi-, extensive-, and pan-drug resistant pathogens. There are compelling evidence suggesting that the incidence of AMR is increasing in high income and low income countries with low income countries being the most affected.


Causes of AMR

Sometimes AMR occurs naturally in some species of microorganisms, but AMR is usually caused by the use of antimicrobials. Specifically, the following are causes of AMR;

  1. Misuse and overuse of antimicrobials: The more we use antibiotics, the more chances bacteria have to become resistant to them. This means that antibiotics won’t work when we need them in the future. If we decrease antibiotic use, the antibiotics may again become effective at killing bacteria.

  2. Poor hygiene and infection prevention control: Poor hygiene provides more opportunity for resistant bacteria and other germs to spread, largely it will make more people sick and increase the need for antibiotics.

  3. Travels: Antibiotic resistance is more common in some countries, and different countries can have different types of resistant bacteria. Travellers can become sick by:

  • eating contaminated food

  • drinking contaminated water

  • touching contaminated surfaces

  • contact with animals

  • receiving medical treatment overseas.

Prevention and Control of AMR

Individuals

To prevent and control the spread of antibiotic resistance, individuals can:

  • Only use antibiotics when prescribed by a certified health professional.

  • Never demand antibiotics if your health worker says you don’t need them.

  • Always follow your health worker’s advice when using antibiotics.

  • Never share or use leftover antibiotics.

  • Prevent infections by regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safer sex, and keeping vaccinations up to date.

  • Prepare food hygienically, following the WHO Five Keys to Safer Food (keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, use safe water and raw materials) and choose foods that have been produced without the use of antibiotics for growth promotion or disease prevention in healthy animals.

Policy makers

To prevent and control the spread of antibiotic resistance, policy makers can:

  • Ensure a robust national action plan to tackle antibiotic resistance is in place.

  • Improve surveillance of antibiotic-resistant infections.

  • Strengthen policies, programmes, and implementation of infection prevention and control measures.

  • Regulate and promote the appropriate use and disposal of quality medicines.

  • Make information available on the impact of antibiotic resistance.

Health professionals

To prevent and control the spread of antibiotic resistance, health professionals can:

  • Prevent infections by ensuring your hands, instruments, and environment are clean.

  • Only prescribe and dispense antibiotics when they are needed, according to current guidelines.

  • Report antibiotic-resistant infections to surveillance teams.

  • Talk to your patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.

  • Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).

Healthcare industry

To prevent and control the spread of antibiotic resistance, the health industry can:

  • Invest in research and development of new antibiotics, vaccines, diagnostics and other tools.

Agriculture sector

To prevent and control the spread of antibiotic resistance, the agriculture sector can:

  • Only give antibiotics to animals under veterinary supervision.

  • Not use antibiotics for growth promotion or to prevent diseases in healthy animals.

  • Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available.

  • Promote and apply good practices at all steps of production and processing of foods from animal and plant sources.

  • Improve biosecurity on farms and prevent infections through improved hygiene and animal welfare.



References


Centers for Disease Control and Prevention (2019) Antimicrobial Resistance Threat in the United States. https://www.cdc.gov/drugresistance/biggest-threats.html


Federal Ministry of Agriculture, Federal Ministry of Environment and Federal Ministry of Health (2017). National Action Plan on Antimicrobial Resistance


Osman M, Hiba A. M, Rayane R, Fouad D, Jean-Yves M, Marisa H, Monzer H (2019) Epidemiology of antimicrobial resistance in Lebanese extra-hospital settings: An overview. Global Antimicrob Resist 17: 123-129

Tanko N, Bolaji RO, Olayinka AT, Olayinka BO (2020) A systematic review on the prevalence of extended spectrum beta lactamase producing Gram-negative bacteria in Nigeria. J Global Antimicrob Resist 22:488–496


World Health Organization (2017, November 1) Antimicrobial Resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance






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