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Antimicrobial resistance: a public health threat in Ghana

Ghana and the rest of the world stand the risk of losing one life every three seconds to an infectious disease by 2050, if the issue of Antimicrobial Resistance (AMR) is not tackled fast; according to studies.

Background

Being one of the biggest health issues that mankind has faced this century, it is currently estimated that in Europe about 50,000 people die each year, and still many experts have predicted that by 2050, there will be 10 million deaths each year, due to the problem of resistance.

AMR is so serious that in the past few years, it featured on the agenda of the World Health Assembly, United Nations General Assembly and the G8 and G20 summits, prompting the development of a Global Action Plan on AMR.

Globally, 150,000 people die out of about 440,000 resistant cases of tuberculosis according to the World Health Organisation (WHO).

What is AMR?

AMR is developed when microorganisms such as bacteria, viruses, fungi and some parasites are able to withstand the therapeutic effects of antimicrobials, rendering treatment of infectious diseases in humans and animals ineffective.

Bacteria that have acquired antimicrobial resistance may infect humans and animals and cause diseases that would be difficult to treat, thereby contributing to prolonged, more expensive treatments, longer hospital stays and increased mortality according to health professionals.

Impact of AMR?

AMR, which can lead to loss of production and productivity in animals also has negative impact on food safety and food security.  The phenomenon is reported to be rising at an alarming rate around the world including Ghana; making it one of the biggest threats to global health and development today.

The case of Ghana

Ghana continues to record multi-drug resistant cases of tuberculosis and this according to Dr (Mrs.) Angela Ama Ackon, Deputy Director, Pharmaceutical Services, Ministry of Health, is a source of concern to the Ministry and for that matter the government.

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

Various studies carried out proved the existence of antibiotic resistant microbes in Ghana. Very common microbes such as Streptococci, Salmonella, and E. coli showed very high levels of multiple drug resistance with some showing as high as 78.7 per cent resistance.

The prevalence of resistance to common and affordable antimicrobials like Tetracycline, Co-trimoxazole, Ampicillin and Nalidixic acid are significantly high (largely above 70 per cent) according to the National Action Plan on Antimicrobial Resistance.

“The commonest medicines that can be used to treat these kinds of infections are no longer working and people are spending more on expensive medicines and where they cannot afford to buy it, they are most likely to die”, the Deputy Director of Pharmaceutical Services at the Ministry of Health said.

Dr Alex Owusu-Ofori, a Clinical Microbiologist, Head of the Clinical Microbiology Unit of the Komfo Anokye Teaching Hospital (KATH) in Kumasi in the Ashanti Region noted that AMR, though not a new phenomenon has advanced to a precarious state.

Dr Owusu-Ofori who is also a Lecturer at the School of Medicine and Dentistry – Kwame Nkrumah University of Science and Technology (KNUST), noted that currently, patients who had infections that could previously be treated with common and inexpensive antibiotics such as Amoxycillin, Tetracyclin, Chloramphenicol and Septrin cannot be treated with the antibiotics any longer due to resistance.

“Rather, we have to use newer, more expensive antibiotics which are not readily available”, he said and stressed that subsequently patients with such infections get sick for longer periods, stay longer in hospitals, pay more for their treatment and are more likely to get complications and die.

He noted for instance that, about 70 per cent of the most common bacteria that cause urinary tract infections are resistant to the commonly used antibiotics.

According to him, lower rates of resistance are observed among sexually transmitted diseases such as gonorrhoea.

Abuse of antibiotics by public

On abuse of antibiotics, Dr Owusu-Ofori noted that buying of non-prescribed antibiotics at pharmacy shops, non-completion of the full course of prescribed antibiotics, and passing-on an antibiotic that has been effective on an individual to another without clinical advice.

Other forms of abuses, he outlined include; one opening an antibiotic capsule and pouring its contents on a wound; individuals taking antibiotics for common cold; and people buying antibiotics from drug peddlers and carrying them on their heads and selling in open market places with no appropriate literature on dosage, side effect and indications.

Evidence of lifestyle abuse of antibiotics abound and ranges from people mixing antibiotics in various alcoholic beverages, and honey to take for various kinds of reasons; and haphazard mixing of animal feed with antibiotics to either treat sickness or to make the animal(s) grow bigger.

Abuse of antibiotics by doctors

He said even though these forms of abuse are rife among the public in the country, there has also been some level of abuse by doctors and health personnel.

Dr Owusu-Ofori noted that ideally, doctors should send the patient(s) sample for investigations in the laboratory to identify the bacteria causing the disease and to know which antibiotic is best suited to treat the infection which is not done in some cases.

“Without performing the investigations, the doctor may give antibiotics which may not work, but which by then might have exposed all the bacteria in the body to the antibiotics”, he emphasized.

He acknowledged that other situations may be beyond the doctor and these include; fake drugs or the use of antibiotics in agriculture, which also contribute to the rapid spread of antibiotic resistance.

WHO Interventions

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

However, 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.

Lack of appropriate laboratory facilities

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.

Reports of drug resistance

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.

Public awareness

Despite the huge threat AMR poses to human life in the country, many Ghanaians are yet to realise the danger as the threat of the monster still remains in darkness.

Its popularity is only among health officials, policy makers, academicians and a hand full of activists despite several efforts by the Ministry of Health to create awareness.

Launch of Ghana NAP 2017

In response to the threat, the government of Ghana in collaboration with the Food and Agriculture Organization of the United Nations (FAO), WHO and the World Organization for Animal Health (OIE) has launched Ghana’s AMR policy and it’s National Action Plan in 2017.

The policy, which was put together with the collaboration of government ministries including; the Ministry of Health, the Ministry of Food and Agriculture, the Ministry of Environment, Science and Technology Innovation, and the Ministry of Fisheries and Aquaculture dwelled much on five strategic areas.

They include; improving awareness and knowledge of AMR; providing evidence-based knowledge to reduce the burden of AMR; reducing the occurrence of infections in establishment; optimising the use of antimicrobials in animal and human health; and creating an enabling environment for sustainable investment in AMR reduction (Ghana NAP 2017).

Regulatory framework

To back the implementation of the AMR policy with functional regulatory framework, President Nana Addo Dankwa Akufo-Addo tasked the Ministry of Health and the Attorney-General Department to take the necessary steps to move some selected aspects of the policy into legislation to ensure public health and safety.

Possible aspects of the policy that could move into legislation may include responsible use of medicines such as rules regarding prescribing of antibiotics and good laboratory practices as well as restricting the use of antibiotics in animal husbandry.

Stakeholders Commitment

This action according to Dr Angela Ama Ackon is a display of high level of commitment by the government to combat the threat of AMR in the country.

However, Madam Cecilia Lodonu-Senoo, Executive Director of Hope for the Future Generations and an AMR Activist, thinks that funding commitment from both government and the donor community was low, thereby making the AMR campaign not as vibrant as it should be.

She said the Ministry of Health was doing well, but the lack of adequate government and donor funding was thwarting their effort to take the campaign to the ordinary person, stressing that without adequate resources one could achieve little despite the level of passion.

She pointed out that the ignorant abuse of antibiotics could reduce if people were aware and informed about the potential health threat. “Because they are not aware and are not informed, you do not expect change from them”, she emphasised.

“The current snail 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”, she noted with passion.

By Prosper K. Kuorsoh

Source: GNA

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