An awareness campaign towards educating Nigerians about what is known as anti-microbial resistance to drugs is underway in the country. IDACHABA SUNNY ELEOJO reports.
What is known as antimicrobials are very essential in treating some diseases like pneumonia, sepsis and other life- threatening infections that may be found in man and animal.
Microbes such as bacteria can develop resistance to antimicrobials when they are used improperly. That means the bacteria is no longer susceptible to what should have been an effective drug. Investigation therefore reveals that globally, antimicrobials are increasingly becoming ineffective due to the inappropriate use of these drugs including the prescription of and use of antibiotics, which target only bacteria, during viral infections like the flu.
As a result of this, antimicrobial-resistant superbugs develop under the pressure of antibiotic abuse which confers on them a transmission advantage that allows them to spread more efficiently since they are now resistant to properly prescribed treatment.
According to the Lancet publication in 2022, an estimated 4·95 million deaths were associated with bacterial AMR globally in 2019. At the level of individual countries, report shows that the burden of death rate attributed to resistance is very high in western Africa, with 27·3 deaths per 100,000, thereby making it a super region for death due to drug-resistant pathogens.
Furthermore, according to the World Health Organisation (WHO), there are 15 priority antibiotic-resistant pathogens causing the greatest threat to human and animal health, a good number of which have been detected in Nigeria.
Available evidence and projections suggest that by 2050, AMR could cost US$300 billion to US$1 trillion annually in global ranking. In addition, the need for more expensive and intensive care, prolonged hospital stays, expensive and intensive treatments add to the direct monetary effects of AMR on health care in resource utilisation. AMR is also associated with the loss of livestock and increased cost of livestock production that indirectly affects the livelihood of farmers which in turn has a debilitating effect on GDP.
With reference to antimicrobial use in Nigeria, seven out of 10 persons in the community access antibiotics outside licensed health facilities or pharmacies, while many patients in the hospitals use overprescribed antibiotics that have a higher risk of bacterial resistance selection (above the 60% target set by WHO).
Statistics from NCDC
According to the Nigeria Centre for Disease Control (NCDC), “In the animal health sector, antimicrobials are available in the open markets without restriction; hence, the misuse of these products especially in food-producing animals. Residues of these antimicrobials in eggs, milk, and meat, when consumed by humans can potentially cause cancers, allergies, and mutations.”
In May 2015, the World Health Assembly (WHA) endorsed a global action plan on AMR under Sustainable Development Goal 3 (SDG 3) urging all member states including Nigeria to develop national action plans. The political declaration on AMR, as approved by Heads of State and adopted at the 71st session of the UNGA in October 2016, reiterated the commitment of UN member states to support the implementation of the One Health Global Action Plan at all levels.
“The novel COVID-19 pandemic is a constant reminder that for us to achieve good health and well-being for all, there is a need for stronger coordination and collaboration among all stakeholders using a One Health approach that assumes human health is inherently linked with that of animals, plants and our shared environments,” a statement by NCDC said.
Account of previous studies
It could be recalled that Nigeria’s AMR response commenced in 2017 following a situational analysis by NCDC in collaboration with the Federal Ministries of Agriculture and Rural Development and that of environment. It investigated antimicrobial-resistant pathogens found in hospitals, animals, agricultural and environmental sources as well as antimicrobial prescriptions. Some of the identified challenges for Nigeria’s AMR response include suboptimal coordination between relevant sectors (regulatory authorities and components of the healthcare delivery system), poor surveillance and response on account of limited availability of diagnostics and inadequate resources, suboptimal adoption and practice of standardised infection prevention and control practices in the community and health facilities, limited access to proper medications, inappropriate prescription practices, and poor enforcement of legal frameworks in place to regulate antimicrobial use. These informed the development of the National Action Plan (NAP) on AMR which is a five-year plan that addresses five key pillars in agreement with the WHO Global Action Plan on AMR.
This include increasing awareness and knowledge of health workers and the public on AMR, building a ‘One Health’ surveillance system, intensifying infection prevention and control and biosecurity, promoting rational use of antimicrobials and access to quality medications, and research into alternatives to antimicrobials, new diagnostics and therapeutics.
Ongoing awareness week
Nigeria is participating in the global health community to commemorate the annual World Antimicrobial Awareness Week (WAAW) which is currently taking place from November 18 to 24. As part of creating awareness of AMR during National Antimicrobial Awareness Week (NAAW), several activities have been outlined by the One Health National Antimicrobial Resistance Coordination Committee (NAMRCC) to include press briefing – Flag-off with partners from the Ministry of Agriculture and Rural Development, Federal Ministry of Environment, and One Health Stakeholders, media appearances across all platforms of public information, sensitisation activities in health facilities, awareness campaign among secondary schools students, awareness talks at religious gatherings, continued engagement with Borno and Kebbi state governments because they have subnational AMR-TWGs, sensitisation workshop for Poultry Value Chain actors like poultry farmers, live bird marketers, feed millers, transporters, poultry drug manufacturers/vendors, members of the Poultry Association of Nigeria (PAN),
Others include a Virtual Community of Practice on AMR meeting on phage, vaccination and probiotics led by the chairman Professor Onyebuchi Chukwu, twitter space discussion on antimicrobials and antimicrobial alternatives, a panel discussion on indiscriminate use of antibiotics and the way forward for pharmacists, patent medicine vendors, physicians and regulatory authorities.
NCDC and One Health stakeholders therefore have continued to urge Nigerians to use antimicrobials responsibly by asking for laboratory tests where possible in order to guide the use of antibiotics and other antimicrobial agents like anti malaria drugs.
It is also asking for the completion of the dose of antibiotics as prescribed by licensed human and animal health workers. To that extent, it is asking that on no account should leftover antibiotics be shared, no antibiotic should be used as prophylaxis or for growth promotion, while urging for strict practice of hand hygiene and environmental sanitation consistently.
“On a final note, ensure effective biosecurity practices on farms, vaccination of family members and animals appropriately.
“Though Antimicrobial resistance does occur naturally, the concern lies with the current high rates of development and spread. Other than overuse and misuse of antimicrobials in human and animal health, other AMR drivers include limited availability and uptake of vaccines; limited diagnostic capacity to support appropriate treatment; lack of access to clean water, sanitation and hygiene, poor infection prevention and control practices, poor disposal practices and the presence of antimicrobials in the environment and water bodies.
WHO in partnership
According to Dr Kazadi Mulombo, WHO representative in Nigeria.
“WHO joins hands with relevant government agencies, United Nations agencies and other partners in advancing and accelerating the efforts to combat AMR, through the One Health approach.”
NCDC says the federal government through NAMRCC led by NCDC remains committed to contributing to the global response to AMR and sustaining advocacy towards responsible use of antimicrobials.
