Africa Must Lead the Fight Against Antimicrobial Resistance through Hospital-based Antimicrobial stewardship Initiatives
Editors’ note In this blog, Ibrahim Kamara, former Inter-CeBIL fellow and now medical doctor, public-health specialist, and researcher scientist, argues that Africa must take the leading role in combating antimicrobial resistant (AMR) by implementing hospital-based antimicrobial-stewardship initiatives. This contribution relates to Inter-CeBIL’s Key Area 2 on Pandemic Preparedness and AMR, with a particular focus on perspectives from the Global South.
Antimicrobial resistance (AMR) is a growing global health threat, but its impact is particularly severe in Africa, where resistance infection rates and death are highest.
In just 2021, 4.7 million deaths were associated with AMR worldwide, the majority of which occurred in Africa, particularly in West African countries like Sierra Leone. Over the next 25 year, it is estimated that 39 million people could die from antibiotic resistant infections. World Health Organization (WHO), in order to mitigate this social menace, developed the global action plan to combat AMR. This plan is a blueprint that countries can use to develop their own national action plans. By 2024, 45 out of 47 countries in the WHO African Region had developed their NAPs and 33 of them were endorsed by the governments. However, there is still room for improvement when it comes to implementation and monitoring.
One of the key objectives of these NAPs aims to promote rational use of antibiotics. Antimicrobial Stewardship Programmes are urgently needed in hospitals across Africa, given the high burden of infectious disease, widespread antibiotic misuse and weak healthcare systems. These programs encourage responsible antibiotic use, improve patient safety, reduce healthcare costs, and promote responsible antibiotic use. ASPs integrate various interventions, including (i) training of healthcare workers, (ii) monitoring of antibiotic use, (iii) prescription audits, (iv) treatment guidelines enforcement, (v) awareness campaigns, and (vi) infection prevention and control (IPC) measures.
With Africa bearing the brunt of high AMR illnesses and deaths, a multisectoral collaboration is mandatory to fast-track the implementation of ASPs and sustain long-term antimicrobial effectiveness for the treatment of bacterial and other infections. This collaboration must include
stakeholders from African governments across ministries concerned with human health, livestock, and the environment; the WHO; health workers, public health professionals, and health system researchers. Additionally, to succeed, each ASP must be context-specific, tailored to the needs of the different health facility levels, because a ‘one size fits all’ approach for ASP establishment is not pragmatic. I recommend a minimum standard at each level of service delivery for the ASP, such as a focal point, or an antimicrobial management (AMS) team depending on the type of facility. The higher-level facilities need multidisciplinary AMS team consisting of an infectious disease specialist or medical doctor, a pharmacist (or a pharmacy technician), a nurse and any other healthcare worker interested in AMS. These AMS focal people/teams are responsible for the daily implementation of AMS activities.
Furthermore a hospital technical team should be formed with a mandate that includes resource mobilization, advocacy and incentivization, to galvanize AMS interventions and maximize their effectiveness. Africa will be better positioned in the fight against AMR by implementing context-specific and cost-effective AMS intervention, as the burden of disease and death is higher in this region than in other parts.
ASP should place greater emphasis on hospital IPC activities because of the higher risk of infection in African countries. Effective IPC will ensure a safe working environment for patients, healthcare workers, and their relatives. Simple measures such as hand hygiene, waste management, accessing clean water and sanitation facilities, a well-ventilated environment with adequate bed spacing, and a cleaner environment can reduce the spread and severity of resistant infections. “An infection prevented is an antibiotic prescription postponed and an avoidance of likely inappropriate antimicrobial use.”
Research is instrumental for effective ASP implementation. African researchers can conduct operational research to test standard ASP initiatives, and expand evidence on what works in local contexts. This research can be conducted by global south and north collaboration in order to ensure shared learning. There is limited evidence about the effectiveness of different AMS interventions across diverse contexts. Africa should be a global player, sharing its learnings with other regions. Africa should not follow the trend of top-down impositions for AMR solutions, but rather contribute to the AMR-reduction agenda using a win-win strategy. The African governments will have to allocate funding to research in order to produce local evidence about AMR and AMS. Knowledge exchange will reduce AMR-related illnesses and deaths worldwide. We urgently need a collective global campaign to curb this menace to society, and Africa must lead this AMR fight!
This post was originally posted by International Health Policies.
About the author
Ibrahim Kamara
is a medical doctor, public health specialist, and research scientist with 12 years of experience in clinical medicine and public health. Ibrahim Kamara
