November 29, 2019

Tackling Antimicrobial Resistance in Nigeria: A multidisciplinary approach as the way forward

Babatunde Yusuf Olalekan

The major causes of morbidity and mortality are communicable diseases and these are generally managed using antimicrobial drugs whose usefulness is being threatened by Antimicrobial Resistance (AMR).

Much antimicrobial use and misuse are driven by patients, farmers and the general populace who demand antimicrobials for real or presumed infections and procure them from unsanctioned sources even when they are not prescribed.

The drugs that have transformed life and longevity and saved countless lives since penicillin was discovered by Sir Alexander Fleming in 1928 now saturate every corner of our environment. We stuff them into ourselves and our animals; we spray them on crops and dump them in rivers.

READ ALSO: Antimicrobial resistance kills more than 700,000 people every year — WHO

As a result of all these, AMR has become a complex and multifaceted problem that cannot be tackled using one approach but rather a multidisciplinary approach. Antimicrobial resistance has made mankind reach its tipping point and some are saying we are already in the post-antibiotic era.

The concept of One Health could be one of the best approaches to this threat. One health is an approach that is designed in such a way that multiple sectors communicate and work together to achieve better public health outcomes.

There is a need for a comprehensive approach that incorporates and intertwines human health, animal health, and environmental factors to tackle antimicrobial resistance. Many professionals with a range of expertise who are active in different sectors such as public health, animal health, plant health, and the environment should come together and think of a multidiscipline solution to AMR.

The One Health approach is particularly relevant in combatting antimicrobial resistance because many of the same microbes infect animals and humans as they share the eco-systems they live in. There should be a collaborative effort of multiple disciplines to tackle antimicrobial resistance.

The importance of studying the human-animal-ecosystem interface in the evolution and emergence of microorganisms or pathogens should be paid more attention to in order to have a good grasp on how to tackle antimicrobial resistance.

Considering the veterinary and environmental understanding in the emergence and re-emergence of infectious disease and in facing the challenges of antimicrobial resistance in addition to human activities can help stewards of AMR look beyond optimizing prescribing practice and strengthening the UK and international collaboration.

READ ALSO: Antimicrobial Resistance in Nigeria: A silent eradicator

Rational use of antibiotics requires access to objective information and awareness; pharmacists, veterinarians, and physicians need a good understanding and up-to-date information about reviews or researches made on antimicrobials to effectively prescribe them.

Due to the lack of a well-established drug information centre in Nigeria, there is no provision for accurate, unbiased and up-to-date information about antimicrobials and their use to the farmers, healthcare professionals, and the general populace.

The awareness factor also contributes to the issue of antimicrobial resistance, proper antimicrobial education to everyone everywhere on antimicrobial resistance and on one health could reduce the misuse of these agents in all related fields.

A well-established forum of collecting, analyzing and disseminating antimicrobials information to the public and also providing appropriate local treatment guidelines to healthcare professionals could help prevent further damage these agents have caused. The antimicrobial information will be disseminated using specific messages among others through bulletins, posters, brochures, billboards, and social media.

In October 2016, the WHO invited stakeholders to solicit general information on how to effectively carry our Antibiotics Awareness Campaigns (AAC) with a particular focus on key messages supporting the optimal use of antibiotics. Stakeholders in 93 countries were contacted and 55 countries responded. Overall, 60 AACs from 16 low/middle-income countries were identified. Forty-five campaigns (75%) were conducted on a national level.

For the purpose of this survey, the term AAC was defined as a comprehensive effort to disseminate information about responsible use of antibiotics and the risks of antibiotics misuse to healthcare professionals in addition to the lay public. The issue that occurred was that the messages conveyed were not rigorously based on scientific evidence and context specificities.

READ ALSO: Lack of infection control, prevention fuels antimicrobial resistance in Nigeria — OGUNSOLA

Conclusively, many but not all the curricula of healthcare professionals contain some mentions of antimicrobial resistance. Curricula revisions that treat the topic more explicitly, continuing education for practitioners professing on AMR is also desirable.

A multidisciplinary approach that tackles antimicrobial resistance from all angles in conjunction with strengthening and enhancing antimicrobial education on the sides of both the healthcare professional and the patients has the potential to positively impact the global issue of Antimicrobial Resistance in Nigeria and this can be adopted in other developing countries.