For many Kenyans, getting a dosage of antibiotics across the counter of a pharmacy is almost as easy as walking into a shop and buying candy.
This, unfortunately, results in the abuse of drugs that are used to treat infections, thus contributing to the medical phenomenon known as Antimicrobial Resistance (AMR).
Antimicrobials are all agents that act against microorganisms, namely fungi, bacteria, protozoa and viruses. They are medicines used to prevent and treat infections in humans, animals and plants.
Antibiotics, used in the treatment and prevention of bacterial infections are the most important class of antimicrobials.
AMR (Antimicrobial Resistance) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.
AMR is a problem for all countries at all income levels. Its spread does not recognize country borders, but its drivers and consequences are exacerbated by poverty and inequality. Low and middle-income countries are most affected.
The Global Research on Antimicrobial Resistance (GRAM) paper published in 2022 provides useful insights into the burden of AMR, with evidence showing that Antimicrobial Resistance is a leading cause of death globally, higher than HIV/AIDS or Malaria. New estimates have revealed that at least 1.27 million deaths in 2019 were attributable to AMR.
AMR threatens our ability to cure common infectious diseases such as pneumonia, tuberculosis and gonorrhoea.
It also threatens to undermine major medical advances such as surgeries, treatment of cancer and care for pre-term babies.
AMR puts at risk our ability to reach global health goals such as reduction of child mortality and improvement of maternal health.
In addition to death and disability, AMR has significant economic costs. The World Bank estimates that AMR could result in $1 trillion in additional healthcare costs by 2050 and $1 trillion to $3.4 trillion in gross domestic product (GDP) losses per year by 2030.
This demonstrates that antimicrobial resistance is a major threat to global health and requires a range of interventions and a multidisciplinary approach.
Factors that contribute to AMR include lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals, poor infection and disease prevention and control in homes, healthcare facilities and farms, poor access to quality and affordable vaccines, diagnostics and medicines, lack of awareness and knowledge and lack of enforcement of relevant legislation.
The misuse and overuse of antimicrobials in humans, animals and plants are the main drivers in the development of drug-resistant pathogens.
We all have a role to play in the fight against AMR. As an individual, we should use antimicrobials sparingly and wisely. Always consult a healthcare professional for diagnosis when unwell. Do not demand to be prescribed antibiotics, instead ask if there are other effective treatments available. Do not self-medicate with antibiotics or use leftover medicines from a previous illness. If you are prescribed a course of antibiotics, follow all the treatment directions.
Uncontrolled use of antibiotics accelerates the development and spread of resistant bacteria. Furthermore, taking antibiotics is associated with risks, including side effects such as diarrhoea, allergic reactions and colonization of resistant bacteria in the body. Therefore, antibiotics should be used only when needed.
The best way to avoid having to use antibiotics is to limit the risk of getting an infection in the first place. To minimise the use of antimicrobials, we should strive to stay healthy rather than fall sick and go for medication. Wash your hands regularly, and insist that others wash their hands as well. Get all necessary vaccinations, and make sure other family members are vaccinated. There are many extensively used and safe vaccines that protect against severe viral and bacterial diseases such as polio and whooping cough. Some vaccines must be taken at regular intervals to remain protected, make sure you adhere to the schedules.
Always prepare and cook food properly; wash your hands before, during and after handling food. Cook meat to recommended temperatures and keep raw meat separated from vegetables and eating utensils. Take measures to ensure that the water you use is of good quality.
Avoid spreading disease, always stay home and rest when you are contagious.
We must learn more about bacteria and antibiotic resistance and raise awareness about it to those around us. Teach others about bacteria and antibiotic resistance, and inform them about possible actions to limit the problem. We should strive to become antibiotic resistance champions; help to raise awareness in our community, and be an example to others.
To tackle the problem of antibiotic resistance, people need to change behaviours at all levels of society. Knowledge is needed on why it is important to act for your own well-being as well as for the good of society, and what can be done to meet the challenge of antibiotic resistance.
By raising awareness, more people can be inspired to act, increasing our chances of succeeding in limiting the emergence and spread of resistant bacteria and preserving the cure for future generations.
Medical workers also have an important role to play in the fight against AMR.
Healthcare professionals should review existing data, collect new data, share results and feed data to surveillance systems.
To prevent infection, practice good hygiene, educate colleagues, establish infection prevention programs, promote vaccination and educate the community.
Healthcare professionals also have a role to play in following antimicrobial guidelines, educating colleagues and the community and establishing rational use programs.
Policymakers also have an important role to play.
The antibiotic resistance issue affects and involves many different actors, activities and sectors of society. In order to address the problem, it is critical to develop appropriate policies on regional, national as well as global levels.
The Global Action Plan on Antimicrobial Resistance calls for the development of national action plans to address antibiotic resistance in all World Health Organisation (WHO) member states.
A national action plan can serve as a core strategy to coordinate and align activities of different stakeholders and in different sectors; and provide a legal and political framework for action.
Dr Grace Wanjohi is the Pharmacy Manager at AAR Hospital, Kiambu Road, Nairobi
