Tiny Fraction of Laboratories in 14 African Countries Can Test for Antimicrobial Resistance
The lack of access to necessary medicines and vaccines creates a vacuum often filled by falsified and substandard medical products.

Despite numerous announcements and plans to tackle antimicrobial resistance (AMR) in Africa, the basic requirements for testing for drug-resistant pathogens are unmet in most areas, according to a new study of 14 countries.

Only 1.3% of the 50,000 medical laboratories in the participating countries were conducting bacteriology testing. Of those, only a fraction are able to handle the scientific processes needed to evaluate AMR. 

Even where laboratories were testing for AMR resistance, only five out of the 15 antibiotic-resistant pathogens designated by the World Health Organization (WHO) as priority pathogens are being consistently tested, and there was high resistance to all five.

The study reviewed about 820,000 AMR records from over 200 laboratories in Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Kenya, Tanzania, Uganda, Malawi, Eswatini, Zambia, Zimbabwe, Gabon, and Cameroon from 2016 to 2019. 

Data from 327 hospital and community pharmacies and 16 national level datasets was also included in the study, which was carried out by the Mapping Antimicrobial Resistance and Antimicrobial use Partnership (MAAP). MAAP is spearheaded by the African Society for Laboratory Medicine (ASLM), with partners including the Africa Center for Disease Control and Prevention (Africa CDC) and the One Health Trust.

No patient information

Out of almost 187,000 samples tested for AMR, around 88% had no information on patients’ clinical profile, including a diagnosis of the possible origin of infection. The remaining 12% had incomplete information. 

“The disconnect between patient data and antimicrobial resistance results, coupled with the extreme antimicrobial resistance burden, makes it incredibly difficult to provide accurate guidelines for patient care and wider public health policies,” said Dr Yewande Alimi, Africa CDC’s AMR programme coordinator. 

“Hence, collecting and connecting laboratory, pharmacy and clinical data will be essential to provide a baseline and a reference for public health actions.”

The research also found that only four drugs comprised more than two-thirds (67%) of all the antibiotics used in healthcare settings. Stronger medicines to treat more resistant infections such as severe pneumonia, sepsis, and complicated intra-abdominal infections were not available.

 

Deaths attributable to and associated with bacterial antimicrobial resistance (2019).

 Lack of access to antibiotics

“Collectively, the data highlights a dual problem of limited access to antibiotics, and irrational use of those that are available,” said Deepak Batra, from IQVIA, a clinical research company that is part of MAAP. 

“As a result, people don’t get the right treatment for severe infections, and irrational use of antibiotics drives antimicrobial resistance for existing available treatment options. Routine monitoring of antimicrobial consumption could help monitor the limited access and irrational use.”

The WHO has described antimicrobial resistance (AMR) as one of the top ten global public health threats facing humanity this century, threatening the effectiveness of the current panel of antibiotic drugs. 

Pascale Ondoa, Director of Science and New Initiatives at ASLM, noted that Africa’s struggle to fight drug-resistant pathogens is being compounded by the lack of information about how AMR is impacting Africans and the continent’s health systems. 

“This study shines much-needed light on the crisis within the crisis,” Ondoa said.

A role for African Medicines Agency?

Dr Ramanan Laxminarayan, Director and President of One Health Trust noted that the future of modern medicine and the world’s ability to treat infectious diseases reliably hinges on the ability to control AMR. 

“This study is an important step forward for Africa’s health systems and the health of people across the continent. I hope MAAP inspires more investment in essential data collection and desperately needed resources,” Laxminarayan said.

The newly formed Africa Medicines Agency (AMA) could become the lead in fighting AMR, considering that this is what its counterparts elsewhere do, including the European Medicines Agency.

But prior to the ratification of its treaty and announcement of Rwanda as the host country for the AMA headquarters, the Africa CDC in 2018 introduced a Framework for Antimicrobial Resistance Control in Africa that did not mention the AMA. 

Instead, it proposed the establishment of the Anti-Microbial Resistance Surveillance Network (AMRSNET) – a network of public health institutions and leaders from human and animal health sectors who will collaborate to measure, prevent, and mitigate harm from AMR organisms.

AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antimicrobials, which include antibiotics, antivirals, antifungals, and antiparasitics. This makes infections harder to treat and increases the risk of disease spread, severe illness and death. 

Given the urgency of the threat of the rise of resistant organisms, the World Health Assembly at its 68th assembly in May 2015, adopted the Global Action Plan on antimicrobial resistance and established the Global Antimicrobial Resistance Surveillance System. 

In February 2020, African Union (AU) Heads of State and Government committed to addressing the threat of AMR across multiple sectors, especially human health, animal health and agriculture.

Image Credits: WHO, The Lancet.

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