Fourteen African countries have taken a “critical step” towards controlling the deadly problem of superbugs — bacteria, viruses, parasites and fungi which are resistant to most antibiotics — by expanding their lab surveillance and reporting on antimicrobial drug resistance.
Africa has the world’s highest death rate from antimicrobial resistant infections, reported at 27 deaths per 100,000.
But only five out of 15 antibiotic-resistant pathogens most dangerous to people were being consistently tested in the 14 countries which participated in the new research, mapping “the growing menace” of antimicrobial resistance across the continent.
Only 1% of the 50,000 participating laboratories were ready to do bacteriology testing and even fewer had the resources to detect antimicrobial resistance (AMR), the researchers found.
Dr Yewande Alimi, AMR programme coordinator for the Africa Centre for Disease Control and Prevention, said the reports put AMR on the map of Africa for the first time.
“It is a critical step to address the threat on the continent,” she said.
Antimicrobial resistance on the continent is a greater health burden than HIV/Aids and far greater than that of Covid-19, warned a 2022 policy brief by the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP) consortium.
The landmark study, led by MAAP, revealed that only four drugs made up the backbone of antibiotic use being used for two-thirds of treatments in healthcare settings.
Only six countries had “reserve category antibiotics” which are vital to treat resistant pathogens. Superbugs can cause pneumonia and skin, urinary tract and hospital-acquired infections which are potentially fatal.
The reports exposed “an alarming picture of antimicrobial consumption” in African countries, in which patients lacked access to the drugs and use was erratic.
Erratic consumption, insufficient dosing or shortening a course of antibiotics increases resistance.
However bleak the findings, the reports are a baseline for moving forward.
“The reports constitute a unique resource for (those) working at reducing the burden of AMR in Africa,” said Pascale Ondoa, science director at the African Society for Laboratory Medicine, which co-published them with the Africa CDC.
Globally, 1,27 million deaths are attributable to infections caused by resistant bacteria and deaths “could rise as high as 10 million in 2050”, according to the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (Charm).
* Enterobacterales, including E. coli, a common food poisoning infection, and Klebsiella pneumonias, common in hospitals. More than half of all samples tested were resistant to penicillins and cephalosporins;
* Staphylococcus aureus, the source of a skin infection that can turn deadly if drug-resistant. More than 40% of samples tested were classified as methicillin-resistant;
* Staphylococcus aureus, a lethal pathogen/drug resistance combination that globally accounted for more than 100,000 deaths in 2019. These can cause infections in the blood, lungs (pneumonia), and other parts of the body after surgeries. More than 30% of samples tested were resistant to Carbapenems, a class of antibiotics used to treat resistant infections. Resistance to these medicines is a grave threat.
Source: 14 country reports, published by the Africa CDC and the African Society for Laboratory Medicine, supported by the UK Aid Fleming Fund
— Five of the most dangerous tested included:
Charm head Prof Nelesh Govender, based at the National Institute for Communicable Diseases (NICD), said: “Antimicrobial resistance affects everyone. AMR is not a single ‘disease’.
“The NICD collects, analyses and shares surveillance data from people with infections caused by AMR bacteria and fungi so we can all act to reduce its effect on human health.
“Antimicrobial stewardship is only one example of how we can all act. We can choose to use antibiotics wisely so we don’t amplify the AMR problem.”
South Africa’s laboratory network and AMR surveillance, across state and private healthcare, is more developed than most countries on the continent, and its 2021 report was the most comprehensive yet.
The public health sector used less than 8% of the total antibiotics procured, while both the public and private sector had a high usage of broad spectrum penicillin, it found.
About 40% of imported antibiotics in South Africa went to human use, while almost 60% was for animal use between 2018 and 2020, broadly aligned with other countries internationally, the report stated.
The countries participating in the MAAP research were Burkina Faso, Cameroon, Eswatini, Gabon, Ghana, Kenya, Malawi, Nigeria, Senegal, Sierra Leone, Tanzania, Uganda, Zambia and Zimbabwe.
More than 819,500 data records of antimicrobial resistance were collected from 205 labs between 2016 to 2019 for the reports, which will inform national action plans and policy in Africa.
Africa heads of states in 2020 committed to tackling the AMR threat across human and animal health and agriculture through the Africa Union Framework for Antimicrobial Resistance Control 2020-2025.
Until now, health experts in most countries have been “flying blind” about how widespread AMR was and what drives it, the study showed. But improved surveillance moving forward will allow them to chart a safer course before Africa runs out of treatment options.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.