Current Challenges in Microbial Drug Resistance in Africa
Mtapuri-Zinyowera S1. Woods P2, Manangazira P1, Hove R1, Kujinga T3, Madzikwa N1, Wekwete W4, Machakwa J5, Midzi S6, Gonah N1, Ndhlovu M1, Makoni Z4, Phiri I1, Nyandoro G7, Gwanzura L7,8.

  • Ministry of Health and Child Care
  • Food and Agriculture Organization
  • Pan African Treatment Access Movement
  • Medicines Control Authority of Zimbabwe
  • Division of Veterinary Services
  • World Health Organization
  • Biomedical Research and Training Institute

 
Introduction
It has been projected that by 2050 antimicrobial resistance (AMR) will cause 10 million deaths per year and this will cost the world 100 trillion dollars. In Tanzania, AMR has been a major risk of poor outcomes in children with septicaemia  aged between 0-7 years. In Kenya Escherichia coli isolated from hospital patients was highly resistant to commonly used drugs.  In Zimbabwe, 70% of Clostridium difficile isolated from diarrheic stools was found to be resistant to cotrimoxazole, Salmonella typhii isolated during an  outbreak were resistant to ciprofloxacilin, Neisseria gonorrhea has been found to be resistant to fluoroquinolines. Major causes of AMR in Africa include the HIV/AIDS epidemic where there is co-trimoxazole prophylaxis, inappropriate use, poor water and sanitation and hygiene, lack of proper diagnosis and poor nutrition.  At the 68th World Health Assembly in May 2015, there was the adoption of the Global Action Plan on AMR and countries were urged to have in place national action plans.
Methodology
The Zimbabwe AMR Core Group carried out a situational analysis on AMR from different sectors by doing desk review of documents in the human health and agriculture sector including the environment. A knowledge attitudes and practices questionnaire was also done including interviews of key informants. This Core Group also organized a workshop, sponsored by Food and Agriculture Organization (FAO), and attended by over a 100 people from the different sectors; the Ministries of Health, Agriculture, and Environment, the academia, regulatory bodies, research institutions, non-governmental organizations, industry and the private sector. The Deputy Ministers of Health and of Agriculture, the Principal Director for Livestock and the Secretary for Health all actively participated on day one of the 3 day workshop. Plenary presentations, discussions, group work, presentations from group work and recommendations were made towards a common plan of action to address AMR.

Results
The situational analysis revealed that there has been a few researches that have been carried out in Zimbabwe which have revealed the presence of resistant microbials. The KAP survey for 101 Medical Doctors indicated that 78% worked in urban areas, 56.1% have had cases of AMR, 91.8% prescribed antibiotics empirically. Out of the 102 pharmacy respondents, 87% worked in urban areas, 59.4% agreed that antibiotic resistance is a serious problem in Zimbabwe, 50% agreed that they sometimes prescribed antibiotics themselves, and that the most common antibiotics that they sold without a prescription were amoxicillin, cotrimoxazole and ciprofloxacin. And that for Veterinary Doctors showed that unqualified Veterinary Medicines General Dealers were the ones that dispense medicines to farmers.
There were 126 participants that attended the workshop on the first day. Sixty-two percent of the participants attended all three days. Information concerning the AMR situation was obtained including the drafting of a national action plan using World Health Organisation (WHO) tools. Six technical working groups on education and awareness, surveillance, antimicrobial use, infection prevention control and bio-security and research and development were formed.
Recommendations

  • There is need for multisectoral collaboration in addressing AMR.
  • Rational use of antimicrobials in both human and animal health.
  • There is need for education and awareness of AMR for the general public and the health professionals.
  • AMR stewardship programs and infection prevention control to be implemented in hospitals.
  • Capacity building of laboratories in order to have an effective surveillance system.
  • AMR research to be carried out.

Conclusion
A ‘One Health Approach’ is being adopted in Zimbabwe in order to combat antimicrobial resistance in the country.