Africa: Alarm as Antimicrobial Resistance Testing Capacity Wanting
By Sharon Atieno
Though Africa was found to have the highest mortality rate from antimicrobial resistance (AMR) infections in the world, with 24 deaths per 100,000 attributable to AMR in 2019, testing is still a challenge for most African countries.
This is according to a new data released on antimicrobial resistance (AMR) from 14 sub-Saharan countries carried out by Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP), a consortium spearheaded by the African Society for Laboratory Medicine (ASLM) and its partners which shows that most laboratory across Africa are not ready for AMR testing.
Only 1.3% of the 50,000 medical laboratories forming the laboratory networks of the 14 participating countries (Burkina Faso, Ghana, Nigeria, Senegal, Sierra Leone, Kenya, Tanzania, Uganda, Malawi, Eswatini, Zambia, Zimbabwe, Gabon and Cameroon) conduct bacteriology testing. Of those, only a fraction can handle the scientific processes needed to evaluate AMR.
The data also notes that of the 205 laboratories that provided data to MAAP, 44% rely solely on paper-based health records. Eighty percent of these labs perform fewer than 1,000 AST per year, and only one in five (most of them at the national level) use automated methods for pathogen identification or AST.And only 23% of the labs are International Organisation for Standardisation (ISO) accredited for bacteriology testing.
Additionally, in eight of the 14 participating countries, only less than half of the population have access to the small pool of bacteriology laboratories is geographically accessible ( reachable within one hour of travel by car or on foot) to less than half of the population.
Worse still, across the 14 countries clinical and treatment data are not being linked to laboratory results, making it hard to understand what’s driving AMR. Out of almost 187,000 samples tested for antimicrobial resistance, around 88% had no information on patients’ clinical profile, including diagnosis/origin of infection, presence of indwelling device (such as urinary catheters, feeding tubes and wound drains) often associated with development of healthcare-associated infection), comorbidities or antimicrobial usage while the remaining 12% had incomplete information.
The research also found that only four drugs comprised more than two-thirds (67%) of all the antibiotics used in healthcare settings. These include amoxicillin (penicillin with extended spectrum class), doxycycline (tetracycline class), the combination of sulfamethoxazole/trimethoprim (combinations of sulfonamides and trimethoprim (incl derivates) class) and ciprofloxacin (fluoroquinolones).
Stronger medicines to treat more resistant infections (such as severe pneumonia, sepsis and complicated intra-abdominal infections) were not available, suggesting limited access to some groups of antibiotics.
Reserve category antibiotics were found in only six of the 14 MAAP countries, the data notes adding that only 0.01% of all antibiotics used come from the Reserve category despite the high level of resistance observed.
Though, WHO does not recommend use of fixed combination antibiotics (two or more antibiotics combined in one tablet), 3.4% of the total antibiotic consumption across the 14 countries is from these combinations. Ampicillin/cloxacillin is the main fixed combination of antibiotics used.
“Africa is struggling to fight drug-resistant pathogens, just like the rest of the world,” said Dr Pascale Ondoa, director of science and new initiatives of the ASLM. “But our struggle is compounded by the fact that we don’t have an accurate picture of how antimicrobial resistance is impacting our citizens and health systems. This study shines much-needed light on the crisis within the crisis.
Based on the findings, MAAP is calling for a drastic increase in the quality and quantity of AMR and AMC data being collected across the continent, along with revised AMR control strategies and research priorities.
“The future of modern medicine and our ability to treat infectious diseases reliably hinges on our ability to control antimicrobial resistance,” said Dr. Ramanan Laxminarayan, director and president, One Health Trust. “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.”