Engagement of Communities in Low- and Middle-Income Countries in Efforts to Reduce Antimicrobial Resistance

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By Hellen Rosette Oundo

For correspondence: helaoundo@gmail.com

Achieving universal health coverage and health-related sustainable development goals in reducing microbial infections has been deeply anchored on the use of antimicrobial, specifically in the areas of treatment and prevention. However, progress to this effect has hit a setback of continuous emergence of microorganisms (or pathogens) resistant to antimicrobials a condition referred to as Antimicrobial Resistance (AMR).

AMR occurs when genotypic changes in microorganisms occur, causing a specific antimicrobial agent used to treat its infections becomes less effective.  AMR remains one of the leading public health threats of the 21st century, with varying effects across economies worldwide. Evidence shows that AMR and its impacts have been greatly less understood in Low- and middle-income countries (LMICs).

LMICs are significantly impacted by AMR because of a combination of factors, such as poor health care infrastructure, inadequate access to clean water and sanitation, improper use of antimicrobials combined with limited AMR surveillance and governance. Furthermore, communities in LMICs are often neglected stakeholders in health initiatives such as sensitization and community-based research, yet they are potential resources that could contribute to the containment of AMR (Jim O’Neill 2016) (World Health Organization 2015).

In related studies, evidence shows that involvement of the community in the fight against AMR, improves their understanding of the subject and empowers them as agents of change with great potential in combating public health challenges(Mitchell et al. 2019). It’s upon this background that practices highlighted in this article if addressed, are a stepping stone towards community inclusion in the fight to reduce AMR in LMICs.

It’s with no doubt that use of antimicrobials, specifically antibiotics in livestock farming as growth boosters or un-prescribed preventive mechanism is still a common practice in LMICs which has led to AMR. In this case, farmers could be offered opportunities to work closely with qualified and trained veterinarians for proper preventive practices.

The huge knowledge and awareness gap of AMR in LMICs’ populations is still a limiting factor. With the necessary knowledge skills, people can be empowered to make better decisions and limit the propagation of AMR.  For instance, educating farmers on the ways AMR is transmitted to the food chain could prompt them to work more closely with veterinarians and other peers to implement strategies to better farm livestock without the need of using antimicrobials as a growth promoter or infection prevention.

Additionally, emphasis can be put on the importance of adherence to the dosage and duration of prescribed treatments by urging patients to continue with their prescribed treatment despite feeling better after a few days to avoid sub-optimal treatment that allows the emergence of resistant strains.

Parents can also be enlightened on the potential impact of unnecessary antibiotic use and antibiotic resistance mainly focusing on outcomes that parents of young children can relate to (like infection recurrence) and in a format that parents will engage with (e.g. face-to-face dissemination at playgroups and parent/child community events) to make a more informed decision about the risks and benefits of antibiotics in regards to their children (van Hecke et al. 2019)

The community can be fully involved in solution seeking and implementation in other words, elaborately explaining to the communities the implications of AMR, encourage them to innovate local measures and equally give them a chance to implement approaches that are acceptable, sustainable and accountable.

Over the counter use of antimicrobials is another challenge. People can often access antibiotics without prescription from pharmacies and markets. Members of the same households or village share antibiotics, the responsible regulatory bodies can pass and approve laws to regulate the supply chain.

Poor community hygiene practices like sharing water sources with animals, open defecation, poor hand hygiene. People can have separate human and animal water sources, get designated areas (latrines) for human waste disposal and practice rigorous hand washing.

Addressing the financial and resource gap that forces most communities in LMICs to practice sharing of antimicrobials amongst same and different households. This can be best done through moving health facilities closer to remote populations and setting up point-of-care (POC) centers where tests are done to reliably discern bacterial from viral infections to which patients are frequently prescribed empirical antimicrobials as they await test.

Poorly maintained health facilities equally contribute to AMR. Enforcing a healthy and clean workforce in health care settings that are reported to be one of the reservoirs of resistant bacterial strains due to factors not limited to reluctance in changing gloves often, using unsterile equipment and patients occupying floors. The health workforce can further be educated on the infection prevention measures so as to as to minimize on the spread of AMR (Matlow and Morris 2009).

Poor medical waste management has further escalated the global burden of AMR, with instances where antimicrobial waste often ends up in water streams and sources used by the communities. This could be curbed by setting up well managed and designated medical waste disposal areas with limited access to humans and animals to reduce their exposure to dumped antimicrobials (Chartier et al. 2014).

Finally, limited engagement of the youth in the AMR research and containment. These can be through involvement in research especially young health care professionals. AMR is an evolutionary occurrence that will always be present and thus will the desire of young professionals to change things for the better (“Youth Perspective: The AMR Burden and Opportunities to Overcome It – IFPMA” n.d.).

References

Chartier, Yves, Jorge Emmanuel, Ute Pieper, Annette Prüss, Philip Rushbrook, Ruth Stringer, William Townend, Susan Wilburn, and Raki Zghondi. 2014. “Safe Management of Wastes from Health-Care Activities Second Edition.” www.who.int.

Hecke, Oliver van, Chris C. Butler, Kay Wang, and Sarah Tonkin-Crine. 2019. “Parents’ Perceptions of Antibiotic Use and Antibiotic Resistance (PAUSE): A Qualitative Interview Study.” Journal of Antimicrobial Chemotherapy 74 (6): 1741–47. https://doi.org/10.1093/JAC/DKZ091.

Manyi-Loh, Christy, Sampson Mamphweli, Edson Meyer, and Anthony Okoh. 2018. “Antibiotic Use in Agriculture and Its Consequential Resistance in Environmental Sources: Potential Public Health Implications.” Molecules (Basel, Switzerland) 23 (4). https://doi.org/10.3390/MOLECULES23040795.

Matlow, Anne G., and Shaun K. Morris. 2009. “Control of Antibiotic-Resistant Bacteria in the Office and Clinic.” CMAJ 180 (10): 1021–24. https://doi.org/10.1503/CMAJ.071891.

Mitchell, Jessica, Paul Cooke, Sushil Baral, Naomi Bull, Catherine Stones, Emmanuel Tsekleves, Nervo Verdezoto, et al. 2019. “The Values and Principles Underpinning Community Engagement Approaches to Tackling Antimicrobial Resistance (AMR).” Global Health Action 12 (S1). https://doi.org/10.1080/16549716.2020.1837484.

Musoke, David, Carol Namata, Grace Biyinzika Lubega, Filimin Niyongabo, Joviah Gonza, Kondwani Chidziwisano, Sarah Nalinya, Rebecca Nuwematsiko, and Tracy Morse. 2021. “The Role of Environmental Health in Preventing Antimicrobial Resistance in Low- and Middle-Income Countries.” Environmental Health and Preventive Medicine 26 (1): 100. https://doi.org/10.1186/S12199-021-01023-2.

“Tackling Drug-Resistant Infections Globally: Final Report and Recommendations The Review On Antimicrobial Resistance Chaired By Jim O’Neill.” 2016.

WHO. 2021. “Antimicrobial Resistance.” July 2021. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.

World Health Organization. 2015. “WHO Library Cataloguing-in-Publication Data Global Action Plan on Antimicrobial Resistance.” Microbe Magazine 10 (9): 354–55. www.paprika-annecy.com.

“Youth Perspective: The AMR Burden and Opportunities to Overcome It – IFPMA.” n.d. Accessed May 2, 2022. https://www.ifpma.org/global-health-matters/youth-perspective-the-amr-burden-and-opportunities-to-overcome-it/.

About the author: Hellen is pursuing a Masters Degree in Immunology and Clinical Microbiology at Makerere University in Uganda. She is an active AMR Champion.

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