AMR in AFRICA - GARDP · 2| Antimicrobial resistance in Africa AMR in AFRICA Infectious diseases (including malaria and TB) still result in a very high burden of disease

Antimicrobial resistance in Africa1 |

AMR in AFRICA

Dr Marc SprengerDirector

AMR Secretariat


AMR in AFRICA

Infectious diseases (including

malaria and TB) still result in a

very high burden of disease.

HIV has exacerbated this.


Why AMR is an issue in Africa

Massive progress against

the MDG

Africa has made huge gains

against priority health

problems

Access to cheap, effective

antibiotics has supported all

of this

These gains are vulnerable

if antibiotics less effective

Av % Reduction Africa 1990-2013

54.2% Child mortality

40.7% Maternal mortality ratio

42% Malaria incidence

57% HIV prevalence

31%TB mortality


Why AMR is a challenge in AfricaWeak health systems

Health systems lack money

African Region total per capita

health expenditure 171 USD

(2012)

Human capacity. Physician

to pop ration 2.7/10 000

(Europe 32.1)

– Nurse ration 12.4/10 000

(Europe 80.2)

– Weak management and

supervision


Why AMR is a challenge in AfricaWeak health systems

Drug supply

Weak supply chain

management

Weak regulation

Stock outs very

common

Substandard, fake

and counterfeit

medicines common



People more vulnerable to infection (Malnutrition, HIV)

People have a huge appetite for antibiotics

• Belief in antibiotics as ‘strong medicine`

• High consumption rates (although still much unmet need)

• % Respondents that have consumed antibiotics in the last month

(WHO 2015): Egypt 54%; Sudan 49%; Nigeria 40%; S Africa 31%


Antibiotics – A substitute for better care

Cheap Accessible antibiotics have allowed progress,

despite very weak systems and poor care.

(50% hospital births are in a facility without basic water, sanitation and hygiene)

– Poor diagnosis (unskilled staff, weak labs)

– Very weak Infection prevention and control

– Treatment very variable, non standard.

But if the bugs become resistant and the drugs more

resistant, health care becomes much more risky, and

universal coverage much harder to achieve.



High rates, and total disease burden


Why AMR is NOT an issue in Africa

Other Priorities

Ebola, Yellow Fever, political instability, drought etc. etc.

Lack of Awareness

Little data on AMR in Africa

Lots of other reasons for treatment failure

First Steps not Clear

Doing something about it is perceived to be difficult and

costly


DATA is PATCHY

Available National Data* on Resistance for Nine

Selected Bacteria/Antibacterial Drug Combinations, 2013


What we do know

Available data suggests major problem, although published

studies may not be representative of general population

– 59% of Central African children under 5 years, are asymptomatic

carriers of extended-spectrum β-lactamase-producing

Enterobacteriaceae (ESBL-E); one of the highest prevalence

ever described in the world.

– Ecoli resistance to Aminopenicillins 80% S Africa, 88% Kenya

– Tanzania Resistance of Strep Pneumoniae, to Trimethoprim

Sulphamethexazole in children under 5 increased from 25% in

2006 to 80% in 2012

– High rates of resistance seen by MSF in rural Niger


Trends and Drivers

Prosperity and urbanisation

• Increasing reliance on the largely unregulated private

market (quacks and traditional healers to hospitals)

• Increasing use of poor quality drugs and diagnostics.

• Very poor environmental sanitation

• Increasing demand for cheap meat and more intensive

agriculture


What needs to happen : GAP in AFRICA

1. Awareness

Political commitment to act

Change of mind-set (Population & HCW)

2. EvidenceBetter surveillance data to inform prescribing and advocacy

3. Infection prevention and control

Improve WASH in communities and health facilities

Increase Immunisation (esp Pneumoccocus, rotavirus etc)

Hand washing, cleaning and IPC practices


What needs to happen : GAP in AFRICA

4. Responsible Use

Improve adherence to (local) treatment guidelines

Improve Drug supply of first line drugs

Improve Regulation systems

Phase out use in agriculture for growth promotion and mass prophylaxis

5. Investment and New Products

Mainstream AMR into Health and agriculture sector development

programmes

African needs reflected in New product development and TPP


Progress :

National Action Plans

NAPS Developed

S Africa, Ethiopia, Ghana, Kenya, Zambia, Guinea-Bissau

Under development

Tanzania, Mozambique, Zimbabwe, Liberia, Swaziland, Cote

d'Ivoire


Progress : Surveillance

19 countries trained in methodology for assessing total

consumption

8 countries attending GLASS workshop

7 expressed interest for GLASS


WHO Response

• Close collaboration between AFRO and HQ

• Joint programming health systems & security teams

• Ali Yahaya is focal point, working closely with Jean Bosco

• Additional resource via Fleming fund (primarily for NAPs)

• 20 Countries have national focal points essential medicines

• Incorporated into Country assessments for emergency

preparedness (GHSA and JEE)


Take Home Message

Political support & engagement needed for the fight against

AMR

Developing a NAP is going through a multisectoral process

and should result in implementation

Without good health systems no AMR control


THANK YOUTHANK YOU

Documents

AMR in AFRICA - GARDP · 2| Antimicrobial resistance in Africa AMR in AFRICA Infectious diseases (including malaria and TB) still result in a very high burden of disease