Priority Action Points To Tackle Antimicrobial Resistance In Nigeria

BY Oluuwadara Alegbeleye and Oluwatosin Dongo

Antimicrobial resistance (AMR) can limit treatment options or contribute to treatment failure for common infections, complicate surgical procedures, and other aspects of healthcare delivery, potentially leading to lengthier hospital stays, higher mortality and morbidity rates or overall worse outcomes for patients.

Considering the potential for resistant pathogens to be easily disseminated within healthcare facilities and local communities, AMR can have potentially significant public health impacts, increasing the risks of nosocomial infections and potentially making the control of infectious outbreaks more difficult. AMR can also have an overall negative socio-economic impact by amongst others, reducing labor force productivity and increasing healthcare costs.

Nigeria, home to at least 213 million people, has the 185th highest age-standardized mortality rate per 100,000 population associated with AMR across 204 countries according to some estimates. Available evidence indicates that Nigeria, a country still grappling with myriad, deep-seated socio-economic and political challenges is not meaningfully collaborating with global efforts to mitigate AMR.

There is no moving forward without understanding what is going wrong and how it is going wrong, and one fundamental issue is that Nigeria so far does not understand and has failed to demonstrate any substantial interest to understand the magnitude of the AMR problem at a national scale. A baseline requirement is thus tangible efforts into measuring or understanding the extent and burden of AMR.

A priority step in this regard would be to collect, analyse and document data on the consumption or utilization of antibiotics in agriculture and healthcare.

Government must establish resilient surveillance systems to monitor the resistance patterns of antimicrobials in humans, animals, and the environment.

It would therefore be necessary to strengthen the capacity of healthcare professionals, researchers, and regulatory agencies to effectively address AMR. This can take the form of research funding, training programs in infection prevention, management and control, antibiotic stewardship, and AMR management.

Due to lax regulatory premise, the country is a dumping ground for, and a hub for the mass production of sub-standard medication and cosmetics. More stringent regulation is required to assure supreme quality, safety and effectiveness of antibiotics and other antimicrobial products in Nigeria. Ample, ambitious investment into research to create new, effective antimicrobials and diagnostics is also required.

Another problem is that healthcare delivery is so poor, and patent medicine is rife. Continued indiscriminatory, porous access to antibiotics can contribute to public health challenges in Nigeria and must be mitigated. Campaign efforts or more broadly, stewardship programs to promote responsible and rational use of antibiotics are required, but it is vital to rejuvenate and strengthen healthcare systems in urban and rural areas.

Meanwhile, since there is a shortage of doctors and other healthcare practitioners, and though potentially fraught, it may be pertinent to invest in more comprehensive, specified training for auxiliary medical staff or other informal actors to responsibly administer and monitor the use of antibiotics in local communities.

Improved access to clean water, sanitation, and hygiene can minimise the risk of infection and relevant infrastructural development is desirable. While acknowledging that it is vital to protect food security, government and regulatory authorities must begin to navigate the regulation of the use of antibiotics in agriculture and animal husbandry in Nigeria. Indiscriminate use of antibiotics in plant cultivation, livestock rearing and animal husbandry for disease prevention, growth promotion, amongst other applications contributes significantly to the emergence and burden of AMR and adequate, properly tailored regulation is required.

To a great extent, AMR like most other public health related issues requires decisive political action, but to protect the Nigerian population and contribute meaningfully to global efforts to combat AMR, a coordinated, multisectoral effort involving the government, relevant stakeholders in agriculture, and healthcare as well as the public is required.

Oluwadara Alegbeleye is a scientist whose research explores the microbiological safety of agricultural input and implications for the microbiological safety of fresh produce.

Oluwatosin Dongo is a medical doctor.

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