What lies ahead in TZ’s plan to curb antibiotic resistance

Sunday October 29 2017

Antibiotics. In April this year, Tanzania

Antibiotics. In April this year, Tanzania launched the National Action Plan to curb antibiotic resistance, with major focus on enhancing the One-Health approach—a collaborative approach involving experts in veterinary medicine and human health. PHOTOI FILE 

By Syriacus Buguzi @buguzi sbuguzi@thecitizen.co.tz

Mwanza. Researchers at the Catholic University of Health and Allied Sciences (Cuhas) say Tanzania can borrow a leaf from United Kingdom’s ongoing campaign dubbed: “Don’t ask your doctor for antibiotics, ’aimed at empowering the public to play part in tackling the threat of antibiotic resistance.

However, for this campaign to be relevant for Tanzania, the researchers say a strong policy is needed to guide consumers of the antibiotics, doctors’ prescription practices and how pharmacies dispense the medications.

A professor of Microbiology from Cuhas, Stephen Mshana, believes the campaign is likely to succeed in the UK because the European country has very strict regulations and policies on how people can access antibiotics in pharmacies.

Here in Tanzania, he says: “If such a campaign was to be initiated, it would face a stiff challenge because people can access antibiotics as they wish—by buying them from street pharmacies with ease.”

“So, if a doctor in Tanzania doesn’t give the antibiotics to those who ask for them, there is usually an alternative, and often a bad one, by which the people can access them for as long as they want,’’ argues Prof Mshana.

Antibiotic resistance

“Most cases of antibiotic resistance have come as a result of over use of the drugs. As a result, there are antibiotics, such as Nitrofurantoin which have less resistance. This is because of the fact that such antibiotics are not very much often prescribed,’’ says Prof Mashana.

An estimated 5,000 people die every year in England because antibiotics no longer work for some infections, according to Public Health England (PHE). Thus, PE has launched the campaign, inspired by the theme, “Keep Antibiotics Working.”

The UK’s new campaign tells people to always trust their doctor, nurse or pharmacist on when to take antibiotics and when not to. The campaign reminds them that if antibiotics are prescribed, they should be taken as directed and never saved for later or shared with others.

In 2015, the Tanzania Pharmacy Council(TPC), in collaboration with other research organisations found that the behaviour of people who dispense antibiotics in drug shops across the country was motivated by customers’ demands.

The study was published in BMC Infectious Diseases and titled: “What motivates antibiotic dispensing in accredited drug dispensing outlets in Tanzania?”

Inappropriate health facility

The researchers found inappropriate health facility prescriptions, and the need to make a profit as the major drivers of antibiotics abuse and overuse.

“Although the majority of dispensers reported that they had intervened in situations where customers asked for antibiotics unnecessarily, they tended to give in to clients’ requests,’’ reads the study in part.

The World Health Organisation (WHO) says antibiotic resistance causes people in most countries, including Tanzania, to be sick for longer and increases the risk of death.

In its 2014 report on the worldwide threat to public health, the WHO said, for instance, people with resistance to certain antibiotics such as the ones having methicillin-resistant Staphylococcus aureus are estimated to be 64 per cent more likely to die than people with a non-resistant form of the infection.

“Resistance also increases the cost of health care with lengthier stays in hospital and more intensive care required,’’ said the report as part of its key findings.

Dr Nyambura Moremi, a clinical microbiologist at Cuhas suggests that Tanzania should embrace UK’s campaign but much more should be done, including emphasising on putting in place and implementing a strong antibiotics policy.

She says people’s consumer behavior must change, and the country should emphasize on vaccination to prevent the bacterial diseases and carry out surveillance on the use of antibiotics in district hospitals.

“As a start, we can embrace the newly launched campaign of “Not asking your doctor for antibiotics, which basically insists on the appropriate use of the antimicrobials, ’she told The Citizen on Sunday during an interview in Mwanza Region.

In April this year, Tanzania launched the National Action Plan to curb antibiotic resistance, with major focus on enhancing the One-Health approach—a collaborative approach involving experts in veterinary medicine and human health.

The launching of the plan was preceded by a symposium themed, “Handle antibiotics with care—antimicrobial resistance in Tanzania,’’ where the Chief Medical Officer Prof Mohammed Bakari addressed public health stakeholders on why Tanzania should fight the resistant microbes.

One of the stakeholders was Jeremiah Seni, a microbiologist from Cuhas, who suggested that Tanzania should have a unified hub where data on the burden of antibiotic resistance can be traced.

Sketchy information

“There is only sketchy information from hospitals and some research institutes,” noted Dr Seni.

It’s here that Dr Nyambura Moremi again, suggests that for the country to succeed in implementing the new action plan, there is need to look into the complexity of the resistance problem.

“The complexity of the spread and the evolution of resistant bacteria in various populations, including humans, animals, the environment and food chain [can be assessed] under the “One Health Approach,” explains Dr Moremi.

Cuhas has conducted a number of studies during the past one year to identify key areas for setting strategies to curb the spread of antibiotic resistance in Tanzania.

The latest is this year’s study when Dr Moremi and other researchers identified resistant bacteria known as Extended Spectrum Beta-lactamse-producing Enterobacteriaseae (ESBL-PE) in 24 percent of patients who had been admitted for surgery at Bugando Medical Centre (BMC) and Sekou Toure Regional.

Dr Moremi says the bacteria were found in the food canals of the patients and that 64 per cent of the surgical infections were caused by the same resistant bacteria, ESBL-PE.

But, according to the researchers, the burden of antibiotic resistance goes beyond hospital premises.

Carriers of the resistant bacteria, ESBL-PE, were also found to be healthy individuals in Mwanza communities by 16.5 to 32 percent.

Yet, as part of the community, animals in Mwanza Region, including dogs, sheep, goats, chicken, pigs and cattle were not spared from the antibiotic resistance burden.

It was found that 22 percent of the 600 animals surveyed, harbored the resistant bacteria (the ESBL-PE).

But also, two-third of these multi-drug resistant bacteria were resistant to the commonly prescribed antibiotics, such as Septrin(known so by its popular name) and tetracycline. One-third were resistant to ciprofloxacin and gentamycin.

Street children are not spared

Then, there is this special group—the street children. They were found to be among the major carriers of the resistant bacteria as healthy individuals during the studies carried out in Mwanza.

According to Dr Moremi, the children who spent day and night on the streets carried more resistant bacteria compared to those who had spent the day on the streets.

Further, the study identified the same strains being shared among street children. The strains had been isolated from their playgrounds including along Mirongo River in Mwanza.

In trying to track down the notorious strains of the bacteria, the Cuhas researchers went further to look for multi-drug resistant bacteria in the waste coming from Mwanza city sewage system that are also discharged into Lake Victoria.

The food chain was no exception

It was then found that the multi-drug resistant bacteria which were previously detected in hospital settings, in animals, healthy people in the community and the environment, were also found in the sewage system.

These notorious bacteria were also found in food chain. According to Dr Moremi, the Tilapia fish from Lake Victoria, retail sources, the meat sold by vendors and the fresh juices sold in restaurants were found to be contaminated with the multi-resistant bacteria.

We are running out of options

In September this year, the WHO declared that the world was running out of antibiotics due to the rise in resistance. This meant that the bacteria are the second to the last stage in this resistance race.

The WHO warned that it would soon be impossible to treat common infections such as Urinary Tract Infections (UTIs) and respiratory tract infections.

This was due to the fact that either a handful of people would be able to afford the last resort antibiotics or there will be no option at all.

Before we could get into total failure. There is need to address the problem systemically. The suggestion that now comes from Moremi and the Cuhas team of researchers is that there is need to implement better sanitation and better sewage management.

This follows a series of studies done on the matter and the evidence gathered from Mwanza city on how multi-resistant bacteria spread through poor management of sewage system.

Other key areas to consider keenly include the disposal of expired/ left over antibiotics and the possibility of unnecessary spillage of active chemical compounds into the environment and the sewage systems.

But what are these trouble-some bacteria?

In early March this year, the WHO came up with a specific list of resistant bacteria that no longer respond to current antibiotics on the market.

The agency called on drug developers, governments and researchers to find ways of coming up with new and effective antibiotics.

The WHO said bacteria causing Urinary Tract Infections (UTI), gonorrhea and food poisoning are some of bugs drawn from 12 families of bacteria known to pose the greatest threat of antibiotic resistance.

Experts have suggested that, in just over 30 years, antibiotic resistance will kill more people globally than cancer and diabetes combined.