Power point presentation on antimicrobial resistance.

1. ANTIMICROBIAL RESISTANCE
IN AFRICA
CHALLENGES, SOLUTIONS AND INNOVATIONS OF AMR IN SUB-SAHARAN
AFRICA

2. CLINICAL BACKGROUND AND RELEVANCE
Antimicrobial resistance is the ability of microorganisms to persist or grow in the
presence of drugs designed to inhibit or kill them resulting to therapeutic
failure thus negatively impacting control and management of infectious
diseases.
• Occurrence of AMR results from acquisition, expression and transfer of
resistance genes from in pathogens whereby the pathogens acquire resistance
gene through natural selection when exposed to antimicrobial pressure.
• Rapid emergence of antimicrobial resistance is accelerated by inappropriate
consumption and overuse of antimicrobial agents especially antibiotics in
humans,animals and agriculture ( the environment).
• Inappropriate use can be from inappropriate consumption, needless lengthy
treatment courses,self medication, incomplete use of prescribed antimicrobial
or irregular use of reserved antimicrobial.
• Though antimicrobial are important to ensure health of animals or humans its
imperative to understand that prolonged use for non therapeutic purposes
such as prophylaxis and growth promotion at sub therapeutic levels
contribute to AMR

3. PATHOGENIC ISOLATION IN AFRICA
OGENIC E COLI
14.6 million episodes per annum
ate ecoli ,shiga toxin producing ecoli ,diffusely adhering
asive ecoli have a prevalence of between 14.7% to 82 %
orts in Burkina Faso,kenya,South Africa and Tanzania
ongst under 5 years
h fecal oral route indirectly or directly Via
water or food.

4. PATHOGEN 2
• Vibrio cholerae causing cholera
• Accounts for 141,918 infections annually
• Reported resistance to penicillin,aminoglycosides,sulfonamides
,quinolones,tetracycline,macrolides and penicillin
• Risk factors being overcrowding, poor WASH infrastructure and
displaced persons
• Solutions being WHO prequalified vaccines like dukoral,shanchol and
euvichol ( mass vaccination ) and improvement of WASH
infrastructure.

5. PATHOGEN 3
• Salmonella typhi causing typhoid fever
• Accounts for 1.5 million cases reporte.d annually with 19900 deaths
• Reported resistance from septrin ,ampicillin and chloramphenicol.
• Diagnostic challenges owed to symptomatic treatment as a result of
insufficient microscopic laboratories to perform culture, unreliable
widal test and skilled labort Shortage accounts for the resistance
• Solution is introduction of sufficient, easy to use,rapid diagnostic
tools for typhoid fever surveillance as well as optimisation
vaccination with typhoid conjugate vaccine and unconjugated
polysaccharide vaccine.

6. PATHOGEN 4
ve non typhoid salmonellosis ( ssa)
unts for 421,600 cases ( 21.6% attributed to HIV infections in
s)
unts for 66,520 deaths annually
utrition, malaria ,underdeveloped immunity are proven risk
rs in under 5 years
ested solution being increased access to diagnostic services (
diagnostic test kits)

7. PATHOGEN 5
MULTIDRUG RESISTANT KLEBSIELLA PNEUMONIAE
ASSOCIATED INFECTIONS
• 3rd leading causative agent of healthcare associated infections after
eclipse and staphylococcus aureus.
• Risk factor being poor hand hygiene among health workers,poor
hospitals waste management practices especially due to inadequate
supply of equipment, poor ipc infrastructure and understaffed
healthcare settings resulting to overcrowded words with high patient
loads.
• Solutions includes but not limited to proper hand hygiene,proper use
of personal protection equipments,proper disinfection of hospital
surfaces,sterilisation of medical equipments and education of
healthcare personell on infection, prevention and control.

8. PATHOGEN 6
CARBAPENEM RESISTANT ACITEBOBACTER
BAUMANII
• Gram negative bacteria commonly spread through soils and water
• Risk factors include prolonged hospital stay beyond 90 days, low
immunity,prolonged antimicrobial exposure, mechanical ventilation
and central venous catheter use
• Solutions cited includes infection, prevention and control emphasy
as well as research on possible vaccine.

9. STAPHYLOCOCCUS AUREUS ESPECIALLY
METHICILLIN RESISTANT STAPHYLOCOCCUS
AUREUS
Pathogen 6
• Resistance reported in kenya,Uganda, Nigeria,South
Africa,Ghana,mozambique,Ethiopia and Tanzania
• Risk factors being hiv infection, improper antibiotic use prior,icy
admission,prolonged hospitalizations,indwelling catheters,invasive
procedures, open wounds,burns,residence at long term care
facilities,mechanical ventilation, renal failure, MRSA colony history
• Resistance reported to erythromycin, tetracycline and cotrimoxazole
• Solution cited being proper implementation of infection, prevention
and control

10. PATHOGEN 7
PSEUDOMONAS AEURUGINOSA
• Gram negative bacteria common in soil and water
• Spread through bloodstream causing utis,pneumonia et al
• Resistance reported to beta lactase especially carbapenems
• Common resistance reported in studies in Uganda,Ghana,South
Africa,Zambia,Nigeria, Ethiopia et al especially through acquisition of
resistance genes
• Proper antibiotics use and infection prevention and control cited as
viable solutions

11. CHALLENGES PREDISPOSING TO AMR
• Ineffective water
• Ineffective sanitation
• Ineffective hygiene
• Inefficient ipc implementation
• Poor regulation of antimicrobial use
• Lack of alternatives to Ineffective antimicrobial
• Constrained healthcare systems
• Prevailing high level of poverty resulting to high infections burden
• Inadequate awareness on sexual health
• Inadequate AMR surveillance, data and reports
• Inadequate antimicrobial stewardship
• Ineffective or inadequate policies
• Lack of institutional and infrastructural capacities

12. SOLUTIONS AND INNOVATIONS TOWARDS AMR
• ONE HEALTH APPROACH integrating human, animal and environmental dynamics/ effects
I surveillance approaches
• Prior approaches focused on animal health and currently the effect have included
environment especially water sources leading to persistent antibiotics residues and
resistant genes in environment,consequently hospital wastes,farm,industrial human
waste, water treatment plants becomes reservoirs and dissemination pathways of AMR
• The approach aims at identifying environmental reservoirs and dissemination pathways
of AMR and AMR surveillance in environment/ improvement of WASH infrastructure as
demonstrated in Global action plan on AMR adopted 2015 by 194 member states of
WHO through decision made at 68th session of World health assembly by food and
agricultural organisation ( FAO) which was an improvement of national action plans
• It aims at successful treatment and prevention of infectious diseases throuh
effective,safe medicines that are quality assured,used in responsible way and accessible
to all in need.

13. OBJECTIVES OF GLOBAL ACTION PLAN
• Improve awareness and understanding.
• Strengthen knowledge through surveillance and research
• Reduce incidence of infection
• Optimize use of antimicrobial agents
• Ensure sustainable investment in countering AMR
• Only 14 countries in the WHO Africa region reported developing national action
plans while 9 monitoring antimicrobial consumption and use with few countries
already developing antimicrobial stewardship guidelines and antimicrobial
legislation
• Africa countries with national action plans include tanzania,Ethiopia,kenya,South
Africa,Zambia and Ghana thus a tripartite agreement was signed between
FA0,WHO and OIE to encourage progress in development,costing, harmonisation
of NAPs while monitoring and evaluating the progress made by member states.

14. GLOBAL ACTION PLAN IMPLEMENTATION
CHALLENGES
• Lack of political commitments due to poor or lack of resources allocation and inadequate
regulatory policies and enforcement
• Inadequate funding due to limited resources, lack of awareness and private / public sector
commitment eg Fleming fund aided implementation of kenyan multisectoral approach.
• Poor multispectral coordination and collaboration
• Inadequate surveillance data.
• Poor infrastructure and health systems.
• Staff shortages
• Poor infection and prevention control implementation
• 20%/ 40% off health budgets are wasted on inefficiency and corruption respectively
• Its of note that scarcity of resources leads to non prioritisation of NAPS since governments
expenditure on heath is inadequate below the Abuja declaration of 15% on public health.

15. RECOMMENDATIONS TO ADDRESS CHALLENGES
ON AMR IMPLEMENTATION
• Strengthening governance
• Prioritising activities for implementation
• Costing the NAPS operational plans
• Resource mobilisation
• Monitoring and evaluation
• Increased awareness of AMR
• Improving AMR surveillance
• Promoting collaboration in and beyond countries
• Antibiotic regulatory enforcement
• Improving the practice of increasing measures at home,food handling
establishments and indeed health facilities

16. PREPARED BY
DENNIS OWUOR OKELLO
• BSC IN HEALTH SYSTEMS MANAGEMENT AND DEVELOPMENT
• DIPLOMA IN CLINICAL MEDICINE AND SURGERY

17. LETS BE THE CHANGE WE WANT TO SEE AS
SAID BY MAHATMA GHANDHI
• THANKS AND MAY THE GOOD GOD BLESS ALL.