A GNA Feature by Prosper K. Kuorsoh
Wa, Dec. 31, GNA – Ghana and the rest of the
world stand the risk of losing one life every three seconds to an infectious
disease by 2050, if the issue of Antimicrobial Resistance (AMR) is not tackled
today according to studies.
Being one of the biggest health issues that
mankind has faced this century, it is currently estimated that in Europe about
50,000 people die each year, and still many experts have predicted that by
2050, there will be 10 million deaths each year, due to the problem of
AMR is so serious that in the past few
years, it featured on the agenda of the World Health Assembly, United Nations
General Assembly and the G8 and G20 summits, prompting the development of a
Global Action Plan on AMR.
Globally, 150,000 people die out of about
440,000 resistant cases of tuberculosis according to the World Health
AMR is developed when microorganisms such as
bacteria, viruses, fungi and some parasites are able to withstand the
therapeutic effects of antimicrobials, rendering treatment of infectious
diseases in humans and animals ineffective.
Bacteria that have acquired antimicrobial
resistance may infect humans and animals and cause diseases that would be
difficult to treat, thereby contributing to prolonged, more expensive
treatments, longer hospital stays and increased mortality according to health
AMR, which can lead to loss of production
and productivity in animals also has negative impact on food safety and food
security. The phenomenon is reported to
be rising at an alarming rate around the world including Ghana; making it one
of the biggest threats to global health and development today.
case of Ghana
Ghana continues to record multi-drug
resistant cases of tuberculosis and this according to Dr (Mrs.) Angela Ama
Ackon, Deputy Director, Pharmaceutical Services, Ministry of Health, is a source
of concern to the Ministry and for that matter the government.
“Given the current state of AMR, if we do
not tackle it with the seriousness it deserves, very soon we may not be able to
boast of fully treated tuberculosis, gonorrhea, pneumonia and other infectious
diseases”, she said.
Various studies carried out proved the
existence of antibiotic resistant microbes in Ghana. Very common microbes such
as Streptococci, Salmonella, and E. coli showed very high levels of multiple
drug resistance with some showing as high as 78.7 per cent resistance.
The prevalence of resistance to common and
affordable antimicrobials like Tetracycline, Co-trimoxazole, Ampicillin and
Nalidixic acid are significantly high (largely above 70 per cent) according to
the National Action Plan on Antimicrobial Resistance.
“The commonest medicines that can be used to
treat these kinds of infections are no longer working and people are spending
more on expensive medicines and where they cannot afford to buy it, they are
most likely to die”, the Deputy Director of Pharmaceutical Services at the
Ministry of Health said.
Dr Alex Owusu-Ofori, a Clinical
Microbiologist, Head of the Clinical Microbiology Unit of the Komfo Anokye
Teaching Hospital (KATH) in Kumasi in the Ashanti Region noted that AMR, though
not a new phenomenon has advanced to a precarious state.
Dr Owusu-Ofori who is also a Lecturer at the
School of Medicine and Dentistry – Kwame Nkrumah University of Science and
Technology (KNUST), noted that currently, patients who had infections that
could previously be treated with common and inexpensive antibiotics such as
Amoxycillin, Tetracyclin, Chloramphenicol and Septrin cannot be treated with
the antibiotics any longer due to resistance.
“Rather, we have to use newer, more
expensive antibiotics which are not readily available”, he said and stressed
that subsequently patients with such infections get sick for longer periods,
stay longer in hospitals, pay more for their treatment and are more likely to
get complications and die.
He noted for instance that, about 70 per
cent of the most common bacteria that cause urinary tract infections are
resistant to the commonly used antibiotics.
According to him, lower rates of resistance
are observed among sexually transmitted diseases such as gonorrhoea.
of antibiotics by public
On abuse of antibiotics, Dr Owusu-Ofori
noted that buying of non-prescribed antibiotics at pharmacy shops,
non-completion of the full course of prescribed antibiotics, and passing-on an
antibiotic that has been effective on an individual to another without clinical
Other forms of abuses, he outlined include;
one opening an antibiotic capsule and pouring its contents on a wound;
individuals taking antibiotics for common cold; and people buying antibiotics
from drug peddlers and carrying them on their heads and selling in open market
places with no appropriate literature on dosage, side effect and indications.
Evidence of lifestyle abuse of antibiotics
abound and ranges from people mixing antibiotics in various alcoholic
beverages, and honey to take for various kinds of reasons; and haphazard mixing
of animal feed with antibiotics to either treat sickness or to make the
animal(s) grow bigger.
of antibiotics by doctors
He said even though these forms of abuse are
rife among the public in the country, there has also been some level of abuse
by doctors and health personnel.
Dr Owusu-Ofori noted that ideally, doctors
should send the patient(s) sample for investigations in the laboratory to
identify the bacteria causing the disease and to know which antibiotic is best
suited to treat the infection which is not done in some cases.
“Without performing the investigations, the
doctor may give antibiotics which may not work, but which by then might have
exposed all the bacteria in the body to the antibiotics”, he emphasized.
He acknowledged that other situations may be
beyond the doctor and these include; fake drugs or the use of antibiotics in
agriculture, which also contribute to the rapid spread of antibiotic resistance.
To contain the problem of AMR, WHO has
provided some interventions including; creating a national task force,
developing indicators to monitor and evaluate the impact of antimicrobial
resistance, and designing reference microbiological facilities that would
coordinate effective surveillance of the phenomenon among common pathogens.
However, lack of resources constrained
implementation in many developing countries where treatment options also tend
to be relatively limited. Thus, although a global problem, AMR tends to be more
significant in developing countries than in the developed world.
of appropriate laboratory facilities
In Ghana, antimicrobial therapy constitutes
a major form of treatment. It is mainly empirical due to a relative lack of
appropriate laboratory facilities for culture and susceptibility testing of
bacteria in several health facilities according to studies.
Even where laboratory facilities are
available, culture and susceptibility tests may not be requested due to the
fact that this is an extra cost to be paid by the patient.
of drug resistance
Studies also has it that in Ghana, drug
resistance has mainly been reported from the Korle-Bu Teaching Hospital
(KBTH) and KATH in Accra and Kumasi respectively, and hardly any from regional
and district hospitals.
Thus, there is inadequate information on the
susceptibility of microorganisms to antimicrobial agents used for treatment in
several areas in Ghana.
Without surveillance records of
antimicrobial susceptibility, empirical treatment could be ineffective and
expensive according to health professionals.
Despite the huge threat AMR poses to human
life in the country, many Ghanaians are yet to realise the danger as the threat
of the monster still remains in darkness.
Its popularity is only among health
officials, policy makers, academicians and a hand full of activists despite
several efforts by the Ministry of Health to create awareness.
of Ghana NAP 2017
In response to the threat, the government of
Ghana in collaboration with the Food and Agriculture Organization of the United
Nations (FAO), WHO and the World Organization for Animal Health (OIE) has
launched Ghana’s AMR policy and it’s National Action Plan in 2017.
The policy, which was put together with the
collaboration of government ministries including; the Ministry of Health, the
Ministry of Food and Agriculture, the Ministry of Environment, Science and
Technology Innovation, and the Ministry of Fisheries and Aquaculture dwelled
much on five strategic areas.
They include; improving awareness and
knowledge of AMR; providing evidence-based knowledge to reduce the burden of
AMR; reducing the occurrence of infections in establishment; optimising the use
of antimicrobials in animal and human health; and creating an enabling
environment for sustainable investment in AMR reduction (Ghana NAP 2017).
To back the implementation of the AMR policy
with functional regulatory framework, President Nana Addo Dankwa Akufo-Addo
tasked the Ministry of Health and the Attorney-General Department to take the
necessary steps to move some selected aspects of the policy into legislation to
ensure public health and safety.
Possible aspects of the policy that could
move into legislation may include responsible use of medicines such as rules
regarding prescribing of antibiotics and good laboratory practices as well as
restricting the use of antibiotics in animal husbandry.
This action according to Dr Angela Ama Ackon
is a display of high level of commitment by the government to combat the threat
of AMR in the country.
However, Madam Cecilia Lodonu-Senoo,
Executive Director of Hope for the Future Generations and an AMR Activist,
thinks that funding commitment from both government and the donor community was
low, thereby making the AMR campaign not as vibrant as it should be.
She said the Ministry of Health was doing
well, but the lack of adequate government and donor funding was thwarting their
effort to take the campaign to the ordinary person, stressing that without
adequate resources one could achieve little despite the level of passion.
She pointed out that the ignorant abuse of
antibiotics could reduce if people were aware and informed about the potential
health threat. “Because they are not aware and are not informed, you do not
expect change from them”, she emphasised.
“The current snail pace of tackling the
issue cannot win the AMR threat, we need real political commitment that comes
with resources for a vigorous campaign – that’s how we can win the fight”, she
noted with passion.